September 2014

Out on a limb: Seeing upside in O&P

1Limb-JordanaJordana Bieze Foster, Editor

“You are what your record says you are.” Hall of Fame football coach Bill Parcells said it first, and it’s a saying that applies to many aspects of life. But when it comes to prescribing orthotic and prosthetic devices, clinicians know that the numbers don’t always tell the whole story.

Now, new research presented earlier this month at the annual meeting of the American Orthotic and Prosthetic Association (AOPA) in Las Vegas suggests that prescribing devices based on numbers that describe a patient’s current function—the patient’s record, if you will—may prevent that patient from reaching his or her functional potential.

As is the case with many O&P devices, reimbursement for prosthetic feet is typically based on a patient’s level of function; community ambulators (K3 level) are eligible for energy-storing or dynamic response feet, while those who are limited community ambulators (K2 level) are not. This is based in part on a some­what short-sighted approach to controlling costs, and based in part on the assumption that limited ambulators will not be able to utilize the potential functional benefits of enhanced technology.

But research from the University of North Texas Health Science Center in Fort Worth, presented at the AOPA meeting, suggests the latter assumption is just not true.

Nicoleta Bugnariu, PT, PhD, and colleagues did an experiment
in which (after providing informed consent) three transtibial amputees who had been wearing K2-level feet were given K3-level feet, and six transtibial amputees who had been wearing K3-level feet were given K2-level feet.

The effects were immediately apparent. Amputees who switched from K2 feet to K3 feet demonstrated improved balance, and their mean self selected gait speed increased from .3 m/s to .5 m/s. The latter finding is particularly important since .4 m/s is typically considered the minimum gait speed required for community ambulation, Bugnariu said.

After wearing the more advanced device for two weeks, the former K2 foot wearers demonstrated significant improvement on the timed up and go test, the Physiological Cost Index, and the Reintegration to Normal Living Index. Meanwhile, the amputees who switched from K3 feet to K2 feet experienced negative effects for most of the measured variables.

Switching to a more advanced foot didn’t automatically make former K2 foot wearers as functional as those who had been longtime wearers of K3 feet. But there’s no question that even limited community ambulators can benefit significantly from enhanced technology. It has the potential to increase amputees’ independence, reduce the risk of falls and injuries, and improve cardiovascular health—all of which amount to considerable healthcare savings. And if that’s true for prosthetic feet, it’s not a huge stretch to think the same can be said for ankle foot orthoses and other O&P devices.

I sincerely hope that findings like these will convince payers to start covering more advanced devices for less advanced patients, rather than continuing to sacrifice long-term healthcare system benefits to save a few dollars on each individual device.

Because a K2 foot isn’t what’s best for a K2 patient. With all due respect to Coach Parcells, sometimes you aren’t what your record says you are.

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