The Experts below are selected from a list of 4632 Experts worldwide ranked by ideXlab platform
Mathias Poussel - One of the best experts on this subject based on the ideXlab platform.
-
Desensitization of the Cough Reflex Induced by Corticosteroids in Ovalbumin-Sensitized Rabbits During Artificial Limb Exercise.
Frontiers in physiology, 2020Co-Authors: Simon Valentin, Bruno Chenuel, Silvia Demoulin-alexikova, Bruno Demoulin, Delphine Gérard, Laurent Foucaud, Mathias PousselAbstract:Introduction: Cough is a major symptom frequently experienced during exercise, mainly in asthmatic patients. Inhaled glucocorticoids represent the keystone treatment in the management of asthma, but little is known about interactions between cough and exercise, especially in controlled patients. During exercise, cough reflex (CR) appears downregulated in healthy animal models whereas a lack of desensitization of CR has been shown in ovalbumin-sensitized animal models, mimicking asthmatic disease. Aims & Objectives: The goal of our study was to clarify the potential modulation of the CR induced by inhaled corticosteroids in ovalbumin-sensitized rabbits during Artificial Limb exercise. Materials & Methods: Seventeen ovalbumin-sensitized rabbits (OVA) were studied. Among them, 9 were treated with corticosteroids delivered intravenously (OVA-Corticoids). The ventilatory response to direct tracheal stimulation, performed at rest and during exercise, was determined to assess the incidence and the sensitivity of the CR. Broncho-alveolar lavage (BAL) and cell counts were performed to determine the level of airway inflammation. Exercise was mimicked by electrically-induced hindLimb muscular contractions (EMC). Results: Compared to rest values, EMC increased minute ventilation by 28% without any decrease in respiratory resistance (Rsr). Among 322 tracheal stimulations, 172 (53%) were performed at rest and 150 (47%) during exercise. The sensitivity of CR decreased during Artificial Limb exercise compared to baseline in OVA-Corticoids rabbits (p = 0.0313) while it remained unchanged in OVA rabbits (p = NS). Conclusions: Corticosteroids appear to restore the desensitization of the CR in ovalbumin-sensitized rabbits during Artificial Limb exercise, suggesting the potential role of airway inflammation in the pathophysiology of cough during exercise in asthmatics.
-
Desensitization of the Cough Reflex Induced by Corticosteroids in Ovalbumin-Sensitized Rabbits During Artificial Limb Exercise
Frontiers in Physiology Front. Physiol, 2020Co-Authors: Simon Valentin, Bruno Chenuel, Silvia Demoulin-alexikova, Bruno Demoulin, Delphine Gérard, Laurent Foucaud, Mathias PousselAbstract:Introduction: Cough is a major symptom frequently experienced during exercise, mainly in asthmatic patients. Inhaled glucocorticoids represent the keystone treatment in the management of asthma, but little is known about interactions between cough and exercise, especially in controlled patients. During exercise, cough reflex (CR) appears downregulated in healthy animal models whereas a lack of desensitization of CR has been shown in ovalbumin-sensitized animal models, mimicking asthmatic disease. Aims and Objectives: The goal of our study was to clarify the potential modulation of the CR induced by inhaled corticosteroids (CS) in ovalbumin (OVA) sensitized rabbits during Artificial Limb exercise. Materials and Methods: Seventeen OVA sensitized rabbits were studied. Among them, 9 were treated with CS delivered intravenously (OVA-Corticoids). The ventilatory response to direct tracheal stimulation, performed at rest and during exercise, was determined to assess the incidence and the sensitivity of the CR. Broncho-alveolar lavage (BAL) and cell counts were performed to determine the level of airway inflammation. Exercise was mimicked by electrically induced hindLimb muscular contractions (EMC). Results: Compared to rest values, EMC increased minute ventilation by 28% without any decrease in respiratory resistance (Rsr). Among 322 tracheal stimulations, 172 (53%) were performed at rest and 150 (47%) during exercise. The sensitivity of CR decreased during Artificial Limb exercise compared to baseline in OVA-Corticoids rabbits (p = 0.0313) while it remained unchanged in OVA rabbits (p = NS). Conclusion: Corticosteroids appear to restore the desensitization of the CR in OVA sensitized rabbits during Artificial Limb exercise, suggesting the potential role of airway inflammation in the pathophysiology of cough during exercise in asthmatics.
Simon Valentin - One of the best experts on this subject based on the ideXlab platform.
-
Desensitization of the Cough Reflex Induced by Corticosteroids in Ovalbumin-Sensitized Rabbits During Artificial Limb Exercise.
Frontiers in physiology, 2020Co-Authors: Simon Valentin, Bruno Chenuel, Silvia Demoulin-alexikova, Bruno Demoulin, Delphine Gérard, Laurent Foucaud, Mathias PousselAbstract:Introduction: Cough is a major symptom frequently experienced during exercise, mainly in asthmatic patients. Inhaled glucocorticoids represent the keystone treatment in the management of asthma, but little is known about interactions between cough and exercise, especially in controlled patients. During exercise, cough reflex (CR) appears downregulated in healthy animal models whereas a lack of desensitization of CR has been shown in ovalbumin-sensitized animal models, mimicking asthmatic disease. Aims & Objectives: The goal of our study was to clarify the potential modulation of the CR induced by inhaled corticosteroids in ovalbumin-sensitized rabbits during Artificial Limb exercise. Materials & Methods: Seventeen ovalbumin-sensitized rabbits (OVA) were studied. Among them, 9 were treated with corticosteroids delivered intravenously (OVA-Corticoids). The ventilatory response to direct tracheal stimulation, performed at rest and during exercise, was determined to assess the incidence and the sensitivity of the CR. Broncho-alveolar lavage (BAL) and cell counts were performed to determine the level of airway inflammation. Exercise was mimicked by electrically-induced hindLimb muscular contractions (EMC). Results: Compared to rest values, EMC increased minute ventilation by 28% without any decrease in respiratory resistance (Rsr). Among 322 tracheal stimulations, 172 (53%) were performed at rest and 150 (47%) during exercise. The sensitivity of CR decreased during Artificial Limb exercise compared to baseline in OVA-Corticoids rabbits (p = 0.0313) while it remained unchanged in OVA rabbits (p = NS). Conclusions: Corticosteroids appear to restore the desensitization of the CR in ovalbumin-sensitized rabbits during Artificial Limb exercise, suggesting the potential role of airway inflammation in the pathophysiology of cough during exercise in asthmatics.
-
Desensitization of the Cough Reflex Induced by Corticosteroids in Ovalbumin-Sensitized Rabbits During Artificial Limb Exercise
Frontiers in Physiology Front. Physiol, 2020Co-Authors: Simon Valentin, Bruno Chenuel, Silvia Demoulin-alexikova, Bruno Demoulin, Delphine Gérard, Laurent Foucaud, Mathias PousselAbstract:Introduction: Cough is a major symptom frequently experienced during exercise, mainly in asthmatic patients. Inhaled glucocorticoids represent the keystone treatment in the management of asthma, but little is known about interactions between cough and exercise, especially in controlled patients. During exercise, cough reflex (CR) appears downregulated in healthy animal models whereas a lack of desensitization of CR has been shown in ovalbumin-sensitized animal models, mimicking asthmatic disease. Aims and Objectives: The goal of our study was to clarify the potential modulation of the CR induced by inhaled corticosteroids (CS) in ovalbumin (OVA) sensitized rabbits during Artificial Limb exercise. Materials and Methods: Seventeen OVA sensitized rabbits were studied. Among them, 9 were treated with CS delivered intravenously (OVA-Corticoids). The ventilatory response to direct tracheal stimulation, performed at rest and during exercise, was determined to assess the incidence and the sensitivity of the CR. Broncho-alveolar lavage (BAL) and cell counts were performed to determine the level of airway inflammation. Exercise was mimicked by electrically induced hindLimb muscular contractions (EMC). Results: Compared to rest values, EMC increased minute ventilation by 28% without any decrease in respiratory resistance (Rsr). Among 322 tracheal stimulations, 172 (53%) were performed at rest and 150 (47%) during exercise. The sensitivity of CR decreased during Artificial Limb exercise compared to baseline in OVA-Corticoids rabbits (p = 0.0313) while it remained unchanged in OVA rabbits (p = NS). Conclusion: Corticosteroids appear to restore the desensitization of the CR in OVA sensitized rabbits during Artificial Limb exercise, suggesting the potential role of airway inflammation in the pathophysiology of cough during exercise in asthmatics.
Debra Berg - One of the best experts on this subject based on the ideXlab platform.
-
innovations of health services and economic evaluation of bone anchored prosthesis using osseointegration the queensland Artificial Limb service s experience 2019 scientific report
2020Co-Authors: Debra Berg, Laurent FrossardAbstract:The design of Artificial Limbs for persons with an amputation has continuously improved over the last decade. Nonetheless, there is still a large portion of individuals who are non-prosthetic users or facing substantial challenges when using a prosthesis. The conventional way to attach a prosthesis to the body is to use a plastic shell, called a socket, enveloping the residual Limb. Unfortunately, this prosthetic attachment presents several shortcomings, mainly due to the friction within the socket causing regular damage to the skin. Altogether, these issues limit mobility and ultimately reduce significantly the quality of life of most prosthetic users. Most of these functional issues can be overcome by ground-breaking surgical procedures. A rod of biocompatible material, called osseointegrated fixation, can be inserted into the residual bone such as the femur or tibia and enable external attachment of a prosthesis. These bone-anchored prostheses present major clinical and prosthetic benefits with acceptable risks of infection, leading to a significant improvement in quality of life, particularly for young, active, and nonvascular individuals with above-the knee amputation. Benefits and opportunities for bone-anchored prostheses have been well echoed in social media worldwide generating an unprecedented high demand from groups of interests. Consequently, policy decision makers including health care managers are under substantial pressure to support the provision of bone-anchored prostheses, while responsibly allocating scarce resources within health care systems. In principle, bone-anchored prostheses could reduce some prosthetic and medical financial burdens for health service administrators by reducing the treatment of skin-socket interface problems over a user’s lifespan. However, little evidence is currently available to support this claim. Consequently, policy decision makers are left facing a series of challenges while addressing burning questions: Is the fair and equitable provision of bone-anchored prostheses required to have a specific procedure? What are the actual costs of the provision of bone-anchored prostheses? What is the cost-effectiveness of bone-anchored prostheses compared to conventional socket-suspended prostheses? In 2011, the Queensland Artificial Limb Ser vice (QALS), an Australian State Government public health organization initiated a research project to address these issues and provide strong evidence supporting the provision of bone-anchored prostheses. The purpose of this report is to share the knowledge gained by QALS during this project and to present subsequent health services innovations in the design of the policy, the assessment of the actual costs and production of cost-effectiveness associated with the provision of bone-anchored prostheses. The outcomes of this first economic evaluation from an Australian State Government public health prosthetic care and funding scheme’s perspective, indicates that the provision of bone-anchored prostheses can be supported by fair, equitable and affordable policy while being cost-effective. Thereby indicating, the new attachment relying on osseointegrated fixation is an acceptable alternative to conventional intervention at least from a public health prosthetic care and funding perspective. The experience reported here provides a working template for the development of economic evaluations to stakeholders responsible for policies around the care of individuals fitted with bone-anchored prostheses worldwide. We are thrilled to share with you some of the most valuable lessons we have learnt during the course of this scientific journey. A wealth of further in-depth information can be found the several scientific articles we have already published in top-ranked journals. We hope this report is both enjoyable and informative and ultimately facilitate a rapid translation of this evidence into practice that, altogether will ultimately improve reliability of many healthcare organizations in increasing quality of life of individuals leaving with the Artificial Limbs.
-
Provision of bone-anchored prostheses using osseointegrated implant: Leading role of Queensland Artificial Limb Service
2019Co-Authors: Laurent Frossard, Debra BergAbstract:Background Direct skeletal attachment is gradually accepted as an alternative to socket-suspended prostheses typically used to wear Artificial Limbs.[1-10] Indeed, the number of patients undergoing surgical implantation of osseointegrated fixation enabling fitting of bone-anchored prostheses is on the rise at an unprecedented pace, particularly in Australia and Queensland.[11-15] Studies showed the biomechanical advantages and clinical benefits of the treatment while highlighting that some adverse events are yet to be fully resolved.[16-26] However, less understood are the health economic benefits. Queensland Artificial Limb Service (QALS) produced a series of leading publications focusing on health services and economic evaluations of the treatment.[11, 27-33] This presentation will particularly focus on the latest cost-effectiveness analyses of provision of transfemoral and transtibial bone-anchored prostheses.[14, 34] Methods A total of 22 participants including 16 with transfemoral and 6 with transtibial fitted with bone-anchored prostheses were included in this study. All participants were registered consumers solely supported by QALS. Actual costs were extracted from financial records and completed by typical costs when needed.[15] Health gains corresponding to quality-adjusted life-year (QALY) were estimated using utility data extracted from the literature.[35, 36] The economical advantage of provision of bone-anchored prostheses over socket-suspended prostheses was determined using incremental cost-effectiveness ratio (ICER) over six-year time horizon.[14, 34] Results The indicative ICERs for provision of transfemoral and transtibial bone-anchored prostheses were approximately $17,000 and $11,400 per QALY, respectively. This study confirmed that provision of both transfemoral and transtibial bone-anchored prostheses might be a reasonable alternative to socket-suspended prostheses at least from a prosthetic care perspective in Australian context. Conclusion Altogether, these initial evidenced-based economic evaluations provided a working approach for decision makers responsible for policies around the prosthetic care of individuals with lower Limb amputation worldwide.
-
innovations of health services and economic evaluation of bone anchored prosthesis using osseointegration the queensland Artificial Limb service s experience 2017 scientific report
2018Co-Authors: Debra Berg, Laurent Frossard, Brendan BurkettAbstract:The design of Artificial Limbs for persons with an amputation has continuously improved over the last decade. Nonetheless, there is still a large portion of individuals who are non-prosthetic users or facing substantial challenges when using a prosthesis. The conventional way to attach a prosthesis to the body is to use a plastic shell, called a socket, enveloping the residual Limb. Unfortunately, this prosthetic attachment presents a number of shortcomings, mainly due to the friction within the socket regularly causing damage to the skin. Altogether, these issues limit mobility and ultimately reduce significantly the quality of life of a typical prosthetic user. Most of these functional issues can be overcome by ground-breaking surgical procedures. A rod of bio-compatible material, called osseointegrated fixation, can be inserted into the residual bone such as the femur and enable external attachment of a prosthesis. These bone-anchored prostheses present major clinical and prosthetic benefits with acceptable risks of infection, leading to a significant improvement in quality of life, particularly for young, active, and nonvascular individuals with above-the knee amputation. Benefits and opportunities for bone-anchored prostheses have been well echoed in social media worldwide generating an unprecedented high demand from groups of interests. Consequently, policy decision makers including health care managers are under substantial pressure to support the provision of bone-anchored prostheses, while responsibly allocating scarce resources within health care systems. In principle, bone-anchored prostheses could reduce some prosthetic, medical, and financial burdens for health service administrators by reducing the treatment of skin-socket interface problems over a user's lifespan. However, little evidence is currently available to support this claim. Consequently, policy decision makers are left facing a series of challenges while addressing burning questions: Is the fair and equitable provision of bone-anchored prostheses required to have a specific procedure? What are the actual costs of the provision of bone-anchored prostheses? What is the cost-effectiveness of bone-anchored prostheses compared to conventional socket-suspended prostheses? In 2011, the Queensland Artificial Limb Service (QALS), an Australian State Government public health organization initiated a research project to address these issues and provide stronger evidence supporting the provision of bone-anchored prostheses. The purpose of this report is to share the knowledge gained by QALS during this project and to present subsequent health services innovations in the design of the policy, the assessment of the actual costs and production of cost-effectiveness associated with the provision of bone-anchored prostheses. The outcomes of this first economic evaluation from an Australian State Government public health prosthetic care and funding scheme’s perspective, indicates that the provision of bone-anchored prostheses can be supported by fair, equitable and affordable policy while being cost-effective. Thereby indicating, the new attachment relying on osseointegrated fixation is an acceptable alternative to conventional intervention at least from a public health prosthetic care and funding perspective. The experience reported here provides a working template for the development of economic evaluations to stakeholders responsible for policies around the care of individuals fitted with bone-anchored prostheses worldwide.
Craig Murray - One of the best experts on this subject based on the ideXlab platform.
-
Being the parent of a child with Limb difference who has been provided with an Artificial Limb: an interpretative phenomenological analysis.
Disability and rehabilitation, 2019Co-Authors: James Oliver, Clare Dixon, Craig MurrayAbstract:Purpose Rehabilitative care for children with Limb difference often includes the provision and use of an Artificial (or prosthetic) Limb. Of key influence in this process is how parents experience and respond to their child's Limb difference and prosthesis use. However, research on this is lacking. Therefore, this study aimed to explore the experiences of parenting a child with Limb difference who had been provided with an Artificial Limb. Design Semi-structured interviews took place with seven parents. Interview data was recorded, transcribed and analyzed using interpretative phenomenological analysis. Results The analysis identified four themes: (1) managing the initial emotional experience through the development of coping resources; (2) opportunities through prosthesis use and its relationship with "normality"; (3) managing and making sense of social reactions toward their child; (4) the intrinsic role of support: developing a collective connection and enabling shared knowledge. Conclusions The study highlighted salient aspects to parents' experiences and sense-making that can inform clinical support. Emotional support, the management of social responses, and the holistic co-ordination of healthcare support with peer support networks are discussed. Healthcare professionals involved in the prosthetic rehabilitation process should look to explore these meanings to help support the management of the child's prosthesis use. Implications for rehabilitation Understanding the sense-making of parents is important in effective service provision for children with Limb difference. Service provision for children with Limb difference should consider the support needs of parents. Working with Limb difference charities and voluntary organizations could help services develop needed parent-to-parent support networks.
-
"Look and feel your best":representations of Artificial Limb users in prosthetic company advertisements
Disability and rehabilitation, 2013Co-Authors: Craig Murray, Mark ForshawAbstract:AbstractPurpose: Artificial Limbs (prosthetics) are considered important for keeping the person physically active and avoiding an array of negative health outcomes associated with non-use. Increasingly, the potential users of these Limbs are the focus of commercial prosthetic company advertisements. It has been argued that it is important to examine such media representations, not least because people’s beliefs regarding health and illness are often forged from the discourses and constructions available to them in such material, but because these representations mediate individual lived experience. Method: This article provides a thematic analysis, drawing upon discourse analysis and semiotics, of textual–pictorial representations of Artificial Limb users in the advertisements of prosthetic companies. The data set was comprised of advertisements that appeared over a 2-year period in inMotion, an international magazine produced and distributed by a major amputee advocacy group. Results: The findings indica...
-
‘Don’t you talk to your prosthetist?’ Communicational problems in the prescription of Artificial Limbs
Disability and rehabilitation, 2012Co-Authors: Craig MurrayAbstract:Purpose: People with lower-Limb amputations are routinely fitted with an Artificial Limb. Good communication with prosthetists is vital in meeting patients’ needs in this process. The present study aimed to identify the salient issues surrounding problematic interaction between patients and prosthetists from the point of view of patients. Method: Three on-line discussion groups for people with lower-Limb amputations were searched for all posts which discussed such issues. A total of 527 electronic messages comprised the data set, from 155 authors. All data served as the basis for analysis. Results: A phenomenologically-informed thematic analysis identified three themes: ‘Becoming a prosthesis user: Not knowing what to expect’; ‘Unmet expectations: Trying to get the prosthetist to do something’; and ‘Working with your prosthetist: The need to communicate well’. The presented results are illustrated with posts from 25 participants. Conclusions: The results indicate the need to improve communication between ...
Laurent Frossard - One of the best experts on this subject based on the ideXlab platform.
-
innovations of health services and economic evaluation of bone anchored prosthesis using osseointegration the queensland Artificial Limb service s experience 2019 scientific report
2020Co-Authors: Debra Berg, Laurent FrossardAbstract:The design of Artificial Limbs for persons with an amputation has continuously improved over the last decade. Nonetheless, there is still a large portion of individuals who are non-prosthetic users or facing substantial challenges when using a prosthesis. The conventional way to attach a prosthesis to the body is to use a plastic shell, called a socket, enveloping the residual Limb. Unfortunately, this prosthetic attachment presents several shortcomings, mainly due to the friction within the socket causing regular damage to the skin. Altogether, these issues limit mobility and ultimately reduce significantly the quality of life of most prosthetic users. Most of these functional issues can be overcome by ground-breaking surgical procedures. A rod of biocompatible material, called osseointegrated fixation, can be inserted into the residual bone such as the femur or tibia and enable external attachment of a prosthesis. These bone-anchored prostheses present major clinical and prosthetic benefits with acceptable risks of infection, leading to a significant improvement in quality of life, particularly for young, active, and nonvascular individuals with above-the knee amputation. Benefits and opportunities for bone-anchored prostheses have been well echoed in social media worldwide generating an unprecedented high demand from groups of interests. Consequently, policy decision makers including health care managers are under substantial pressure to support the provision of bone-anchored prostheses, while responsibly allocating scarce resources within health care systems. In principle, bone-anchored prostheses could reduce some prosthetic and medical financial burdens for health service administrators by reducing the treatment of skin-socket interface problems over a user’s lifespan. However, little evidence is currently available to support this claim. Consequently, policy decision makers are left facing a series of challenges while addressing burning questions: Is the fair and equitable provision of bone-anchored prostheses required to have a specific procedure? What are the actual costs of the provision of bone-anchored prostheses? What is the cost-effectiveness of bone-anchored prostheses compared to conventional socket-suspended prostheses? In 2011, the Queensland Artificial Limb Ser vice (QALS), an Australian State Government public health organization initiated a research project to address these issues and provide strong evidence supporting the provision of bone-anchored prostheses. The purpose of this report is to share the knowledge gained by QALS during this project and to present subsequent health services innovations in the design of the policy, the assessment of the actual costs and production of cost-effectiveness associated with the provision of bone-anchored prostheses. The outcomes of this first economic evaluation from an Australian State Government public health prosthetic care and funding scheme’s perspective, indicates that the provision of bone-anchored prostheses can be supported by fair, equitable and affordable policy while being cost-effective. Thereby indicating, the new attachment relying on osseointegrated fixation is an acceptable alternative to conventional intervention at least from a public health prosthetic care and funding perspective. The experience reported here provides a working template for the development of economic evaluations to stakeholders responsible for policies around the care of individuals fitted with bone-anchored prostheses worldwide. We are thrilled to share with you some of the most valuable lessons we have learnt during the course of this scientific journey. A wealth of further in-depth information can be found the several scientific articles we have already published in top-ranked journals. We hope this report is both enjoyable and informative and ultimately facilitate a rapid translation of this evidence into practice that, altogether will ultimately improve reliability of many healthcare organizations in increasing quality of life of individuals leaving with the Artificial Limbs.
-
Provision of bone-anchored prostheses using osseointegrated implant: Leading role of Queensland Artificial Limb Service
2019Co-Authors: Laurent Frossard, Debra BergAbstract:Background Direct skeletal attachment is gradually accepted as an alternative to socket-suspended prostheses typically used to wear Artificial Limbs.[1-10] Indeed, the number of patients undergoing surgical implantation of osseointegrated fixation enabling fitting of bone-anchored prostheses is on the rise at an unprecedented pace, particularly in Australia and Queensland.[11-15] Studies showed the biomechanical advantages and clinical benefits of the treatment while highlighting that some adverse events are yet to be fully resolved.[16-26] However, less understood are the health economic benefits. Queensland Artificial Limb Service (QALS) produced a series of leading publications focusing on health services and economic evaluations of the treatment.[11, 27-33] This presentation will particularly focus on the latest cost-effectiveness analyses of provision of transfemoral and transtibial bone-anchored prostheses.[14, 34] Methods A total of 22 participants including 16 with transfemoral and 6 with transtibial fitted with bone-anchored prostheses were included in this study. All participants were registered consumers solely supported by QALS. Actual costs were extracted from financial records and completed by typical costs when needed.[15] Health gains corresponding to quality-adjusted life-year (QALY) were estimated using utility data extracted from the literature.[35, 36] The economical advantage of provision of bone-anchored prostheses over socket-suspended prostheses was determined using incremental cost-effectiveness ratio (ICER) over six-year time horizon.[14, 34] Results The indicative ICERs for provision of transfemoral and transtibial bone-anchored prostheses were approximately $17,000 and $11,400 per QALY, respectively. This study confirmed that provision of both transfemoral and transtibial bone-anchored prostheses might be a reasonable alternative to socket-suspended prostheses at least from a prosthetic care perspective in Australian context. Conclusion Altogether, these initial evidenced-based economic evaluations provided a working approach for decision makers responsible for policies around the prosthetic care of individuals with lower Limb amputation worldwide.
-
innovations of health services and economic evaluation of bone anchored prosthesis using osseointegration the queensland Artificial Limb service s experience 2017 scientific report
2018Co-Authors: Debra Berg, Laurent Frossard, Brendan BurkettAbstract:The design of Artificial Limbs for persons with an amputation has continuously improved over the last decade. Nonetheless, there is still a large portion of individuals who are non-prosthetic users or facing substantial challenges when using a prosthesis. The conventional way to attach a prosthesis to the body is to use a plastic shell, called a socket, enveloping the residual Limb. Unfortunately, this prosthetic attachment presents a number of shortcomings, mainly due to the friction within the socket regularly causing damage to the skin. Altogether, these issues limit mobility and ultimately reduce significantly the quality of life of a typical prosthetic user. Most of these functional issues can be overcome by ground-breaking surgical procedures. A rod of bio-compatible material, called osseointegrated fixation, can be inserted into the residual bone such as the femur and enable external attachment of a prosthesis. These bone-anchored prostheses present major clinical and prosthetic benefits with acceptable risks of infection, leading to a significant improvement in quality of life, particularly for young, active, and nonvascular individuals with above-the knee amputation. Benefits and opportunities for bone-anchored prostheses have been well echoed in social media worldwide generating an unprecedented high demand from groups of interests. Consequently, policy decision makers including health care managers are under substantial pressure to support the provision of bone-anchored prostheses, while responsibly allocating scarce resources within health care systems. In principle, bone-anchored prostheses could reduce some prosthetic, medical, and financial burdens for health service administrators by reducing the treatment of skin-socket interface problems over a user's lifespan. However, little evidence is currently available to support this claim. Consequently, policy decision makers are left facing a series of challenges while addressing burning questions: Is the fair and equitable provision of bone-anchored prostheses required to have a specific procedure? What are the actual costs of the provision of bone-anchored prostheses? What is the cost-effectiveness of bone-anchored prostheses compared to conventional socket-suspended prostheses? In 2011, the Queensland Artificial Limb Service (QALS), an Australian State Government public health organization initiated a research project to address these issues and provide stronger evidence supporting the provision of bone-anchored prostheses. The purpose of this report is to share the knowledge gained by QALS during this project and to present subsequent health services innovations in the design of the policy, the assessment of the actual costs and production of cost-effectiveness associated with the provision of bone-anchored prostheses. The outcomes of this first economic evaluation from an Australian State Government public health prosthetic care and funding scheme’s perspective, indicates that the provision of bone-anchored prostheses can be supported by fair, equitable and affordable policy while being cost-effective. Thereby indicating, the new attachment relying on osseointegrated fixation is an acceptable alternative to conventional intervention at least from a public health prosthetic care and funding perspective. The experience reported here provides a working template for the development of economic evaluations to stakeholders responsible for policies around the care of individuals fitted with bone-anchored prostheses worldwide.
