The HHS Agency for Healthcare Quality Research has released a draft review of current scientific literature related to the use of lower limb prostheses. The agency concluded, in part, that there is no evidence to support “the selection of specific components for patient subgroups to maximize ambulation, function, and quality of life or to minimize abandonment or limited use.”
In response, officials with the American Orthotic and Prosthetic Association have released a statement questioning the agency’s conclusions, pointing to a pair of recent studies that suggest there is evidence to support specific components for patient subgroups for maximizing favorable patient outcomes.
“While AOPA supports the need to review the current research that addresses lower limb prostheses, we do not agree with much in the conclusions, and particularly its final abstract conclusion noted above, as there is clear evidence, apparently not considered by [Agency for Healthcare Quality Research] AHQR or its contractor to support specific components for patient subgroups for maximizing favorable patient outcomes,” according to the AOPA statement. “It is important to recognize that the draft systematic review did not include recent research by the RAND Corporation and the health economics firm Dobson DaVanzo that specifically studied both the clinical and cost-effectiveness of the provision of higher technology prosthetic limbs, despite AOPA’s having submitted both preliminary findings of both studies before the December 2016 AHRQ deadline, as well as the final study results of both, being submitted to AHRQ as soon as the first became available 7 weeks ago. It is particularly unfortunate to see a purportedly current literature review be deficient in not reflecting the latest determinative scientific findings.”
The AHQR developed the systematic review in conjunction with contractor Evidence-based Practice Center. It was originally announced in September 2016, with a request for additional comments in December of that year on the “key questions” that would be used in the review.
According to AOPA, the major findings of the 440-page review document include:
- A total of 92 studies that examined the performance of lower limb prostheses were identified by the researchers;
- Of those 92 studies, 29 were deemed valid and reliable by the researchers;
- Of the 29 studied identified as valid, 19 were generally applicable to Medicare-aged patient populations;
- Approximately 11% to 22% of amputees abandon their lower limb prosthesis within 1 year of delivery; and
- Unilateral trans-femoral amputees are twice as likely to abandon their prosthesis than unilateral trans-tibial amputees.
AOPA is encouraging members to review the document and provide comments, as it prepares its own formal response.
The draft review can be viewed here: https://effectivehealthcare.ahrq.gov/topics/prosthesis/draft-report/.
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