Value and Applicability of Large Administrative Healthcare Databases in Prosthetics and Orthotics Outcomes Research.

The goal of health economics and outcomes research is to improve healthcare decision making. In the absence of high-value clinical data, the availability and quality of administrative healthcare data could be vital in the generation of evidence for orthotics and prosthetics services. The purpose of this article is to provide a stronger understanding of administrative healthcare data analysis, an area that has been scarcely examined within prosthetics and orthotics despite the wealth of information available within such data. Examples of common datasets in this arena currently available are provided, as well as an overview of the limitations and advantages of studies utilizing such datasets.

The Value of Health Economics and Outcomes Research in Prosthetics and Orthotics.

The demand has increased for evidence regarding the effectiveness and value of prosthetic and orthotic rehabilitation interventions. Clinicians and managers are under pressure to provide treatment recommendations and demonstrate effectiveness through outcomes. It is often assumed that rehabilitation interventions, including the provision of custom-made and custom-fit orthotic and prosthetic devices, are beneficial to patients. Assessing the value of orthotic and prosthetic services has become more critical to continue to ensure equitable access to needed services. Health economics and outcomes research methods serve as tools to gauge the value of prosthetic and orthotic rehabilitation interventions. The purpose of this article is to provide an overview of the current need of health economics and outcomes research in orthotics and prosthetics, to introduce common economic methods that assist to generate real-world evidence, and to discusses the potential value of economic methods for clinicians and clinical practice.

Reduced vertical displacement of the center of mass is not accompanied by reduced oxygen uptake during walking.

The six determinants of gait proposed that the goal of gait is to minimize vertical displacement of the body's center of mass (CoM) with the objective to optimize energy expenditure. On the contrary, recent investigations suggest that reduced vertical displacement leads to an increase in energy expenditure. However, these investigations had the included subjects deliberately changing their gait, which could bias the endpoint measures. The present study investigated the effect of reduced vertical displacement of the CoM on oxygen uptake and walking economy without imposing altered gait patterns. This was accomplished by having subjects walk on a curved treadmill and on a flat treadmill. Vertical displacement of the CoM (sacrum marker displacement), oxygen uptake, walking economy, stride characteristics and lower limb joint angles were measured. There were significant differences in stride characteristics and phase dependent differences in lower limb movement pattern between the two conditions which in size were comparable to the changes observed between different speeds. The vertical displacement of the CoM was significantly reduced on the curved treadmill. This was accompanied by an increase in oxygen uptake and walking economy. These results support recent assertions that the six determinants of gait do not serve to improve walking economy.