Happenings

FAST FACT

Medical Bills Burden Americans

One quarter of adults with healthcare debt owe more than $5,000. Approximately 1 in 5 with any amount of debt said they don’t expect to ever pay it off.

SOURCE: “Healthcare Debt in the U.S.,” KFF Healthcare Debt Survey, June 2022

MEDICARE MATTERS

More Beneficiaries Choose Part C Plans

Nearly half (48% of) eligible Medicare beneficiaries, or 28.4 million people

out of 58.6 million, are enrolled in Medicare

Advantage plans in 2022. The percentage choosing Part C plans has more than doubled since 2017.

Source: “Medicare Advantage in 2022: Enrollment Update and Key Trends,” Kaiser Family Foundation, August 2022.

RESEARCH ROUNDUP Regular Device Use Corresponds With Below-Elbow Prosthesis Functionality

Researchers from Austria and London teamed up to study the actual daily use of prostheses among individuals with below-elbow amputation. Their goal was to consider actual prosthetic dexterity, rather than study wear time, because some individuals wear upper-limb prostheses for aesthetic purposes only.

The researchers, led by Stefan Salminger, MD, PhD, from the Medical University of Vienna, worked with five unilateral patients with transradial amputations to record the number of grasping motions during objective and timed assessments, including the Southampton hand assessment procedure, the box-and-block test, the action research arm test, and the clothespin-relocation test. They also examined patient-reported wear time and estimated number of prosthetic movements over a three-month period.

After studying the results of the assessments and the patient-reported feedback, Salminger’s team reported that neither high functionality nor long wear times necessitate the frequent use of a prosthesis in daily life. However, frequent daily motions correspond with good functional scores, “indicating that regular device use in different real-life settings relates to functionality.” The study was published in October in Prosthetics and Orthotics International.

Altering a Measurement Tool To Better Accommodate Women

Recognizing that women with upper-arm amputation are more likely than men to discontinue prosthesis use, a research team led by Linda J. Resnik, PT, PhD, recently modified the Orthotics and Prosthetics User Survey (OPUS) Client Satisfaction With Device (CSD) instrument, an upperlimb prosthetic satisfaction survey, to render it more responsive to women. Members of the research team included scientists from the VA Providence Medical Center, Brown University, and Northwestern University.

The team conducted a telephone survey, calling 468 individuals in the United States with upperlimb amputation. The team identified three subscales, for comfort, appearance, and utility, with seven new items identified as important to women. The appearance and comfort subscales were found to have good reliability for group-level use in clinical and research applications, whereas the utility subscale was found to have poor to fair person reliability but excellent item reliability, according to the researchers. The study was published in June in Archives of Physical Medicine and Rehabilitation.

Stiffness of Running Legs Impacts Intact Limbs

A new study examines how the stiffness of running-specific prostheses affects limb stiffness, running performance, and associated joint kinematics among individuals with unilateral belowknee loss. The research team, led by Cleveland Barnett, PhD, from the School of Science and Motion in the United Kingdom, collected kinematic and ground-reaction force data from eight males wearing running legs. The participants ran on a 15-meter runway at self-selected speeds using three different prosthetic stiffness conditions. The research team collected data for each participant at each stiffness condition to evaluate stance-phase center-ofmass velocity, contact time, and limb stiffness and joint/prosthesis work.

The researchers found that as stiffness of the running prosthesis increased, participants experienced “acute increased mechanical demands” on their intact limbs. This finding reflects a reliance on the intact limb during running, according to Barnett’s team. “However, overall running was unaffected,” concluded the researchers, “suggesting participants acutely adapted to a running-specific prosthesis of a nonprescribed stiffness.” The study was published in October in Gait & Posture.

INSURANCE INSIGHTS

Fewer PPOs, More Managed Care

Since 2014, preferred provider organization (PPO) health insurance plans have declined by 36% as a share of all plan type offerings. Managed care

plans have grown steadily and now account for 82% of plan type offerings.

SOURCE: “Insights Into the 2022 Individual Health Insurance Market,” McKinsey & Co.

DIABETES DOWNLOAD ADA Debuts Alliance To Address Amputation Inequities

The American Diabetes Association (ADA) announced the launch of the Amputation Prevention Alliance to focus on addressing communities facing disproportionately high rates of amputations and amputation mortality. “This Alliance, through the groundwork laid by the ADA’s Health Equity Now platform, will increase awareness among patients and healthcare professionals of risk factors for amputations and opportunities to avoid these procedures,” said Charles Henderson, CEO of ADA. “This initiative aims to advance needed policy changes to ensure that healthcare professionals have the tools necessary to prevent unnecessary procedures and save lives moving forward.”

ADA pointed to the high rates of amputation among people of color as a driving factor for the initiative, with Black Americans facing rates of amputation up to four times higher than those of non-Hispanic white Americans, and high rates of amputation in both LatinX and Indigenous communities.

The Amputation Prevention Alliance has been designed as a three-year effort aiming to improve care for people living with diabetes and enhance access to quality care, technology, and interventions. “It is without question that diabetes-related amputations unfairly afflict communities of color at an alarming rate,” said Mike Griffiths, MD, president, CEO, and medical director at Advanced Oxygen Therapy Inc. and a founding partner of the Alliance. “When you consider that five-year mortality rates among those having a limb amputated due to diabetes are higher than most forms of cancer, then this situation is as dire as it is tragic.” Details are available on ADA’s website.