Outcome

1
Outcome Cost Analysis of Physiotherapist-fabrica
ted Temporary Prostheses

• Multi-centre data collection
• AKA BKA
• Hypothesis
• The use of temporary prostheses will provide a
  safe, cost-effective, and efficient means of
  rehabilitating lower limb amputees

2
Why?

• Review of the NSW Artificial Limb Service
• June 2004
• We recommend that the use of plaster of paris
  interim prostheses in NSW amputees be phased out
  that the provision of mechanical interim
  prostheses manufactured by a prosthetist be
  implemented as standard practice.

3

• universal consensus among all rehabilitation
  clinicians consulted that the use of plaster of
  paris interim prostheses was inconsistent with
  contemporary best practice nationally
  internationally.
• Who was consulted?

4

• interim prostheses manufactured by a prosthetist
  would deliver superior outcomes in terms of
  patient comfort rehabilitation.

5

• In the absence of a robust empirical framework
  with which to assess current practice in NSW, we
  have focussed on identifying areas of significant
  variation in practice in NSW and recommending
  changes to practice where we consider these to be
  supported by the available evidence or broad
  clinical consensus.

6
Literature

• No published studies comparing plaster temporary
  prostheses with interim prostheses
• Victorian QA project from 1983.
• Some studies describe outcomes with IPOP
  (converted rigid dressing) or prosthetist
  manufactured interims.

7
Research

• Effectiveness
• Time to temporary definitive
• Time to discharge
• Complications such as wound breakdown
• Who made the temporary expert/novice
• Number of temporaries to definitive
• Time to 2nd definitive socket (if in data
  collection period)
• Occasions of temporary prosthetic failure
  patient weight
• Measure load bearing capacity of plaster
  temporaries

8
Research

• Outcome
• Time to definitive
• Discharge date
• Discharge destination
• Aids
• 10m walk time
• 2 min walk
• Level of independence
• Stairs ability
• Bed mobility (acute setting time to first
  mobilise)

9
Research

• Cost
• Cost of components recycled or consumables
• Number of appointments (inpt / outpt)
• Who made by (expert / novice)
• Time to make temporary
• Time to make interim / definitive (prosthetist)
  98.25 hourly rate
• ALS quote 1400 for manufacture of interim
  prostheses at Albury

10
Research

• Results How do we prove efficacy?
• Suggestions
• Comparison between sites bench-marking for best
  practice.
• Measure occurrence of complications due to
  temporary / temporary prosthetic failure
• Compare cost of programme with costs from
  prosthetists to implement the same programme
• Set outcome bench-marks, and find what achieve
  this.

11
Research

• Possible comparison of results with Victorian
  data on use of interim prostheses.
• (If we can find it??)

12
Research

• Publication requires ethics approval, including
  patient information sheets consent forms.
• Apparently OK to modify plans as we go, as long
  as ethics committees are informed, and outcomes
  of the project remain unchanged.
• Centres indicating interest so far
• SWAHS (Westmead Nepean)
• SSWAHS (RPAH / Concord / Liverpool / Bankstown)
• Port Kembla
• Rankin Park