How will the care needs of amputees be met differently in future?
This was a question posed by Prosthetics visionaries Alan and Christopher Hutchison, founders of the ProsFit company. They recognised that the traditional approach to amputee support is simply not cost-effective enough to be scalable, the investment in bricks and mortar clinics is too capital-intensive and this clinic-centred model makes it very hard for patients living in remote locations to receive timely follow-up if there are any complications. The clinic-centred model puts the onus on the amputee to travel to the clinic. This may work well with good, accessible AND affordable public transport. However it can be a costly model for the amputee, and also to the clinic if appointments are missed for whatever reason.
One has a very different view of clinic-centric service if one takes an amputee-centred approach. Christopher Hutchison came to this field not as a medical professional, but as an amputee.
Christopher became an amputee when he was 17 in a traumatic accident. In 2021 Christopher Hutchison was invited to give the International Confederation of Amputee Associations (IC2A) Inspirational Lecture “Prosthetics for All – Changing Lives through Digital Technologies” at the 18th World Congress of the International Society for Prosthetics and Orthotics (WIPO). In this lecture, he highlighted both the scope of the challenge now.
And the reason why the need for innovation is so vital.
And how innovations, particularly involving digital technologies are opening up new opportunities, for making prosthetics both more accessible and affordable.
Often 'necessity can be the mother of invention'.
The Covid 19 Pandemic with social distancing measures and restricted access to some prosthetics services led to a range of innovative initiatives that included. Project Limitless
brought together a consortium of amputee support charities and businesses in the UK to create a scheme to that provided universal access to self-fitting soft prosthetic devices for limb-different children.
Alan and Christopher Hutchison began to envisage how the healthcare delivery ecosystem may look different after the lockdown, and if already expected changes would accelerate. They tested these ideas with the wider community through a poll exploring how “the current pandemic might lead to a New Normal in healthcare delivery”. They wanted to explore questions such as “How the needs of amputees will be met differently going forward?”, with options being “Home Visits”, “Telehealth Consultations”, “Mobile Clinic Services”, and “Other”.
An analysis of the responses by participant profile and region showed that participants from outside the prosthetics industry, especially in Europe, expect more use of Mobile Units & Telehealth, and participants in the Americas felt that service provision would be complemented more strongly by Community Service Points and Home Visits.
The feedback and comments during the process, gave clear perspectives on how participants believe prosthetics provision will change, although there were differences of opinion about how and how fast this will happen.
Distributed Care Networks
There was a good consensus that amputee care services will ultimately be delivered through Distributed Care Networks (DCNs), each comprising a Principal Clinical Centre, with a network of linked Satellite Centres, mainly in urban areas. These will be complemented in more remote areas by Community Service Points and Mobile Units.
Alan and Christopher Hutchison envisaged that Community-Based Rehabilitation (CBR), including approved Home Visits, would increasingly be adopted where local healthcare professionals and rehabilitation specialists see this to be the best course of action.
How integrated service providers configure their DCN will depend on population dispersion, and how best to construct the “last mile” to most effectively serve the needs of amputees using available expertise, resources, infrastructure and technologies.
Efficiency will be gained the through use of telehealth and telerehab approaches to facilitate patient-specialist communication and make dispersed knowledge, expertise, clinical decision-making and personalised services accessible at the point of care. Patients who continue to attend existing urban centres will use a growing number of specialised transportation providers.
The key drivers of DCNs are:
· the demands from both users and payers for accessibility and affordability
· the need to effectively leverage available professional resources, knowledge, skills, and expertise
· the increasing availability of digital technology solutions, and acceptance of new business models.
In the evolution of DCNs, Alan and Christopher envisaged changes in what is being done, why, how, when, where and by whom. They imagined new efficient value chains that could source and deliver products and services in a cost-effective, efficient and timely manner.
As the DCNs focus on patient-centred care, they might outsource manufacturing and delivery to owned or sub-contracted external fabrication hubs. There are likely to be multi-disciplinary teams interacting with the users in a well-synchronised way, especially in the front line, with task shifting being used to leverage well-trained specialists, enabling them to be more productive.
This is only possible through several simultaneous advances, highlighting the importance of a systems perspective. Typically people overestimate the speed and impact of adopting new technologies and practices and underestimate the long-term cumulative impact.
We have focussed below, on a number of practical examples and emerging trends that could play pivotal roles in shaping the future of prosthetics provision, and the evolution of distributed care networks (DCNs).
1. Telehealth and Telerehabilitation
Telehealth consultations have already seen a significant uptick due to the pandemic. For amputees, this could mean more sophisticated virtual assessments, where prosthetists and therapists use high-definition video calls and specialized software to evaluate the fit and function of prosthetics remotely.
For instance, the use of AR (Augmented Reality) technology can help in the remote fitting and customization of prosthetic limbs, allowing practitioners to overlay digital images onto the physical world for precise measurements and adjustments. However such a digital based approach might be left redundant by the growing adoption of remoldable sockets like Amparo which enable a near perfect fit in a single session – in a material that can be quickly modified allowing better and quicker patient follow up and care.
2. Wearable Technology and Sensors
The integration of wearable sensors in prosthetics can provide continuous feedback on the user's movement patterns, prosthetic fit, and even the health of the residual limb. This data can be monitored remotely by healthcare providers, enabling timely adjustments without the need for physical visits. For example, smart prosthetics equipped with IoT (Internet of Things) capabilities can send real-time data to clinicians, who can then analyse this information to improve the comfort and functionality of the prosthetic limb.
This could be particularly significant in low resource settings were remote experts can monitor the work of the teams on the ground, mentoring them and alerting them if the analytics suggest the patient may be struggling with using their prosthetics effectively.
3. 3D Printing and Mobile Fabrication Units
3D printing technology has the potential to revolutionize prosthetics manufacturing, making it faster, more customizable, and accessible. Mobile fabrication units equipped with 3D printers could bring this capability directly to communities, reducing wait times for prosthetics and allowing for on-the-spot adjustments. This approach can be especially beneficial in remote areas or disaster zones where access to traditional prosthetic services is limited.
However there may be other solutions that offer quick fitting and easy adjustment such as Koalaa’s soft prosthetics.
4. Community-Based Rehabilitation (CBR) and Peer Support
Expanding on the concept of CBR, peer support networks facilitated by technology can play a crucial role in the rehabilitation process. Online platforms and mobile apps can connect amputees with peers for emotional support, advice, and sharing of resources. We have explored this in the context of peer to peer support in Ukraine.
These networks can also serve as valuable feedback channels for service providers, helping them to better understand and meet the holistic needs of their users, particularly recognising that the psychosocial support can be every bit as important at the physical.
5. Advanced Training for Practitioners
The shift towards DCNs and the integration of new technologies will require advanced training for prosthetists, therapists, and other healthcare professionals. This might include specialized training in remote diagnostics, digital fabrication techniques, and the use of emerging technologies such as AI (Artificial Intelligence) for personalized care planning.
Virtual reality (VR) simulations could provide practitioners with a hands-on learning environment without the need for physical presence. This has been explored in already in a series of blogs on simulation-based training tools for JIT capacity building (a project supported by the UK Humanitarian Innovation Fund.
6. Policy and Accessibility
As new models of care emerge, so too will the need for supportive policy frameworks that ensure accessibility, affordability, and quality of care. This includes how funds are allocated in humanitarian programmes, reimbursement policies for telehealth services, standards for remote care delivery, and regulations that promote innovation while protecting patient safety.
Conclusion
The transition to a new normal in prosthetic care, driven by distributed care networks and supported by technological advancements, promises to make services more personalized, accessible, and efficient.
By leveraging digital technologies, enhancing the skills of healthcare providers, and embracing innovative service delivery models, the future of care for amputees looks more promising.
The practical examples provided illustrate a pathway towards this future, highlighting the importance of adaptability, collaboration, and patient-centred approaches in transforming prosthetic care.