Characterization of initial ankle-foot prosthesis prescription patterns in U.S. Service members following unilateral transtibial amputation.
Patrick G Monaghan, Ashley D Knight, Sarah A Brinkerhoff and 9 others
PMID 37691914WHAT IT FOUND
Most military amputees received a passive energy-storing foot.
Those fitted later, or with cancer or dysvascular causes, were more likely to get an articulating foot. Women were more likely to get a computer-controlled foot. This describes current prescribing habits, not which foot works best.
Key findings
01The majority of participants were first prescribed a non-articulating energy-storage-and-return (ESR-NA) prosthesis.
02Patients prescribed articulating or computer-controlled devices were more likely to have experienced a longer delay between injury and prescription compared to those prescribed non-articulating energy-storage-and-return devices.
03Amputation etiology and sex were associated with the type of first device prescribed, with women more likely to receive computer-controlled devices and blast injuries most likely to result in non-articulating energy-storage-and-return devices.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study is retrospective and describes prescription patterns rather than clinical outcomes, so it cannot determine which device type is functionally superior. 131 potential participants were excluded due to missing data, which may bias the sample. The analysis is limited to one military medical center, so findings may not generalize to Veterans Affairs, civilian practice, or other military facilities. The sample size for computer-controlled prostheses was very small (N=8), limiting the reliability of findings related to this device category. Functional status, such as Medicare Functional Classification Levels (K-Levels), was not available or analyzed, despite being a key driver in prosthetic decision-making.
Declared interests
The work was supported by the Assistant Secretary of Defense for Health Affairs through the Orthotics and Prosthetics Outcomes Research Program.
The easy way to misread this
Do not interpret these findings as evidence that articulating or computer-controlled prostheses are clinically superior or inferior to non-articulating devices. The study only describes which devices were prescribed based on patient characteristics and timing, without reporting functional outcomes or satisfaction.