Outcome & Cost Analysis of Physiotherapist-fabricated Temporary Prostheses

1. Outcome & Cost Analysis of Physiotherapist-fabricated Temporary Prostheses • Multi-centre data collection • AKA & BKA • Hypothesis: The use of temporary prostheses will provide a safe, cost-effective, and efficient means of rehabilitating lower limb amputees

2. Why? • Review of the NSW Artificial Limb Service • June 2004 • “We recommend that the use of plaster of paris interim prostheses in NSW amputees be phased out & that the provision of mechanical interim prostheses manufactured by a prosthetist be implemented as standard practice.”

3. “…universal consensus among all rehabilitation clinicians consulted that the …use of plaster of paris interim prostheses was inconsistent with contemporary best practice nationally & internationally.” • Who was consulted?

4. …interim prostheses manufactured by a prosthetist would deliver superior outcomes in terms of patient comfort & rehabilitation.”

5. “In the absence of a robust empirical framework with which to assess current practice in NSW, we have focussed on identifying areas of significant variation in practice in NSW and recommending changes to practice where we consider these to be supported by the available evidence or broad clinical consensus.”

6. Literature • No published studies comparing plaster temporary prostheses with interim prostheses • Victorian QA project from 1983. • Some studies describe outcomes with “IPOP” (converted rigid dressing) or prosthetist manufactured interims.

7. Research • Effectiveness • Time to temporary & definitive • Time to discharge • Complications such as wound breakdown • Who made the temporary – expert/novice • Number of temporaries to definitive • Time to 2nd definitive socket (if in data collection period) • Occasions of temporary prosthetic failure & patient weight • Measure load bearing capacity of plaster temporaries

8. Research • Outcome • Time to definitive • Discharge date • Discharge destination • Aids • 10m walk time • 2 min walk • Level of independence • Stairs ability • Bed mobility (acute setting – time to first mobilise)

9. Research • Cost • Cost of components – recycled or consumables • Number of appointments (inpt / outpt) • Who made by (expert / novice) • Time to make temporary • Time to make interim / definitive (prosthetist) $98.25 hourly rate • ALS quote $1400 for manufacture of interim prostheses at Albury

10. Research • Results – How do we prove efficacy? • Suggestions • Comparison between sites – bench-marking for best practice. • Measure occurrence of complications due to temporary / temporary prosthetic failure • Compare cost of programme with costs from prosthetists to implement the same programme • Set outcome bench-marks, and find what % achieve this.

11. Research • Possible comparison of results with Victorian data on use of interim prostheses. (If we can find it??)

12. Research • Publication requires ethics approval, including patient information sheets & consent forms. • Apparently OK to modify plans as we go, as long as ethics committees are informed, and outcomes of the project remain unchanged. • Centres indicating interest so far… • SWAHS (Westmead & Nepean) • SSWAHS (RPAH / Concord / Liverpool / Bankstown) • Port Kembla • Rankin Park