Turning routine prosthetist visits into vital health checks

In the study, the research team sought to determine whether comorbidity screenings at prosthetist appointments were feasible, acceptable and beneficial. 

The screening checked for depressive symptoms, suicidal ideation, low back pain, poor blood flow to the feet and neuropathy, or loss of protective sensation. These conditions are common among people with limb loss due to diabetes or vascular disease, but researchers were surprised by additional findings. 

“Many individuals with amputations due to trauma had lost some protective sensation and weren’t getting the follow-up care or monitoring of their non-amputated limb we typically see when someone loses a limb due to diabetes or issues with blood flow,” noted Stauffer, director of research for Independence Prosthetics-Orthotics.

The screenings didn’t add significant time to patients’ appointments, which is important because prosthetic services are billed by device delivery, not evaluations. 

“As small businesses trying to make it, it’s important that the screenings don’t take too much extra time,” Sions said.  

The study also explored whether screenings encouraged patient follow-up with medical providers. 

“We learned that the vast majority of patients weren’t previously aware of possible issues identified in the comorbidity screenings, and they did seek medical attention,” Sions said. 

Mental health emerged as a key concern.  

“Mental health is a major issue for people with limb loss, but prosthetists aren’t always comfortable having these conversations,” Stauffer said. “We learned there needs to be more training so clinicians can gain confidence.”

The trial also tested whether the healthcare community would be receptive to prosthetist screenings and input.  

“Historically, prosthetists aren’t always viewed as critical members of a patient’s healthcare team, and they wondered if there’d be pushback,” Sions said. “But the healthcare community was very receptive to hearing from prosthetists.” 

Horne and Stauffer, as certified prosthetists and orthotics providers, found the screenings valuable.

“It made us engage in more conversations with our patients and pay more attention to things that might affect them medically,” Horne said. 

Stauffer added, “It showed my patients that I care about them as a person and enhanced my rapport with them. Physicians were responsive to concerns that I had.” 

Horne said it wouldn’t take much for Independence Prosthetics-Orthotics to implement the screenings permanently, and he sees it as one way the field can evolve.

“Studies like this help elevate the prosthetics industry,” Horne said. “We have insights that no one else has, which is why we’re a specialty provider, and this helps us step outside our comfort zone and contribute to the overall healthcare of our patients.”

Next, Sions’ research team hopes to launch a larger clinical trial involving practices across the U.S. to gauge feasibility on a larger scale. For Stauffer, this work is an important first step toward viewing limb loss as much more than a mobility issue. 

“We must look at these patients holistically and address the health complexities they face,” Stauffer said. “Identifying these health problems is the first step to improving quality of life and longevity among adults with limb loss.”