Happenings

RESEARCH ROUNDUP Orthoses Improve Plantar Pressure Distribution

Children with infantile tibia vara (ITV), or Blount’s disease, present with one or two legs with a bow or bend in the leg below the knee; left untreated, the condition can worsen over time and create increased risk of joint arthritis of the knee or other degenerative changes.

Children with ITV are frequently prescribed knee-ankle-foot orthoses at an early age to correct the deformity. In a new study, researchers from Ankara University in Turkey studied the effect of orthoses on plantar pressure among children with ITV.

Congenital Limb Difference

Every year, approximately 1 in every 1,900 babies born in the U.S. is born with a congenital limb difference. Some of these babies will have both upperand lower-limb reduction defects.

The researchers assembled a study group of 14 children between 1 and 3 years of age who had been diagnosed with ITV who could walk independently and who had not had surgery, as well as a control group of children who could walk independently without health problems. They evaluated plantar pressures on five specified sites on the children’s feet using a WALKINSENSE plantar pressure evaluation device, measuring how much pressure the children applied to each sensor in the three phases of gait.

Following orthosis use, the pressure in the lateral hindfoot decreased in the children with ITV, while the pressure in the medial increased and the pressure in the medial forefoot decreased, according to the researchers: “We found that an orthosis in children with ITV was effective in decreasing the plantar pressure distribution closer to the level reported in healthy children,” they reported. The study was published February in Scientific Reports

Novel Tool Aids Terminal Device Selection

A decision-making tool developed by researchers from the Netherlands can assist individuals with upper-limb loss in determining preferences regarding terminal devices. Because studies have shown that patient-centered upperlimb prosthetic fittings may enhance prosthetic acceptance rates, the researchers created a patient decision aid with a primary focus on terminal devices, called the PDA-TULA.

The research team queried prosthetists to determine which terminal devices to include, then collected manufacturer information about the features of the various devices included in the tool. The PDA-TULA consists of instructions for users, an explanation of aims and scope, and

Lack Of Sleep Increases Pad Risk

Individuals who sleep less than five hours per night have a 74% higher chance of developing peripheral artery disease, compared with those who sleep seven to eight hours per night.

a request for personal information, followed by terminal device information, personal values related to terminal devices, and terminal device feature comparisons.

The PDA-TULA enables patients to educate themselves about the various attributes of different devices and consider their preferences, and recommends that patients and clinicians discuss the results of the assessment during their next consultation. Rehabilitation teams at different facilities and institutions can use the same educational materials to assist patients and make informed terminal device decisions. Details were published March in Prosthetics and Orthotics International

Diabetes Download

Healthcare Costs Of Dfus

Diabetic foot ulcers place an enormous burden on the U.S. healthcare system, costing between $9 and $13 million annually.

SOURCE: “HUMAN WOUNDS AND ITS BURDEN,” JOURNAL OF ADVANCED WOUND CARE

PEDIATRIC PROSTHETICS New Center Focuses on Children’s Blast Injuries

A first-of-its-kind institution dedicated to advancing care for children with blast injuries opened in London last month. Imperial College London and Save the Children joined forces to launch The Centre for Pediatric Blast Injury Studies at Imperial’s White City campus.

Experts at the center will use motion capture technology and 3D-printing technologies to advance the care of children with blast injuries. They plan to develop low-cost, age-appropriate prostheses that take into consideration growth and physiological development in conflict-affected areas.

Medics, engineers, pain specialists, operational humanitarians, prosthetists, and rehabilitation specialists will work together to address the lack of prostheses for musculoskeletal and extremity injuries in Ukraine, where four children are injured or killed each day amid the ongoing war, according to Imperial College London. Children are seven times more likely to die from blast injuries compared to adults,

O&P By the Numbers

and they experience different types of injuries than adults—requiring specialized care, according to the launch team.

“As more and more children today live in conflict zones, we need child-specific, translational research that looks at everything from the initial emergency response, to treatments, to prosthetics and development into adulthood,” said Anthony Bull, director. “This new center will address an unmet need: treating children with blast injuries in a researchled, highly translational way to help them become healthy adults.”

Early Receipt of a Prosthesis Reduces Healthcare Costs and Emergency Department Visits

Findings from “Hanger Institute for Clinical Research and Education 2022 Annual Report” show benefits for patients who receive prostheses within first three months postamputation

REDUCED HEALTHCARE UTILIZATION AND COST

LESS LIKELY TO RECIVE CARE IN AN EMERGENCY DEPARTMENT

Percentage of ED Use By Group

U.S. ADULTS SAY MEDICARE MUST EVOLVE

In a March survey, 73% of respondents agreed changes need to be made to the Medicare program to keep it financially sustainable for the future.

RESEARCH ROUNDUP VA Researchers Adapt PEQ for Upper-Limb Use

Researchers at the VA Medical Center and Brown University School of Public Health modified the Residual Limb Health Scale of the Prosthetic Evaluation Questionnaire (PEQ) for use in persons with upper-limb amputation. Let by Linda Resnik, PT, PhD, FAPTA, the team modified the PEQ response scale to a Likert scale and conducted a telephone survey of 392 upper-limb prosthesis users, with a 40-person retest sample.

Results of the PEQ-designed phone survey indicated that the upper-limb prosthesis users experienced sweating (91%), prosthesis odor (73%), blisters/ sores (12%), and ingrown hairs (8%).

The researchers found that the modified scale had “excellent structural validity, fair person reliability, very good test-retest reliability, and no floor or ceiling effects” and is recommended for use among patients with wrist disarticulation, transradial amputation, elbow disarticulation, and aboveelbow amputation. Details were published March in Prosthetics and Orthotics International

Tech Talk

CODING CORNER DME MACs Announce Retirement of Upper-Extremity Correct Coding Guidance

Last month, the durable medical equipment Medicare administrative contractors (DME MACs) and the Pricing, Data, and Coding (PDAC) contractor announced the retirement of their previously published correct coding guidance for upper-extremity prostheses. The correct coding guidance, originally published March 31, 2022, resulted in significant concern from AOPA and its partners in the O&P Alliance about the impact the correct coding guidance was having on access to clinically appropriate, medically necessary upper-extremity prosthetic care, not only for Medicare beneficiaries but also for individuals covered by other insurers who adopted the correct coding guidance into policy decisions.

The O&P Alliance submitted extensive written comments regarding its concern about the correct coding guidance. After several months of follow-up communication, last month AOPA and the O&P Alliance had a productive meeting with CMS representatives, the DME MACs, and PDAC.

The DME MACs and PDAC announced March 15 the official retirement of the previously published upper-extremity prostheses correct coding guidance. This positive development shows the value of open and trusted communication, according to AOPA, and is an important step in working toward the development of proper guidance that will ensure adequate access to clinically appropriate, medically necessary upper-extremity prosthetic care for Medicare beneficiaries.

How Could ChatGPT Impact O&P Research?

The AI-powered chatbot ChatGPT, released by OpenAI in November, simulates human conversation and has garnered much attention and scrutiny across industries. In a new “Ideas and Opinions” piece published in the March Annals of Internal Medicine, researchers from Amsterdam University Medical Center outlined the possible benefits and problems associated with the technology and discussed the future of medical research assisted or written by AI applications like ChatGPT and the soon-to-be released Apprentice Bard from Google.

The authors noted that these new technologies will allow researchers to create manuscripts more efficiently by assisting in generating complete, standard scientific text. However, they warned that the knowledge bases of software like ChatGPT are limited, so those leveraging the technology should cross-check information to ensure accuracy. They also pointed out that ChatGPT’s tendency to generate nonexistent references may complicate the writing. They recommended that journals create clear policies for using ChatGPT transparently.

Happenings

Q: What do you recommend for patients who participate in physical activities such as dance, gymnastics or even football?

Professionals

Jim Campbell, PhD, CO, FAAOP, was honored with the Titus Ferguson Lifetime Achievement Award by the American Academy of Orthotists and Prosthetists during the Academy’s Annual Meeting & Scientific Symposium in March.

Campbell has been involved in the O&P profession since 1976 when he attended Strathclyde University. In 1988, he started his first position in the United States with the Cleveland Clinic, and in 1994 he returned to his alma mater, where he received a doctorate in bioengineering. Campbell returned to the United States in 1997 to join Becker Orthopedic, and in 2015, he joined Hanger as the company’s first chief clinical officer. He currently serves as senior vice president and chief clinical officer and leads the Department of Clinical and Scientific Affairs. Campbell was instrumental in the launch of the Hanger Institute for Clinical Research & Education in 2020.

In addition to his role at Hanger, Campbell has served on AOPA’s Board of Directors, including serving as president in 2016.

“I have known and worked with Kit for over 15 years,” said Wayne van Halem, president of The van Halem Group. “She is a widely recognized thoughtleader in our industry, and I am proud to have her on our team.”

An industry speaker, Shellhouse will continue to participate and present at industry events and trade shows. “Working with The van Halem Group is such an exciting opportunity,” said Shellhouse. “I look forward to connecting with their clients and sharing the immensely important work they do for our industry.”

Jerrica Thurman has been named chief strategy and communications officer for the Amputee Coalition. She leads the information technology, communications, development, and events initiatives for the organization. Thurman’s focus is to increase awareness of limb loss and limb difference, expand the organization’s reach, and grow engagement opportunities that advance national efforts to serve people living with limb loss and limb difference.

A: Many practitioners advise patients to take a break from their scoliosis TLSO during such activities, but there is also an alternative.

The Providence Nocturnal Scoliosis® System does not require taking breaks from wearing the brace during daytime activities such as school and sports because it is only worn at night.

Learn More about this alternative solution Spinal.Tech/Providence 508-957-8311

“Jim’s tenure at Hanger has brought tremendous milestones, from landmark research studies to unmatched clinical education and outcomes, that continue to push the envelope and move our industry forward,” said Vinit Asar, Hanger chairman and chief executive officer. “He is truly a pioneer in O&P, whose dedication has elevated not only our field, but the entire healthcare profession.”

Kit Shellhouse, formerly of ECS North and ACU-Serve, has joined The van Halem Group, a division of VGM Group, as the director of business development. With more than 20 years of experience in the home medical equipment industry, her duties will include managing key partnerships, generating new clientele, and fostering relationships while building The van Halem Group brand.

Businesses

Hanger Clinic is celebrating Limb Loss and Limb Difference Awareness Month in April by hosting a Virtual Recognition Board, where members of the amputee community can recognize a fellow community member who embodies the Amputee Coalition’s 2023 theme “Inspire to Elevate.” Throughout the month of April, the Recognition Board is being updated with photos and submissions highlighting the impact members of the limb loss and limb difference community have had on one another.

Add your facility’s name to the growing list of providers that have already joined the LLPR:

American Prosthetic Institute, Ltd.

Arise Orthotics & Prosthetics

Bionic P&O Group

Clark & Associates Orthotics & Prosthetics Inc.

Dynamic by DESIGN

Horton’s Orthotics & Prosthetics

Kenney Orthopedics Prosthetics & Orthotics

Mayo Clinic

Nevada Orthotics & Prosthetics Inc.

Orthocare Innovations LLC

Prosthetic Center of Excellence

Quantum Prosthetics & Orthotics

UAB Medicine

UCHealth Hospital System

Union Orthotics & Prosthetics Inc.

University of Michigan Health

UTHealth Houston System

Victory Orthotics & Prosthetics

Calling all clinical practices!

You’re invited to join the Limb Loss & Preservation Registry (LLPR)

The LLPR is the first national quality database designed and built to generate knowledge about which O&P advances and treatments produce the best outcomes for individuals with limb loss, limb difference, and limb preservation. The LLPR collects and standardizes data from hospitals, providers, and patients over time. This data is used to improve prevention, treatment, and rehabilitation approaches for this population. Join the growing list of O&P providers and hospital systems contributing data to help demonstrate the quality and impact of the care practitioners provide.

Why join?

“A patient registry is an organized system that uses observational study methods to collect uniform data (clinical and other) to evaluate specified outcomes for a population defined by a particular disease, condition, or exposure.”

—RICHARD GLIKLICH, MD

Using the data from the LLPR, practitioners, clinical leaders, and operators can:

X Evaluate treatment options and care plans to improve and maximize patient function

X Set meaningful, realistic, and consistent goals and objectives with patients and the care team

X Critically assess the care provided compared to regional and national benchmarks

X Use patient population and social disparities to risk-adjust outcomes.

Participating in clinical registries allows smaller practices to effectively leverage larger volumes of data and requires no additional practitioner time to collect information.

Connecting is easy, secure, cost effective, and sustainable for ALL practice sizes

The registry has partnered with OPIE, OPSolutions, and Nymbl to make exporting data convenient. The LLPR is designated a Federal Risk and Authorization Management Program (FedRAMP) Moderate Impact Level secure database. Providers push their data to the registry—the LLPR does NOT and cannot access a provider’s electronic medical records system.

Currently, there is no cost to join, send data, and receive basic dashboard reports from the registry. Beginning in 2024, subscription plans offering varying levels of benchmarking, progress, and performance will be available for purchase.

For more information, including scheduling a one-hour Q&A with the LLPR team, visit the LLPR website, llpregistry.org, or email info@llpregistry.org

DEVON BERNARD