Team Approach to Prosthetic Prescription Decision-Making
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AMPUTATION REHABILITATION (J HECKMAN, SECTION EDITOR)
Team Approach to Prosthetic Prescription Decision-Making Alex C. Donaghy 1,2 & Sara J. Morgan 3 & George E. Kaufman 3,4 & David C. Morgenroth 1,3,4 Accepted: 3 September 2020 # This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply 2020
Abstract Purpose of Review This paper aims to review the key concepts in prosthetic limb prescription for adults with limb loss, including the benefits of a multidisciplinary team. Recent Findings There is a relative absence of literature directly describing the role of a team-based approach to prosthetic limb prescription. However, comparable literature can be found in other rehabilitation topics and medical disciplines, generally in support of team-based approaches to patient care. While there is a growing body of comparative effectiveness literature for prosthetic componentry, there is generally a lack of coherent prescribing guidelines. Thus, specific prescription choices are often guided by foundational knowledge, expected functional outcomes, and the clinical experience of the prescribing team. Summary Given the inherent complexities and lack of established guidelines, prosthetic limb prescription is ideally accomplished through a team-based approach involving a physiatrist, prosthetist, and physical or occupational therapist. Each member serves a valuable role based on their unique educational backgrounds and clinical experience. Keywords Amputation . Amputees . Artificial limbs . Physical and rehabilitation medicine . Interdisciplinary communication
Introduction The oldest known evidence for the use of a prosthesis dates to 1000 BC Egypt in the form of a wooden toe. The “Capua leg” of 300 BC Italy is the earliest known artificial leg [1]. Modern prosthetics practice is intimately tied to World Wars I and II in response to soldiers returning home with limb loss; unsurprisingly, this is the same era in which physical therapy and physiatry were established [2, 3]. The “prosthetics clinic team” approach to prosthetic prescription is highlighted in texts as early as 1954 [4]. An optimal prosthetic prescription is often a key component of successful limb loss rehabilitation. Rates of prosthetic fitting have been shown to range from 27 to This article is part of the Topical Collection on Amputation Rehabilitation * Alex C. Donaghy [email protected] 1
VA Puget Sound Health Care System, Seattle, WA, USA
2
Tacoma, USA
3
VA RR&D Center for Limb Loss and Mobility (CLiMB), Seattle, WA, USA
4
Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
86% and vary depending on factors such as age, amputation level, and comorbid health conditions [5]. With the prevalence of limb loss in the USA expected to double between 2005 and 2050 [6•] and with a limited number of physicians with sufficient expertise in prosthetic prescription and amputee rehabilitation, there is a growing need for well-coordinated teams to guide optimal prescription an
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