A scoping literature review of studies assessing effectiveness and cost-effectiveness of prosthetic and orthotic interventions

Abstract

Purpose: Approximately 1.5% of the world’s population (∼100 million people) need a prosthesis/orthosis. The objective of the study was to establish an overview of the literature that has examined prosthetic and orthotic interventions with a view to inform policy development.

Methods: Fourteen databases were searched from 1995–2015. Studies reporting primary research on the effectiveness or cost-effectiveness of prosthetic and orthotic interventions were examined. Metadata and information on study characteristics were extracted from the included studies.

Results: The searches resulted in a total of 28,958 articles, a focus on studies with the words “randomized” OR “randomized” OR “cost” OR “economic” in their citation reduced this total to 2644. Research has predominantly been conducted in Australia, Canada, Germany, Netherlands, UK and USA. A total of 346 randomized controlled trials were identified, with only four randomized controlled trials examining prosthetic interventions. The majority of research examined lower limb orthoses in the adult population and used a wide range of outcome measures.

Conclusions: While various international organizations have highlighted the value of providing prosthetic and orthotic services, both to the user and society as a whole, the availability of scientific research to inform policy is limited. Future structured evaluation of prosthetic and orthotic interventions/services is warranted to inform future policy developments.

Implications for rehabilitation

• Research into prosthetic and orthotic interventions has grown substantially in the last 20 years, with most of this research conducted in a small number of countries and focusing on the use of lower limb orthotics in adult populations.

• Research to date has utilized an extensive range of outcome measures, the development of agreed standardized sets of outcomes would allow comparison and combination of results in future research.

• This study highlights the need for further research in this area, especially studies which examine the cost-effectiveness of prosthetic and orthotic provision.

Keywords:

• Orthotic device
• prosthetics
• footwear
• amputation
• artificial limb
• mobility
• effectiveness
• cost-effectiveness

Acknowledgments

The authors gratefully acknowledge the support of the advisory panel who supported this work: Anil Kumar Jain, Santokba Durlabhji Hospital, Jaipur, India; Elizabeth Hardin, Louis Stokes Cleveland DVA Medical Center, USA; Géza Kogler, Georgia Institute of Technology, Atlanta, USA; Isabel Sacco, University of Sao Paulo, Brazil; Saeed Zahedi, Chas A Blatchford & Sons, UK; Sarah Curran, Cardiff Metropolitan University, UK; Stefano Negrini, Italian Scientific Institute for the Spine, Italy; Zulfiqarali G. Abbas, Abbas Medical Centre, Tanzania. We also acknowledge our colleagues Dave Parkes and Paul Biggs, Staffordshire University, UK and Mathew Stone, Royal Stoke University Hospital, UK who supported the development of the database search strategies.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work is supported by International Society for Prosthetics and Orthotics