Evidence-Based Healthcare Innovation - the key role universities can play

Evidence-based approaches are essential in healthcare innovation because they ensure patient safety, optimise limited resources, and fulfil ethical obligations to provide effective care. Unlike other sectors, innovations in healthcare have immediate and profound consequences for human lives, making rigorous testing and validation critical before implementation. This evidence-based foundation helps meet regulatory requirements, demonstrates cost-effectiveness to healthcare systems and insurers, and minimises the risk of cognitive biases that may otherwise result in the adoption of ineffective or potentially harmful practices.

Universities serve as crucial engines in the healthcare innovation ecosystem through their unique combination of research capabilities and educational mission. Academic institutions conduct the foundational scientific research that underlies healthcare breakthroughs, provide the infrastructure for clinical trials and validation studies, facilitate interdisciplinary collaboration among diverse experts, and train the next generation of practitioners.

Synergistic collaborations between academic institutions, healthcare systems, business, and government organisations are becoming more and more important for effective innovation in healthcare. By balancing the demands of scientific rigour, regulatory compliance, and patient-centred outcomes, these partnerships help translate scientific discoveries into clinically relevant solutions.

The academic environment also makes it possible to pursue research agendas that may not have immediate commercial benefits but address important gaps in public health and global health.

Through these diverse contributions, universities can act as catalysts for long-term improvements in health systems and outcomes in addition to providing the evidence base required for safe and successful healthcare innovation.

The Challenge of delivering healthcare in Emergencies

In healthcare innovation, the journey from discovery to delivery remains plagued by systemic barriers that delay life-changing innovations from reaching those who need them most. This issue becomes particularly acute in medical emergencies and in humanitarian crises, where traditional healthcare delivery models simply cannot cope with the extraordinary demands on the healthcare system.

Systemic obstacles that prevent the prompt translation of innovation into clinical practice, such as regulatory limitations, inadequate infrastructure, and logistical difficulties, frequently obstruct the transition from scientific discovery to the provision of healthcare interventions. In humanitarian and emergency situations, these difficulties are greatly exacerbated, as traditional care delivery models are unable to satisfy pressing and complicated needs, and current healthcare systems are frequently overburdened. The need for quick and efficient innovation is particularly pressing in these situations.

One of the most striking examples of successful collaborative research was the development of COVID-19 vaccines, which compressed vaccine development timelines from years to months and is estimated to have saved millions of lives around the world.

This accomplishment is thought to have prevented millions of deaths globally and has established a standard for what can be achieved when responding to global health emergencies with coordinated, evidence-based action.

On a much smaller scale, the case of amputees in Gaza represents a powerful example of how a crisis can catalyse innovation, challenging established approaches and constraints and accelerating the development of more accessible healthcare solutions and services such as a lightweight, remouldable socket for children. A case study that we look at in more detail.

The Innovation Access Gap in Healthcare

Despite remarkable acceleration in scientific and technological advancements, many barriers remain which prevent healthcare innovations from reaching patients quickly and equitably. Barriers include:

• Economic constraints: High development costs and pricing models that prioritise profit and return on capital over accessibility

• Regulatory complexities: Complex approval processes, so essential for patient safety, which can be both unduly lengthy and vary between countries and regions

• Infrastructure limitations: Weak healthcare systems, shortages of trained personnel, and fragmented delivery networks

• Geographic challenges: "Last mile" distribution problems, particularly in areas affected by conflict or remote areas

• Knowledge silos: Disconnect between innovation developers and end-users' needs

These barriers can be particularly pronounced in specialised areas like prosthetics, where traditional models have centred heavily on adult users in stable, resource-rich environments. The result is a system ill-equipped to address the unique needs of children, especially those in crisis situations. 

Engaging with universities to define the need, and assessing the evidence around the effectiveness of a new approach and innovation is crucial, as is involving them in training programmes so practitioners get early access to the insights and skills they need to make considered decisions about adopting a new technology or methodology.

The University of Jordan's School of Rehabilation Studies

Case Studies: Agile Innovation in Crisis

The Restoring Hope initiative builds on a combination of five main innovations. Each is significant in its own way, but it is the combination of all five that makes the MASU approach feasible.

A continuous research programme is needed both to evaluate and share the lessons and understand the cumulative impact and potential of the Mobile Amputee Support Unit decentralised approach.

The use of specialist mobile units following the destruction of the healthcare infrastructure in Gaza represents an example of how the crisis can drive innovation.

There were four important elements that needed to be brought together:

1. Mobile delivery model: Rather than requiring patients to access fixed clinics, MASU vans bring the services directly to patients visiting the field hospitals. It is also inherently faster to deploy and scale than traditional static clinics.

2. Simplified fast-fitting technologies: Prosthetics which could be fitted in a single visit, often providing a 'definitive fit', dramatically increased frontline capacity, and the cost effectiveness of the process

3. Enabling earlier rehabilitation giving the greater agency to the patient and potentially a faster track to recovery

4. Digital integration: The service was further enhanced by access to electronic patient records and the use of smart monitors, which could capture Real World Evidence (RWE) of how well the patient was able to use a prosthetic after fitting.

Simplifying the process through fast-fitting prosthetics

Remouldable sockets

Amparo's remouldable socket technology represents a transformational approach to prosthetic care, particularly in mobile and humanitarian settings. The ability to fit and adjust prosthetic sockets in a single visit—as opposed to the traditional model requiring 4-7 clinic appointments over 3-6 weeks—could dramatically accelerate rehabilitation for amputees. This single-appointment approach is especially valuable in crisis zones where patients face significant barriers to accessing fixed clinical facilities, such as in Gaza where the MASU (Mobile Amputee Support Unit) model has been successfully deployed. By bringing prosthetic services directly to patients through mobile vans and utilising sockets that can be fitted immediately, Amparo enables amputees to begin rehabilitation immediately rather than enduring extended waiting periods. Most critically, the technology's capacity to be remoulded up to five times allows for ongoing adjustments as a patient's residual limb changes shape during healing, or as the child grows without requiring fabrication of entirely new sockets.

The environmental and resource implications of Amparo's approach are equally significant. Traditional prosthetic socket fabrication involves multiple test sockets and material wastage throughout the iterative fitting process, generating substantial non-biodegradable waste.

Amparo's remouldable technology eliminates this waste stream by using a single socket that can be thermally adjusted multiple times as needed. This resource efficiency makes the system particularly suitable for resource-constrained environments and emergency response settings where material supplies may be limited.

Additionally, the simplified fitting process requires fewer specialised tools and materials, reducing the logistical footprint required to deliver prosthetic care. By combining mobility, immediacy, and adaptability, Amparo's approach not only accelerates the delivery of critical rehabilitation services but does so with significantly reduced material waste and environmental impact compared to conventional prosthetic care models.

The Above Elbow Prosthetic

Difficult surgical interventions and serial infections have often made saving injured upper limbs challenging and this, combined with infections has led to a higher than normal prevalence of above elbow amputations.

This led to the challenge of designing an above-elbow prosthetic that was easy to put on and off, adaptable and comfortable. Koalaa was tasked with designing a soft, lightweight above-elbow prosthetic, using similar manufacturing and fitting techniques as their below-elbow socket - the ALX. The new design uses a modular structure and flexible materials, making it easy to adjust for different users and their needs.

An initial prototype of the above-elbow prosthetic was developed in the UK and subsequently tested with a user in Jordan. Over the course of three days, the design was refined by collaborating closely with CPOs from the RMS. Daily feedback from both the user and the clinical team informed continuous improvements, with updated iterations produced and tested each day. The combination of the modular design and textile-based materials enabled rapid prototyping between sessions.

Returning to the UK, a further refined version of the prosthetic was developed, incorporating all insights gained during the testing process. The latest iteration will be used in a set of user trials conducted concurrently in Jordan and the UK.

The success of the prosthetic design will be assessed based on several key user-focused metrics:

1. User satisfaction with the cosmetic appearance, weight and comfort of the device

2. The user's ability to perform everyday tasks independently

3. The user's ability to engage in a specialist activity, such as a sport or hobby, using the terminal devices provided

4. The user’s ability to independently don and doff the prosthesis

If the trial demonstrates that the above-elbow prosthetic is both functional and effective, it will be made available to amputees in Gaza through the Restoring Hope Initiative, with the support of the Jordanian Royal Medical Services.

The use of Real World Evidence

Smart monitoring technology and Real World Evidence (RWE) collection represent a paradigm shift in amputee rehabilitation, particularly in field and humanitarian settings. As demonstrated by the Adapttech Motio Stepwatch system deployed in Gaza, these technologies provide unprecedented objective data on patient mobility that traditional clinical assessments often miss. Unlike subjective evaluations that capture only brief clinical encounters, smart monitors continuously track critical metrics—including step count, cadence, activity intensity, and distance covered—revealing patients' true functional capabilities in their everyday environments. This objective perspective is especially valuable in crisis zones where medical resources are stretched thin and clinicians have limited time with each patient, allowing healthcare providers to make evidence-driven decisions about prosthetic adjustments, rehabilitation plans, and resource allocation.

The benefits extend far beyond improved clinical assessments to fundamentally transform the entire care ecosystem. By generating detailed activity data, smart monitors bridge communication gaps between multidisciplinary team members who may be geographically dispersed, creating what one document calls a "common language of objective data." This enhanced communication enables prosthetists, physical therapists, and physicians to collaborate more effectively, even when separated by distance or working in challenging environments. The technology also empowers patients by providing visible evidence of their progress, which several case studies showed significantly boosted motivation and engagement with rehabilitation. Perhaps most importantly, these systems help identify discrepancies between clinical assessments and real-world capabilities—a particularly striking finding from Gaza showed patients achieving functional levels well above their traditional K-level ratings, suggesting many amputees have greater potential than conventional evaluations indicate.

Evaluating the impact of smart monitoring systems requires a multidimensional approach that extends beyond clinical outcomes to system-level benefits. As suggested by the University of Jordan's research programme, evaluation should combine quantitative mobility metrics with broader measures such as quality of life improvements, increased independence in daily activities, and reduced caregiver burden. The economic impact should also be measured through metrics like reduced clinical visits, more efficient resource allocation, and faster progress through rehabilitation phases. Longitudinal studies tracking patients throughout their recovery journey would be particularly valuable in determining how these technologies affect long-term outcomes. Most significantly, evaluation should explore how real-world evidence transforms clinical practice itself—examining whether the data leads to more personalized prosthetic prescriptions, better-informed component selection, and the development of new prosthetic designs that better address patient needs in challenging environments. This approach will help us better understand the transformative potential of smart monitoring technologies in humanitarian and resource-constrained settings.

Digital health records for e-consultation and patient follow up

Electronic health records (EHRs) like the Hakeem system described in the article hold remarkable potential for transforming amputee support in field settings, particularly in crisis zones where healthcare infrastructure is compromised. By creating a digital backbone for patient care, EHRs enable seamless coordination across multidisciplinary teams, bridging geographical divides that would otherwise prevent specialists from contributing their expertise. This digital continuity is especially vital for amputee patients, whose care journey spans assessment, surgical intervention, prosthetic fitting, rehabilitation, and long-term follow-up—phases that traditionally require different specialists working in different locations and often result in fragmented care experiences. The mobile nature of systems like those deployed through the Mobile Amputee Support Units (MASU) allows practitioners to bring comprehensive care directly to patients who cannot travel to centralised facilities, while maintaining the same standard of record-keeping and care coordination as would be expected in established medical centres.

The benefits of EHR implementation in field-based amputee care extend beyond basic record-keeping to fundamentally reshape care delivery. As demonstrated in Gaza, these systems enable real-time teleconsultations between frontline providers and specialists at centres of excellence, effectively extending expert reach into remote or conflict-affected areas without physical deployment. The continuous data collection creates opportunities for evidence-based improvements to prosthetic designs and fitting protocols, while simultaneously allowing for personalised treatment plans that evolve with the patient's changing needs. Perhaps most significantly, EHRs facilitate the transition from episodic intervention to continuous care relationships—particularly crucial for children whose prosthetic needs change rapidly with growth. The digital infrastructure also supports training and knowledge transfer between specialists and field practitioners, gradually building local capacity while maintaining quality standards.

The impact of EHR systems in field-based amputee care may be best evaluated through a multidimensional approach that combines quantitative outcomes with qualitative assessment of the care experience.

Drawing from the University of Jordan's research programme described in the article, evaluation aims to incorporate both traditional clinical metrics (prosthetic functionality, patient activity levels) and broader measures of impact such as quality of life improvements, reduction in caregiver burden, and system-level efficiencies. Electronic records themselves provide ideal data sources for longitudinal studies that track outcomes across the entire care continuum rather than isolated intervention points.

Crucially, the monitoring and evaluation needs to assess how the data from the complete health records and economic modelling can bridge the "valley of death" between innovation and implementation. Can we practically show how digital systems actually accelerate the adoption of evidence-based practices in resource-constrained settings is one of the questions the researchers are considering. If we can build the evidence base, can we then use it to cut the time it will take to scale innovative approaches like the MASU model across different contexts and populations?

Evaluating the Impact of the MASU Model: An Academic-Community Research Collaboration

Evaluating the clinical and socio-economic impact of each of these innovations requires different approaches. LSN and the Restoring Hope Society is working with the University of Jordan to explore how a research programme can help evaluate and refine the MASU model, providing the evidence base needed for broader implementation in different contexts be it in conflict, remote locations, or providing surge capacity. The initial trials looks at “Activity Levels and Quality of Life Among Trans-Tibial Amputees Managed by the MASU“.

The purpose of this trial is to assess how the Mobile Amputee Support Unit (MASU) affects unilateral transtibial amputees' rehabilitation results in environments affected by conflict. The study contrasts two different service delivery models, the innovative, community-based MASU model and the traditional hospital-based rehabilitation approach, in recognition of the pressing need for prompt and efficient prosthetic care in areas with disrupted healthcare infrastructure, like Gaza.

Unilateral trans-tibial amputees are divided into two groups based on the mode of prosthetic delivery. Participants in the MASU group receive the Amparo prosthesis through a mobile support unit, which delivers at-home fitting and rehabilitation services supplemented by regular visits and digital monitoring. This approach is designed to address barriers related to accessibility, limited local resources, and infrastructural constraints. In contrast, the control group receives standard prosthetic care through hospital-based rehabilitation services, which involves multiple in-person visits to clinical facilities for prosthesis fabrication, fitting, and follow-up rehabilitation sessions.

The Amputee Mobility Predictor (AMP), the Prosthetic Limb Users Survey of Mobility (PLUS-MTM), and the Prosthesis Evaluation Questionnaire (PEQ) will be used to conduct outcome assessments. This will allow for a thorough assessment of physical function, patient satisfaction, comfort, and health-related quality of life. The Motio Stepwatch activity monitor, a validated and highly accurate pedometer attached to the prosthesis that enables the collection of precise, real-world mobility data outside of clinical settings, will be used to track the objective activity levels of each participant. Complication rates, carer burden, and a cost-effectiveness comparison of the MASU model and traditional hospital-based rehabilitation will be secondary endpoints. To evaluate rehabilitation results and track adverse events, data will be methodically gathered ten days, three months, six months, and twelve months after fitting.

By integrating smart technology, validated patient-reported outcome instruments, and real-world service delivery, this study will generate critical evidence to inform the scale-up of mobile rehabilitation services. The findings are expected to support policy decisions, optimize resource allocation, and, ultimately, improve the functional independence and quality of life for amputees in crisis-affected communities.

This approach shows how academic institutions help provide the evidence base that can accelerate the adoption of better practice and policy, and ensure healthcare innovation is safe, combining traditional trials with Real World Evidence leading to much faster development cycles.

The aim is to ensure the MASU programme is underpinned by:

• A comprehensive evaluation methodology: The programme employs a prospective cohort study design comparing MASU recipients with those receiving traditional hospital-based care

• Comprehensive outcome measures: The research measures not only physical function but also quality of life, satisfaction, and caregiver burden

• Smart technology integration: Smart sensors (Motio Stepwatch) enable objective measurement of activity levels beyond clinical settings

• Long-term follow-up enabbled by the study which includes 12-month follow-up to assess durability and sustained impact

• Focus on implementation science: The research explicitly examines cost-effectiveness and system-level impacts

This comprehensive research approach we hope to address the challenge of the "valley of death" that often prevents promising innovations from achieving widespread adoption and sustainable scale, because of insufficient clinical and socio-economic data to support the changes to standard policy and practice that can block the swift adoption of breakthrough innovations.

Finally, Lessons for Healthcare Innovation

The experiences from Gaza demonstrate that a crisis can be a powerful catalyst for healthcare innovation when supported by appropriate collaboration between universities, healthcare providers, and technology developers. The MASU model and collaboration with the University of Jordan represents not just a response to an immediate crisis but potentially a fundamental shift in how prosthetic fittings are delivered faster, from mobile units that can be scaled more easily and made more accessible to those in need.

The University of Jordan enables this approach to be evaluated in a controlled environment in parallel to the emergency response.

By moving away from centralised, resource-intensive models towards distributed, simplified approaches, and connecting frontline practitioners with engineers and designers around the world we can dramatically accelerate access to life-changing technologies.

University research networks play a crucial role in this transformation by providing rigorous evaluation, addressing implementation challenges, and building the evidence base for policy change.

As we look to the future, the lessons from this experience extend far beyond prosthetics. They offer a template for how healthcare innovations more broadly can be developed and delivered in ways that overcome traditional barriers, particularly for vulnerable populations in challenging environments. By embracing agile innovation approaches and forming strategic partnerships, we can ensure that healthcare breakthroughs reach those who need them most, regardless of their circumstances or location.