Leveraging Digital Technology to Overcome Barriers in the Prosthetic and Orthotic Industry: Evaluation of its Applicability and Use During the COVID-19 Pandemic

Abstract

Background The prosthetic and orthotic industry typically provides an artisan “hands-on” approach to the assessment and fitting of orthopedic devices. Despite growing interest in digital technology for prosthetic and orthotic service provision, little is known of the quantum of use and the extent to which the current pandemic has accelerated the adoption. Objective This study’s aim is to assess the use of digital technology in prosthetics and orthotics, and whether its use can help overcome challenges posed by the current COVID-19 pandemic. Methods A web-based survey of working prosthetists, orthotists, and lower limb patients was conducted between June and July 2020 and divided into three sections: lower limb amputees, prosthetist and orthotist (P&O) currently using digital technologies in their practice, and P&O not using any digital technology. Input was sought from industry and academia experts for the development of the survey. Descriptive analyses were performed for both qualitative (open-ended questions) and quantitative data. Results In total, 113 individuals responded to the web-based survey. There were 83 surveys included in the analysis (patients: n=13, 15%; prosthetists and orthotists: n=70, 85%). There were 30 surveys excluded because less than 10% of the questions were answered. Out of 70 P&Os, 31 (44%) used digital technologies. Three dimensional scanning and digital imaging were the leading technologies being used (27/31, 88%), primarily for footwear (18/31, 58%), ankle-foot orthoses, and transtibial and transfemoral sockets (14/31, 45%). Digital technology enables safer care during COVID-19 with 24 out of 31 (77%) respondents stating it improves patient outcomes. Singapore was significantly less certain that the industry's future is digital (P=.04). The use of virtual care was reported by the P&O to be beneficial for consultations, education, patient monitoring, or triaging purposes. However, the technology could not overcome inherent barriers such as the lack of details normally obtained during a physical assessment. Conclusions Digital technology is transforming health care. The current pandemic highlights its usefulness in providing safer care, but digital technology must be implemented thoughtfully and designed to address issues that are barriers to current adoption. Technology advancements using virtual platforms, digitalization methods, and improved connectivity will continue to change the future of health care delivery. The prosthetic and orthotic industry should keep an open mind and move toward creating the required infrastructure to support this digital transformation, even if the world returns to pre–COVID-19 days.

Business practices efficiency: Impact of integrating digital technology on clinical P&O practices

“…This is a known barrier to adopting 3D scanning and digital modification procedures. 3,10,11 Tactile sensing on the residuum by the clinician obtains not only the pressure applied but also the spatial information of the contact area. However, existing hand-held scanners cannot provide clinical data in this form; therefore, the clinician still needs to assess the limb through palpation to get an idea of crucial tissue information under the skin surface.…”

“…During the coronavirus pandemic (COVID-19), the use of virtual clinic consultations became an alternative tool for seeing patients remotely. 3,12 Scanning can take place anywhere with smartphones, and the digital files can be sent to the clinician for processing and printing locally, thus reducing unnecessary patient–clinician contact. Furthermore, digital practices facilitate remote teaching of P&O device design in schools.…”

“…Moreover, as more clinicians and facilities use AM, the business model for P&O facilities may need considerable change. 3,4 Designing prosthetic sockets poses a great opportunity to leverage AM technology. 5 As the interface between the human limb and the prosthetic device, prosthetic sockets must be custom made to fit each patient's unique residual limb.…”

Understanding the adoption of digital workflows in orthotic & prosthetic practice from practitioner perspectives: a qualitative descriptive study

“…[2][3][4] A recent web-based survey has identified prohibitive costs, lack of training, and limited improvement over existing techniques as key barriers to the adoption of DT in O&P practice. 5 Despite these challenges, the perception on DT remains overwhelmingly positive and practitioners believe the major role DT will play in the future of O&P practice. 5,6 As such, there is a need to build on current findings and develop a richer understanding of the perceived challenges and opportunities in DT adoption.…”

“…5 Despite these challenges, the perception on DT remains overwhelmingly positive and practitioners believe the major role DT will play in the future of O&P practice. 5,6 As such, there is a need to build on current findings and develop a richer understanding of the perceived challenges and opportunities in DT adoption. Interview-based studies are well suited for obtaining detailed information from experts about a particular topic where questions can be tailored to gather richer and fuller information.…”