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Frossard, Laurent A., Berg, Debra, Merlo, Gregory,& Burkett, Brendan (2017) Governmental perspective on fair and equitable provision of bone- anchored prostheses: Barriers and facilitators. In 16th International Society of Prosthetics and Orthotics (ISPO) World Congress, 8 - 11 May 2017, Cape Town, South Africa.

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Governmental Perspective on Fair and Equitable Provision of Bone-anchored Prostheses: Barriers and Facilitators

Laurent Frossard 1,2, Debra Berg 3, Gregory Merlo 1,4, Tanya Quincey 3, Brendan Burkett 2

1 Queensland University of Technology, Brisbane, QLD, Australia, 2 University of the Sunshine Coast, Maroochydore, QLD, Australia, 3 Queensland Artificial Limb Service, Brisbane, QLD, Australia, 4 Australian Centre for Health Services Innovation, Brisbane, QLD, Australia

Frossard L, Berg D, Merlo G, Quincey T, Burkett B. Governmental Perspective on Fair and Equitable Provision of Bone-anchored Prostheses: Barriers and Facilitators. XVIth International Society of Prosthetics and Orthotics (ISPO) World Congress. 2017. Cape Town, South Africa. Paper Number 487.

Speaker’s information bone using an osseointegrated fixation.[1-31] Dr Laurent Frossard is Government organizations are facing currently an Adjunct challenges in adjusting procedures to Professor at the accommodate the emergence of bone- Queensland University of anchored prostheses.[32-35] This study shares Technology (QUT) and the knowledge gained by the Queensland University of Sunshine Artificial Limb Service (QALS) an Australian Coast (USC) as well as State government organization, while the Director/Chief implementing a procedure for fair and Scientist Officer at YourResearchProject. equitable provision of bone-anchored He is a Biomechanist focusing on the prostheses care. locomotion and rehabilitation of individuals with lower limb loss. He is one of the very few Aim independent experts in the clinical benefits of The aim of this study was to share some bone-anchored prostheses. insights drawn from QALS’ experience with His academic track record includes strong emphasis on barriers and facilitators over 140 publications, several grants, encountered when implementing procedure for supervisions of students and international provision of bone-anchored prostheses care in collaborations. Queensland, Australia.

Background Method Individuals with lower limb amputation fitted Barriers and facilitators were identified over with conventional artificial limbs often nearly 3 years following typical phases of experience continuous socket-related action research led by QALS’ management discomfort leading to a dramatic decrease in team and researchers who consulted key quality of life. Most of these functional issues stakeholders (e.g., 18 Queensland-based can be overcome by replacing the socket with consumers, 3 prosthetists, 2 multidisciplinary a surgically implanted bone-anchored clinical teams). prosthesis attached directly to the residual

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Governmental Perspective on Fair and Equitable Provision of Bone-anchored Prostheses: Barriers and Facilitators

Results consumers. All consumers had unilateral One outcome of this study was the transfemoral amputation. They were mainly identification of barriers to overcome during located in metropolitan areas in reasonable the implementation of such a procedure proximity of prosthetists. Only a small number including, but not limited to: of dedicated prosthetists and clinicians were  Initial lack of a definitive rehabilitation involved. Consequently, revisiting regularly program, particularly for the treatment the presented barriers and facilitators will be with press-fit fixation. This issue is required following consideration for more resolving as rehabilitation programs complex case mixes (e.g., transtibial, multi- are becoming more established level amputations), the geographical spread of nationally and worldwide.[1, 2, 4, 16-18, 36- consumers extending to rural areas with 39] limited access to a prosthetists, the increasing  Initial uncertainty in the relevance and number of treatment sites in Australia and timing of prosthetist involvement for abroad as the surgery becomes more routinely pre- and post-operative prosthetic care. performed.  Need to fit bone-anchored prostheses’ consumers with advanced micro- For the first time, an overview of barriers and processing knees, providing critical facilitators for implementation of procedure biomechanical advantages but from one government organization for fair and expensive.[17-21, 25-30] equitable bone-anchored prostheses are  Consistent updating of complex presented. The QALS’ experience reported procedure to accommodate bone- here is a stepping-stone providing a working anchored prostheses clinical template for both development and improvements (e.g., surgical implementation of procedure to stakeholders procedures, long terms outcomes) and responsible for policies around prosthetic care. development of prosthetic components (e.g., biomechanical performance, To know more cost).[10, 37, 40-54]

Equally important were the facilitators to implementation also identified during the development of the procedure including, but not limited to:  Early and consistent consultations of stakeholders to warrant relevance and adhesion,  Adapting existing processes rather than References 1. Hagberg, K., E. Hansson, and R. creating new ones, Branemark, Outcome of Percutaneous  Use a passport of service to facilitate Osseointegrated Prostheses for Patients continuum of care particularly for With Unilateral Transfemoral multidisciplinary services performed Amputation at Two-Year Follow-Up. interstate. Arch Phys Med Rehabil, 2014. 95(11):

p. 2120-2127. Discussion and Conclusion 2. Branemark, R., O. Berlin, K. Hagberg, To date, the proposed QALS’ procedure has P. Bergh, B. Gunterberg, and B. only been implemented over one year for 18 Rydevik, A novel osseointegrated

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percutaneous prosthetic system for the Rehabilitation Research & treatment of patients with transfemoral Development, 2008. 45(4): p. 6-14. amputation: A prospective study of 51 10. Pitkin, M., On the way to total patients. Bone Joint J, 2014. 96(1): p. integration of prosthetic pylon with 106-113. residuum. J Rehabil Res Dev, 2009. 3. Branemark, R., P.I. Branemark, B. 46(3): p. 345-60. Rydevik, and R.R. Myers, 11. Pitkin, M., Design features of implants Osseointegration in skeletal for direct skeletal attachment of limb reconstruction and rehabilitation: a prostheses. J Biomed Mater Res A, review. J Rehabil Res Dev, 2001. 2013. 101(11): p. 3339-48. 38(2): p. 175-81. 12. Kang, N.V., D. Morritt, C. Pendegrass, 4. Hagberg, K. and R. Branemark, One and G. Blunn, Use of ITAP implants hundred patients treated with for prosthetic reconstruction of extra- osseointegrated transfemoral oral craniofacial defects. J Plast amputation prostheses-rehabilitation Reconstr Aesthet Surg, 2013. 66(4): p. perspective. J Rehabil Res Dev, 2009. 497-505. 46(3): p. 331-44. 13. Fitzpatrick, N., T.J. Smith, C.J. 5. Khemka, A., L. Frossard, S.J. Lord, B. Pendegrass, R. Yeadon, M. Ring, A.E. Bosley, and M. Al Muderis, Goodship, and G.W. Blunn, Osseointegrated total knee replacement Intraosseous transcutaneous connected to a lower limb prosthesis: 4 amputation prosthesis (ITAP) for limb cases. Acta Orthop, 2015: p. 1-5. salvage in 4 dogs. Vet Surg, 2011. 6. Juhnke, D., J. Beck, S. Jeyapalina, and 40(8): p. 909-25. H. Aschoff, Fifteen years of experience 14. Kang, N.V., C. Pendegrass, L. Marks, with Integral-Leg-Prosthesis: Cohort and G. Blunn, Osseocutaneous study of artificial limb attachment integration of an intraosseous system. Journal of Rehabilitation transcutaneous amputation prosthesis Research and Development, 2015. implant used for reconstruction of a 52(4): p. 407-420. transhumeral amputee: Case report. 7. Van de Meent, H., M.T. Hopman, and The Journal of Hand Surgery, 2010. J.P. Frolke, Walking ability and quality 35(7): p. 1130-1134. of life in subjects with transfemoral 15. Pendegrass, C.J., A.E. Goodship, and amputation: a comparison of G.W. Blunn, Development of a soft osseointegration with socket tissue seal around bone-anchored prostheses. Arch Phys Med Rehabil, transcutaneous amputation prostheses. 2013. 94(11): p. 2174-2178. Biomaterials, 2006. 27(23): p. 4183- 8. Aschoff, H., R. Kennon, J. Keggi, and 91. L. Rubin, Transcutaneous, distal 16. Vertriest, S., S. Pather, P. Sondergeld, femoral, intramedullary attachment for and L. Frossard, Rehabilitation above-the-knee prostheses: an endo- programs after the implantation of exo device. J Bone Joint Surg Am, transfemoral osseointegrated fixations 2010. 92 Suppl 2(Supplement 2): p. for bone-anchored prostheses: a 180-6. scoping review protocol. JBI Database 9. Pitkin, M., One lesson from of Systematic Reviews and arthroplasty to osseointegrationin Implementation Reports, 2017. 15(2): search for better fixation of in-bone p. 1-13. implanted prosthesis. Journal of

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