Identifying and linking prosthetic outcomes to the ICF framework: a step to inform the benefits measured in prosthetic health economic evaluations

Abstract

Purpose

Prosthetic research seems focused on measuring gait-related outcomes that may not adequately measure real-world benefits of prosthetic interventions. Systematically cataloguing a comprehensive range of outcomes is an important steppingstone towards developing a holistic way to measure the benefits of prosthetic interventions for future health economic evaluations. The purpose of this research was to identify and catalogue the outcomes measured in lower-limb prosthetic research using the International Classification of Functioning, Disability, and Health (ICF) framework and a custom clinical framework, and thereby describe the existing research focus and identify evidence gaps.

Materials and methods

A structured literature search identified systematic reviews of lower-limb prosthetic interventions. Reported outcomes were extracted from included studies and linked to the ICF- and clinical-frameworks.

Results

Of the 1297 extracted outcomes, 1060 were linked to the ICF framework. Most outcomes linked to second- (63.8%) or third-level categories (33.4%), such as Gait Pattern Functions (b770, 49.8%). Most of these outcomes (31.2%) describe temporospatial, kinematic or kinetic gait measures as categorised by the clinical framework.

Conclusions

Lower-limb prosthetic research is focused on laboratory-based measures of gait. There are evidence gaps describing participation in real-world activities – important outcomes to inform policy and investment decisions that determine the prosthetic interventions available for people with limb-loss.

Implications for rehabilitation

• Cataloguing the outcomes used in prosthetic research to the International Classification of Functioning, Disability, and Health (ICF) allows important evidence gaps to be illuminated given the holistic description of function and disability.

• Establishing a comprehensive list of prosthetic outcomes, described using an internationally recognised framework with unified and consistent language, is an important steppingstone towards developing a core outcome set (COS) for prosthetic interventions and informing the benefits measured in future prosthetic health economic evaluations (HEEs).

• Being able to measure the benefits of a prosthesis that are most important to prosthesis users and funders has potential to fundamentally change future HEEs that influence funding policies, and ultimately the prostheses made available to people living with limb-loss.

Keywords:

• Prosthesis
• amputation
• ICF
• outcomes
• linking
• health economics
• benefits
• core outcome set

Acknowledgements

The authors gratefully acknowledge the expertise provided by: Ms Aloka Seneviratne of La Trobe University who developed and helped refined the custom data extraction and linking spreadsheet (Supplementary file 2) and Dr Eduardo Cofre Lizama of La Trobe University who developed the polar histograms. Further we acknowledge the expert guidance and supervisory support provided by Professor Alan Shiell of La Trobe University.

Disclosure statement

The authors report no conflicts of interest.

Additional information

Funding

LC gratefully acknowledges the support provided by the American Orthotic and Prosthetic Association (AOPA) Centre for Orthotic and Prosthetic Learning and Outcomes/Evidence-Based Practice (COPL) Grant (EBP-053119).