How can the Motio StepWatch™ System help improve lower limb prosthetic user care and relationships?
The evolution and variety of prosthetic components make prosthetic prescription, fitting, and adjustment complex. While this complexity underscores the pressing need for evidence-based guidelines and benchmarks to evaluate prosthetic components and patient functional potential, it also brings to light the challenge of supporting diverse perspectives within a multidisciplinary team. Not all members think in the same way, and although diversity in experience levels and academic backgrounds is key to creating this team’s value, it can delay the decision-making process and impact patient care.
Although the key components of a successful rehabilitation program haven’t yet been well defined in the literature, experts agree that establishing a multidisciplinary team is essential [1]. Different experiences and knowledge bases should be shared in order to develop an integrated and coordinated program that provides optimal care to people with limb loss. Studies have shown that when all team members provide input on patient cases, treatment planning is more effective and patient care is improved [2]. Establishing a healthcare team that understands optimal prosthetic outcomes is critical for patient success because it reveals the positive impact of prosthetic usage on the user's life and allows for a better rehabilitation strategy [3,4].
Furthermore, a problem in the O&P field is the inconsistency in evaluating a prosthetic user's functional level among practitioners. This assessment typically combines patient information with the clinician's subjective in-office evaluation. While various tests are available to support these assessments, they primarily reflect the patient's behavior within the confines of an O&P Clinic or Rehabilitation Center. This presents a challenge in determining the most suitable components for individual prosthetic users, streamlining the reimbursement process without the need for manual intervention in every instance, and having an easy reimbursement workflow without the need for everything to be manually created.
Adding to this, a lack of interdisciplinary dialogue among the rehabilitation team leads to a shortage of available support documentation, optimal gait training, and rehabilitation process guidelines. As per the current literature, no “best practice guidelines” for physiotherapy for amputees have been established, nor do guidelines for prosthetic prescription exist.
Consequently, we can identify different problems that can negatively impact a multidisciplinary team in lower limb prosthetic user care:
Communication isn’t easy when team members are standing in different locations.
Understanding the patient’s needs in a real-world environment might be difficult due to limited access to objective data.
Traditional tests can be subjective, and ratings are often based on the clinician's assessment.
The O&P field lacks structured information about techniques, tools, processes, guidelines, etc. Expertise is still deeply grounded in years of practice. Teaching new team members can be incredibly hard, as there is little standardization and a lot of interpersonal variability in terms of everything from methodologies to technology usage.
So, how can the Motio StepWatch™ System help improve communication and patient care?
By supporting communication:
The rehabilitation team should share common practices for acknowledging and understanding the patient's complaints, for example, regarding pain, employing the right functional outcome measures, the right tools, and exercises. These tasks can be overseen by different team members but should be understood by all. If the team is sharing knowledge, information, and ideas, everyone can better understand the patient’s evolution, prosthetic goals, and expectations. Here is a quick example:
On the CPO-patient side, having access to objective activity data might help improve prosthetic prescription and care, and track patient’s evolution. This is precisely one of the advantages of utilizing the Motio StepWatch system. By monitoring a patient for a minimum of 7 days, the CPO can collect data on key metrics such as top cadence, distance covered, maximum speed, and more, in order to quantify different metrics and better understand the functional potential of the patient.
On the side of the physical therapist (PT), gait training sessions should not always have to be postponed due to residual limb pain or a lack of understanding of how prosthetic components work. How? The CPO can educate the therapist on evaluating the residual limb, volume management, and prosthetic fit, which can lead to clues on mobility issues, and also explain the basics of the prosthetic components being used. Educating the PT to triage a situation can prevent them from wasting a therapy appointment and also avoid the need for a patient to make an appointment with their CPO. Just a little bit of shared knowledge on the residual limb and fitting analysis would allow the PT to improve their decision-making process: “Should this patient be referred to a physician or a CPO, or can I understand where the issues are coming from and work from there?"
On the CPO side, learning with the PT some basic concepts about therapy and the rehabilitation process can lead them to obtain more and better-informed outcomes and improve the way they adjust different prosthetic components. For example, the patient reports some distal-lateral and medial-proximal pain during the stance phase to the CPO; this issue can be related to the patient not contracting his abductor muscles. The CPO can learn some tips and tricks from the PT that will help him during rehabilitation. In addition, effective communication means providing helpful information about potential issues or concerns while respecting the work of the PT.
By structuring information:
BEST PRACTICE STRATEGIES! If standard procedures are designed, registered, and shared, the whole team can become more successful with their patient outcomes. These strategies can include, for example, using tools for tracking and understanding real-world activity by using the Motio StepWatch system. Then, they can better engage in productive conversations with the rest of the rehabilitation team, discussing gait training, therapy session plans, take-home messages, prosthetic components, and the next steps.
Best Practice Strategies shouldn’t come from the knowledge of a team member alone or even a single team. Although it is important that standard operating procedures are agreed upon and understood by the whole team, sharing them, and getting ideas from the “outside world” can be key to a more unified practice! Moreover, it is a win-win situation if you can help the patient care community improve and the world can share its experiences with you.
By sharing expertise:
If done right, it will be beneficial, not only to improve communication but also to educate patients, new therapists and prosthetists that have less experience. Educating them on how to track and understand activity, patient potential, discussing gait training, or discussing patient rehabilitation using various technologies will help them grow and become better professionals.
How does technology impact the rehabilitation team's communication?
As pointed out the key to success is teamwork and cooperation among the different team members, but it’s important to include patients as well. We live in an era where technology is enabling the rehabilitation team to improve healthcare and patient quality of life. Telehealth, artificial intelligence, cloud computing, etc. are emerging each day and nearly everyone has access to it. We have seen ways for patients to keep in touch with practitioners from the comfort of their homes, wearables that track their progress and report it back to the team, components that change their behavior “intelligently”, and there is certainly more data flowing in healthcare than ever before. But how can it impact the rehabilitation team?
Most technological “gadgets” for rehabilitation are meant to significantly increase the efficiency of processes, routines, and appointments. What they are also doing is improving communication across team members, increasing connectivity, namely between those who work in separate locations and have different backgrounds. The ability of the different team members to embrace innovative technology and incorporate it into daily tasks ultimately determines how effective it will be.
With data being transformed into information and the latter being shared among the team, practitioners become more engaged and motivated to work together for the common goal of improving patient care. On the other hand, technology is only one of the multiple factors or players in education. Traditional and contemporary methods of instruction should always be used together since good teaching includes understanding practices, where they come from, where technology can help and where it cannot. The taught methodologies, practices and routines, and the education procedure itself, are not replaced by technology but rather enhanced by it.
References
Pasquina PF, Bryant PR, Huang ME, Roberts TL, Nelson VS, Flood KM. Advances in amputee care. Arch Phys Med Rehabil. 2006;87(3 Suppl 1):34-43. doi:10.1016/J.APMR.2005.11.026
Soukup T, Lamb BW, Arora S, Darzi A, Sevdalis N, Green JSA. Successful strategies in implementing a multidisciplinary team working in the care of patients with cancer: an overview and synthesis of the available literature. J Multidiscip Healthc. 2018;11:49-61. doi:10.2147/JMDH.S117945
Abrams D, Davidson M, Harrick J, Harcourt P, Zylinski M, Clancy J. Monitoring the change: Current trends in outcome measure usage in physiotherapy. Man Ther. 2006;11(1):46-53. doi:10.1016/J.MATH.2005.02.003
J. Y, L. R, S. L, C. C, H. W. Measuring Change: An Introduction to Clinical Outcomes Measures in Prosthetics and Orthotics.; 2015.
