Happenings

FAST FACT

Prosthetics Comprises the Majority of O&P Facilities’ Gross Sales/Billings

1.9% 4.0% 3.3%

36.3% 54.6%

Prosthetics Orthotics Pedorthics Durable Medical Equipment Other

—“2020 AOPA Operating Performance Report”

RESEARCH ROUNDUP Study Identifies Disparities for Limb Loss Patients With PAD

Individuals with peripheral artery disease (PAD) located in rural communities with markers of low socioeconomic status experience higher rates of major lower-extremity amputation, according to a study published in the Journal of the American Heart Association (JAHA).

Researchers from the University of Pennsylvania estimated rates of major lower-extremity amputation per 100,000 Medicare beneficiaries. Between 2010 and 2018, ZIP codes that experienced the highest levels of amputation rates (top quartile) had a greater proportion of Black residents (17.5 percent Black residents versus an average of 4.4 percent).

They also found that, within more populous metropolitan areas, households with lower median household incomes (less than $10,000) were associated with a 4.4 percent higher amputation rate.

“In metropolitan areas, where most individuals undergoing lowerextremity amputation live, markers of lower socioeconomic status and Black race were associated with higher rates of major lowerextremity amputation,” concluded the researchers. “Development of community-based tools for peripheral artery disease diagnosis and management targeted to communities with high amputation rates in urban areas may help reduce inequities in peripheral artery disease outcomes.”

The study was published in the September 7 issue of JAHA.

Lower-Limb Loss Patients Benefit From Increased Ambulation

Researchers at Columbia University recently conducted a scoping review to map the evidence regarding steps per day as a physical activity measure for individuals with lower-limb loss. The research team, led by Christopher Kevin Wong, PhD, PT, reviewed 21 studies and found that most individuals with limb loss have low activity levels compared with the 10,000 steps per day generally recommended, or 6,000 steps per day recommended for individuals with diabetes.

“People with lower-limb loss take fewer steps per day than suggested for general health,” concluded the researchers. “Increasing steps per day may be a useful goal for this population, and this study is a first step in improving knowledge of physical activity levels in people with lower-limb loss.”

The study was published in the August 1 issue of Physical Therapy.

INTERNATIONAL O&P Type 1 Diabetes-Related Amputations Drop in Sweden

The rate of amputation due to type 1 diabetes has fallen 40 percent over the past 20 years in Sweden, according to a new study from the University of Gothenburg.

Researchers studied registry data of individuals in Sweden with type 1 diabetes. Between 1998 and 2001, the probability of amputation was 2.84 per 1,000 people; this number dropped to 1.64 per 1,000 between 2017 and 2019.

“We see a trend reversal in the period from 2014 to 2016, and a couple of years before that there were evidently declining long-term blood sugar levels and improving kidney function,” said Sara Hallström, MD, author of the study and a doctoral student in molecular and clinical medicine at Sahlgrenska Academy at University of Gothenburg. “These are the risk factors that, in the study, proved to be the major ones for amputation in people with type 1 diabetes.”

Hallström and her colleagues attribute the decline in amputation rate to more advanced diabetes care, the proliferation of multidisciplinary diabetes footcare teams to treat diabetic foot ulcers, and greater use of technologies such as advanced insulin pumps and continuous blood-glucose measurement machines. “The declining amputation rate for people with diabetes is important,” said Hallström, “given that amputation is a procedure that causes great suffering and disability for those who have to undergo it.” The full study was published in September in Diabetologia.

VIRTUAL MEDICINE U.S. Telehealth Usage Stabilizes at 38 Times Higher Than Prepandemic Numbers

More healthcare facilities have embraced telemedicine as the country recovers from the pandemic. In April 2020, telehealth spiked to encompass more than 32 percent of office and outpatient visits. In O&P specifically, 44 percent of facilities reported using telehealth in April 2020, according to AOPA’s COVID-19 Patient-Care Facility Survey.

Since then, telehealth utilization has stabilized at approximately 17 percent of visits, according to a new report from McKinsey & Co. That equates to approximately 38 times more than the pre-COVID-19 baseline.

McKinsey surveyed consumers and found that 40 percent will continue to use telehealth going forward, up from 11 percent prior to the pandemic. And 58 percent of providers view telehealth more favorably now than before COVID-19, according to the research.

The McKinsey researchers noted that virtual healthcare models are evolving, moving from “virtual urgent care” toward a range of virtual services and hybrid virtual/ in-person care models. “Telehealth appears poised to stay a robust option for care,” said the researchers. “Strong continued uptake, favorable consumer perception, the regulatory environment, and strong investment into this space are all contributing to this rate of adoption.”