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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.
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.
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.
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 (
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.
In prosthetic and orthotic facilities, there is a need for a combination of care and technical expertise. Prosthetic and orthotic services are generally delivered face-to-face with a high amount of physical contact. As a result, the pandemic provides unique challenges that can be difficult to overcome. Currently, the prosthetic and orthotic industry designs devices to restore, replace, correct, protect, or immobilize a body part through handcrafted artisan approaches. These devices are highly patient-specific and are a result from the specialized skills and experience of the individual prosthetist and orthotist (P&O) [
The introduction of digital technologies aims to improve these inefficiencies. Digital technology in this paper refers to 3D scanners, tablets, computers, computer cloud-based software programs, and computer-aided design and manufacturing (CADCAM). Virtual care refers to the use of telehealth, telerehabilitation, virtual assessments, and fittings. Digital technology and virtual care have successfully provided assistive devices assessment [
To reduce the risk of COVID-19 spread, emerging protocols are advising for less physician-patient contact, shortening the contact time, and keeping a safe distance. It is recommended that unnecessary casting of patients be avoided and that alternative methods be used [
The use of CADCAM in the prosthetic and orthotic applications has been rapidly developing as a technology since the mid-1980s [
Despite its benefits to improve outcomes and use the contactless process of scanning to reduce cross-contamination [
Prosthetic and orthotic patient treatment during the current pandemic with digital technology has opened up the possibility for virtual measurements, fitting, and home-based rehabilitation [
Virtual care offers a unique capacity for remote screening, triage, and treatment. It could be a powerful tool for reducing transmission of contagious diseases such as COVID-19 to and among health care workers and patients who are not infected [
Several barriers exist in virtual care implementation, including the lack of reimbursement [
Novel technologies like telemedicine may be useful in maintaining social distancing, monitoring a patient’s condition, or detecting infectious diseases, protecting not only patients but also health care providers [
The delivery care model will need to change as a result of COVID-19. There may be a “new normal” that is different from traditional practice, including the increased use of digital technologies. Digital technologies can potentially lead to different and more efficient designs, provide greater access to care, and limit physical contact. However, digital technology must be implemented thoughtfully and designed to address issues that are barriers to current adoption.
This paper presents the results of a study aimed at assessing the applicability and barriers of digital technology use in prosthetics and orthotics, and whether this technology can help overcome challenges posed by the current COVID-19 pandemic on the industry.
An online survey was designed and used to survey P&Os currently practicing and lower limb amputees using a prosthesis on their use and attitudes toward digital technology. This study was approved by the Institutional Review Board (IRB) at Singapore University of Technology and Design. Interested participants agreed to a preceding statement of consent, and a participant information sheet link was provided describing the survey, including length of the survey, purpose of the study, investigators, and how data would be collected and stored. The survey was hosted and all data stored on a secure server. Participants were asked for their email only if they agreed to a follow-up interview. This information was stored separately from the responses to maintain confidentiality. Participants were able to review and change their answers before submission. The survey was developed by the authors in conjunction with ProsFit Technologies, Bulgaria and tested with five Singaporean P&Os. This data was not included in the final analysis but was analyzed to adjust the survey for any errors.
The survey was open to participants who met the inclusion criteria. The survey was administered between June and July 2020 via the SurveyMonkey platform and was voluntary to complete. Participants were recruited via IRB-approved social media platforms like LinkedIn, WhatsApp, and social chat groups.
The 68 items of the qualitative and quantitative survey were divided into three sections, with adaptive questioning routing the participant to questions based on previous responses. The first section of the survey gathered lower limb amputees’ (LLA) experiences and preferences. This included questions relating to prosthetic use, barriers to care, and opinions on the use of virtual assessments and home fittings. Section two was designed for the P&O who did not use digital technology (P&O-nonDT) in their facility. Questions included the number of patients seen per day, attitudes toward digital technology, and its importance to the future of the profession. Section three was for P&O who are currently using digital technology (P&O-DT) in their facilities. Additional questions about the use and limitations of technology were included in this section.
All three sections included demographic questions and questions on the use of virtual assessments or fittings. A variety of formats were used: multiple choice with single or multiple answers, ranking of answer options, 5-point Likert-scale questions, and open-ended questions. Where options were provided, the option “Other” was included to allow respondents to enter a different answer.
Follow-up interviews were conducted on selected patients and P&O respondents. Interviews were unstructured and conducted face-to-face or via phone and email.
Survey responses were analyzed with Stata/SE software (StataCorp LLC). Time stamps were collected at the start and end of the survey. All tests were carried out using a 5% level of significance. Answer options were presented as counts (%), mean (SD), or median (IQR) as appropriate. The Pearson chi-square test was used to assess difference between frequencies as observed and expected for certain answers.
We received 113 survey responses, of which 83 were eligible for inclusion (n=13 LLA; n=70 P&Os). Surveys were excluded if less than 10% of the questionnaire was answered. On average, the survey took 13 minutes for the P&O to answer and 15 minutes for the LLA to complete.
Demographics of the respondents.
Demographics | Prosthetists/orthotists (n=70), n (%) | Lower limb amputee (n=13), n (%) | ||||
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18-24 | 5 (7.1) | 1 (7.7) | |||
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25-34 | 33 (47.1) | 2 (15.4) | |||
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35-44 | 22 (31.4) | 3 (23.1) | |||
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45-54 | 8 (11.4) | 4 (30.8) | |||
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55-64 | 2 (2.9) | 3 (23.1) | |||
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Male | 41 (58.6) | 13 (100) | |||
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Female | 29 (41.4) | 0 (0) | |||
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56 (80) | 13 (100) | |||
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Singapore | 13 (18.6) | 12 (92.3) | ||
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Myanmar | 8 (11.4) | 0 (0) | ||
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Thailand | 8 (11.4) | 0 (0) | ||
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Malaysia | 7 (10) | 0 (0) | ||
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Cambodia | 6 (8.6) | 0 (0) | ||
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Indonesia | 4 (5.7) | 0 (0) | ||
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Sri Lanka | 4 (5.7) | 0 (0) | ||
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India | 3 (4.3) | 1 (7.7) | ||
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Hong Kong | 1 (1.4) | 0 (0) | ||
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Philippines | 1 (1.4) | 0 (0) | ||
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Japan | 1 (1.4) | 0 (0) | ||
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2 (2.9) | 0 (0) | |||
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Yemen | 1 (1.4) | 0 (0) | ||
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Saudi Arabia | 1 (1.4) | 0 (0) | ||
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8 (11.4) | 0 (0) | |||
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Bulgaria | 2 (2.9) | 0 (0) | ||
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UK | 2 (2.9) | 0 (0) | ||
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Germany | 1 (1.4) | 0 (0) | ||
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Ireland | 1 (1.4) | 0 (0) | ||
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Scotland | 1 (1.4) | 0 (0) | ||
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France | 1 (1.4) | 0 (0) | ||
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4 (5.7) | 0 (0) | |||
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Australia | 4 (5.7) | 0 (0) |
Characteristics of lower limb amputees.
Characteristics | Lower limb amputee (n=13) | |
K2: community ambulator, n (%) | 1 (8) | |
K3: unlimited community ambulator, n (%) | 7 (54) | |
K4: unlimited and recreational sports, n (%) | 5 (38) | |
Nontrauma (cancer, diabetes, vascular disease), n (%) | 5 (38) | |
Trauma, n (%) | 8 (62) | |
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Range | 0-18 |
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Mean (SD) | 8.69 (5.22) |
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Median (IQR) | 8 (6.3) |
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Range | 4-9.4 |
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Mean (SD) | 6.97 (1.15) |
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Median (IQR) | 7.3 (1.5) |
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Plaster wrap | 11 (84.62) |
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Scanning | 0 (0) |
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Measurement alone | 2 (15.38) |
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Pain | 2.46 (1.89) |
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Easy to wear | 2.92 (1.85) |
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Access to care | 4.54 (1.51) |
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Breathability/temperature | 4.54 (1.90) |
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Durability | 4.69 (1.93) |
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Stability | 4.85 (2.91) |
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Weight | 4.92 (1.71) |
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Appearance | 7.08 (1.66) |
Characteristics of prosthetist and orthotist respondents.
Characteristics | Prosthetist and orthotist (n=70) | |
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Range | 1-32 |
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Mean (SD) | 9.33 (7.37) |
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Median (IQR) | 7 (10.0) |
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Range | 0-20 |
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Mean (SD) | 5.81 (4.28) |
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Median (IQR) | 4 (6.0) |
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Yes | 31 (44.29) |
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No | 39 (55.71) |
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Range | 0.5-24 |
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Median | 2 |
Country of prosthetist and orthotist respondents.
Country | P&O-DTa (n=31), n | P&O-nonDTb (n=39), n | ||
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24 | 34 | ||
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Singapore | 11 | 2 | |
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Myanmar | 0 | 8 | |
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Thailand | 4 | 4 | |
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Malaysia | 1 | 6 | |
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Cambodia | 1 | 5 | |
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Indonesia | 2 | 2 | |
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Sri Lanka | 1 | 3 | |
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India | 0 | 3 | |
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Hong Kong | 1 | 0 | |
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Philippines | 0 | 1 | |
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Japan | 1 | 0 | |
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1 | 1 | ||
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Yemen | 0 | 1 | |
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Saudi Arabia | 1 | 0 | |
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5 | 3 | ||
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Bulgaria | 2 | 0 | |
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UK | 1 | 1 | |
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Germany | 0 | 1 | |
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Ireland | 1 | 0 | |
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Scotland | 1 | 0 | |
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France | 0 | 1 | |
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3 | 1 | ||
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Australia | 3 | 1 |
aP&O-DT: prosthetists and orthotists who are currently using digital technology.
bP&O-nonDT: prosthetists and orthotists who did not use digital technology.
The number of years the P&O-DT had been using digital technology varies greatly, from 0.5 to 24 years, with a median of 2 years. Many of the P&O had CADCAM facilities where they worked (23/31, 74%). The iPad with a structure scanner was the preferred method for digital capture (12/31, 39%) with a mix of other scanners used, including Artec Eva Lite, Omega, and Rodin 4D. Geometrical modification of the scans were performed using various programs, which can be grouped into P&O-specific software (24/31, 77%) and engineering software such as Rhinoceros or Solidworks (6/31, 19%). One P&O respondent was unsure of the program they used (1/31, 4%).
The applications of digital technology used in clinical practice. AFO: ankle-foot orthosis; P&O: prosthetic and orthotic; TLSO: thoracic-lumbar-sacral orthosis.
Five-point Likert-scale questions showed that the attitudes toward digital technology among P&O using technology were generally positive (see
Attitudes of prosthetists and orthotists who use digital technologies at work.
Attitudes | Total (n=31), n (%) | Singapore (n=11), n (%) | Non-Singapore (n=20), n (%) | |||
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.13 | |||||
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Strongly agree | 9 (29) | 2 (18.2) | 7 (35) |
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Agree | 15 (48.4) | 8 (72.7) | 7 (35) |
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Disagree | 7 (22.6) | 1 (9.1) | 6 (30) |
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Strongly disagree | 0 (0) | 0 (0) | 0 (0) |
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.12 | |||||
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Strongly agree | 4 (12.9) | 3 (27.3) | 1 (5) |
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Agree | 16 (51.6) | 6 (54.6) | 10 (50) |
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Disagree | 11 (35.5) | 2 (18.2) | 9 (45) |
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Strongly disagree | 0 (0) | 0 (0) | 0 (0) |
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.28 | |||||
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Strongly agree | 21 (67.7) | 8 (72.7) | 13 (65) |
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Agree | 9 (29) | 2 (18.2) | 7 (35) |
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Disagree | 0 (0) | 0 (0) | 0 (0) |
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Strongly disagree | 0 (0) | 0 (0) | 0 (0) |
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Missing | 1 (3.2) | 1 (9.1) | 0 (0) |
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.19 | |||||
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Strongly agree | 0 (0) | 0 (0) | 0 (0) |
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Agree | 5 (16.1) | 0 (0) | 5 (25) |
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Disagree | 20 (64.5) | 8 (72.7) | 12 (60) |
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Strongly disagree | 5 (16.1) | 2 (18.2) | 3 (15) |
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Missing | 1 (3.2) | 1 (9.1) | 0 (0) |
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.55 | |||||
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Strongly agree | 2 (6.5) | 0 (0) | 2 (10) |
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Agree | 5 (16.1) | 1 (9.1) | 4 (20) |
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Disagree | 22 (71) | 9 (81.8) | 13 (65) |
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Strongly disagree | 0 (0) | 0 (0) | 0 (0) |
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Missing | 2 (6.5) | 1 (9.1) | 1 (5) |
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.39 | |||||
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Strongly agree | 2 (6.5) | 0 (0) | 2 (10) |
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Agree | 15 (48.4) | 4 (36.4) | 11 (55) |
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Disagree | 11 (35.5) | 6 (54.6) | 5 (25) |
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Strongly disagree | 1 (3.2) | 0 (0) | 1 (5) |
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Missing | 2 (6.5) | 1 (9.1) | 1 (5) |
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.04 | |||||
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Strongly agree | 12 (38.7) | 2 (18.2) | 10 (50) |
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Agree | 16 (51.6) | 9 (81.8) | 7 (35) |
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Disagree | 3 (9.7) | 0 (0) | 3 (15) |
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Strongly disagree | 0 (0) | 0 (0) | 0 (0) |
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Singaporean P&Os who use technology agreed significantly less strongly (
The common barriers to greater integration of digital technology for the P&O-DT respondents as obtained using open-ended questions can be seen in
Barriers to greater integration of technology (prosthetist and orthotist who use technology, n=31).
Where nonuse of technology was common, stable internet was still a problem, particularly in developing countries such as Sri Lanka (2/3, 66%), Cambodia (2/5, 40%), and Myanmar (2/6, 33%), and many of the P&O respondents in these countries did not have computers (35/39, 89%). Other reasons mentioned for not using technology were cost (25/39, 64%) and the lack of awareness and skills (20/39, 51%).
The use of virtual assessments and virtual fittings were analyzed for agreement. A primary benefit of virtual services is to reach those who face obstacles in coming for their appointments. Out of 70 P&O respondents, 29 (41%) felt their patients had difficulties coming for their appointments. The main reasons mentioned were transportation (n=16, 19%), cost (n=11, 13%), and the lack of family members or caregivers to bring them to their appointment (n=9, 13%). P&O respondents found that virtual assessments would benefit the patient in these situations (n=59, 84%). Interestingly, 11 out of 13 (85%) LLA did not find access to care an issue and preferred to come to the clinic for their follow-ups even during the pandemic.
Out of 70 P&O respondents, 51 (73%) would use virtual assessments if it was made available. Most respondents agreed or strongly agreed that virtual assessments would be suitable in rural areas (n=47, 67%) but just over half suggest virtual fittings would improve patient outcomes (n=38, 54%). The potential benefits mentioned were to save clinical time and reduce the need to travel (n=32, 46%); this often reduces costs (n=17, 24%), and—of relevance during this current pandemic—10 (14%) suggested it would be safer for the patient and decrease the risk of infection.
Some confusion arose when P&O were asked about the format of the virtual assessments. Out of 7 selected interviewees, 5 (71%) revealed they had merely agreed to the statement without thinking how they might apply this service. Suggestions for the service included a “
The major potential challenges with virtual assessment mentioned by the P&O respondents were difficulties in assessing the limb for strength, ROM, palpation, and pain (26/70, 37%). Other problems were concerns of the skills the patient had to use for items such as computers (12/70, 17%), the high chance of miscommunication when giving advice (11/70, 16%), and internet connectivity (8/70, 12%).
Out of 70 P&O respondents, 27 (39%) were open to providing virtual fittings using a third person
The confidence of lower limb amputees adjusting their own prosthesis (n=13).
Confidence in adjusting the prosthesis | By self, n (%) | With internet guidance, n (%) |
Extremely confident | 4 (30.8) | 4 (30.8) |
Very confident | 2 (15.4) | 1 (7.7) |
Somewhat confident | 4 (30.8) | 2 (15.4) |
Not so confident | 0 (0) | 5 (38.5) |
Not at all confident | 3 (23) | 1 (7.7) |
To date, research has focused on the development of digital technologies or how new technology can be applied to the industry for a particular application. This survey reports the actual current use of digital technologies in the prosthetic and orthotic industry and suggests its suitability during pandemics such as COVID-19. Although infection prevention practices like social distancing, the wearing of masks, and regular washing of hands have been implemented, the use of digital technology for prosthetic and orthotic services remains challenging with many barriers to overcome. Current adoption levels of technology despite the pandemic suggest the potential benefits of safer care have not outweighed the limitations of the technology to provide sufficient value to both the patient and P&O. Furthermore, changing organizational behaviors in delivering digital health care require the right skills among health care professionals to leverage technology-driven solutions toward technology adoption.
Approximately half of the P&O respondents use some form of digital technology. The use of scanners, computers, and computer-augmented design and manufacturing are the most common ones. The use of scanners provides a mess-free and reduced physical contact environment, improving patient safety during the pandemic. There is still a need for the clinician to be present to conduct the scan; thus, only the physical touch component is improved.
The P&O respondents preferred the more cost-effective iPad with a structure scanner (Occipital) over high-end accurate scanners such as Vorum’s Spectra scanner or Artec EVA scanner. P&O interviewees stated that the wireless iPad was easier and lighter to maneuver to capture the limb shape but can be limiting when capturing the posterior view due to the screen’s position forcing an awkward posture of the person scanning. This finding is aligned with a study by Brunsman et al [
The use of low-cost cloud-based engineering modeling and analysis software programs such as Rhinoceros (Robert McNeel & Associates), Fusion360 (Autodesk), and Solidworks (Dassault Systèmes) was also common due to their affordability, usability, and applicability. Considering the P&O respondents stated that more training and skills are needed to increase adoption of technology, the use of point and click options in software [
Interviewees appreciated the improved efficiencies of digital scanning and software for the making of larger casts like transfemoral sockets or spinal braces. Stating that these types of casts can be modified using preloaded templates in the software in a shorter amount of time than physically removing or adding plaster via traditional methods. This process is more convenient and safer for the patient and faster for the P&O.
The use of 3D printing is often touted as the next big transition for the industry [
The main barriers (cost, lack of skills or experience, and effectiveness of the technology) for adopting digital technology were found to be the same issues that prevented greater adoption in facilities already using some form of digital technology.
The initial cost outlay in purchasing scanners, computers, or 3D printers can cause apprehension over the return on investment. Interviewees reported that prosthetic- and orthotic-specific software requires special training, software updates, and yearly licensing, often based on the number of modules needed, adding to the cost and deterring more users from greater adoption. The use of 3D printing was found to be limited by the same factors identified in a systematic review of 3D printed sockets [
Even though the design and manufacturing of highly accurate prostheses and orthoses is possible with the help of digital technology, it was concerning to see that a majority of P&O who already used digital technology did not find the devices had a better fit. This result may be attributed to the need for ongoing training and practice to enhance the skills; most P&O were only using the technology for less than 5 years. Another reason could be the printing quality, which has increased over recent years but still requires the more expensive printers.
The use of scanning for AFOs was high but limitations in contactless scanning were voiced during the interviews as the P&O would often need to position the limb on a clear Perspex plastic scanning platform or the ground before scanning. The scanning of residual limbs for prosthetic sockets was easier, although—as previously discussed—positioning the scanner still remains troublesome to obtain a full 360° image with multiple positions needed to capture the entire shape [
Our survey suggests a low use of digital technology for transtibial socket design, with the LLA respondents complaining of poor design, fit, and ease of wearing their prostheses as major factors inhibiting their mobility. This is despite digital technology such as Finite Element Analysis, MRI, CT, and photogrammetry showing benefits to improve outcomes by predicting accurate interface pressures through better imaging of the muscles and tissues. It also allows further optimization in the design of comfortable high quality devices [
Out of 13 respondents, 11 (85%) of LLA did not find access to care an issue and preferred to come to the clinic for their follow-ups even during the pandemic. It should be noted all but 1 patient was from Singapore. Almost half of all P&O respondents outside Singapore found their patients had difficulties coming for their appointment. This is at odds with other countries where patients are more comfortable using telemedicine rather than risk infection with face-to-face consultations [
Questions remain about what types of tasks are suitable for virtual care particularly during the pandemic; all P&O interviewees suggested that triaging a patient or providing education to patients may be most suitable. The National Health Service program “Attend anywhere” suggests that virtual care is only useful if it results in improved efficiencies, significant time savings, reduced need to take time off work, no travel costs, and no technical issues [
In a telehealth consumer study in the United States, the authors found that 66% of patients were willing to use telemedicine in 2019, but only 8% had used it previously. The authors suggest that the main reasons were the lack of familiarity with the new technology and a lack of trust in the clinician whom they have not met in person [
This same issue of trust was highlighted in this study by both LLA and P&O respondents. In an industry that customizes devices, any change in the care model should reflect a strong need for such change. By merely moving consultations online, we may overcome some barriers found in this study, such as the travel burden, the lack of support to bring patients to their appointments, and reduced overall costs. However, there appears a need to develop a rapport between P&O and LLA before the use of virtual care and certain P&O tasks may be difficult to fulfill (see next section). A thoughtful application and design of digital technology is needed, considering all stakeholders involved.
Literature suggests minimizing casting processes to prevent the virus spread [
In rural settings, our survey suggests the use of virtual care may be more suitable. This study found that P&Os would use virtual care where patients have to travel long distances for care or are too sick to come to a facility. However, in such rural locations, there may be other challenges such as internet connectivity and the IT skills of patients, limiting its applicability [
The impetus for change and adoption of digital technology varies based on the funds and infrastructure available. Budgets may be too small to invest in digital technology and on training, government support may be low, and the use may be too infrequent to justify the investment. The purchase power to outsource may also present challenges, particularly if it is too low. Digital technology would be more widely adopted if it demonstrated enhanced patient care and outcomes, and lowered overheads of the facility, provided the infrastructure of the country can support the technology.
Our online survey was developed to obtain a broad understanding of digitalization in the P&O industry. Its length may have been the reason why 30 of the 113 respondents answered less than 10%. Furthermore, as this was an online survey, only respondents with internet connection were able to respond. This may have particularly affected the number of LLA responses; 12 of the 13 LLA respondents were from Singapore, contacted through the amputee support chat group, where internet connection is not a barrier. The P&O respondents may have been less affected, as they could have used the internet connections at work. Another reason for the low LLA response might be that they were contacted indirectly, via their P&O, or that multiple languages of the survey were not available.
The responses for Singapore are considered an accurate reflection of the P&O use of digitalization with over 65% of all P&O in Singapore participating. Although the other respondents came from a large number of countries, their numbers were limited. The study is, therefore, not representative of current practices outside of Singapore, even though the results are informative.
Further investigation should focus on the exact nature of how virtual care during the pandemic can be conducted, particularly the lack of the element of touch in an assessment by the P&O. There is a clear need for the development of a digitalization framework to facilitate digital technology implementation in the industry. Understanding how, when, and why to use digital technology is vital for successful outcomes to both clinic and patient. Particular attention should be paid to delivery care models that overcome the shortfalls with current technology, including sensory feedback through palpation, low IT awareness, and poor connectivity, while maintaining safer care. The use of distributed care models (DCMs) is an alternative to switching all business to digital means. DCMs consist of a hybrid of care that includes central-based fabrication, satellite clinics, mobile clinics, and digital technology. Using a third person trained to digitalize the anatomy of a limb should be considered to enhance the outreach where prevailing laws allow.
The use of digitalization during a pandemic such as COVID-19 can mitigate the concerns regarding ongoing patient care and safety for both patient and P&O. The use of scanning and virtual care provides avenues for the continuum of care for the patient. However, essential characteristics of P&O assessments such as palpation and sensory feedback have yet to be overcome. Providing the patient with the appropriate technology and answering what needs the technology is addressing is essential and may encourage adoption among the industry. Education and training should be provided to centers and individuals to enhance confidence levels and awareness of digital care benefits and risks during and beyond pandemic times. Ensuring the staff has a high technology readiness level is critical. The delivery care model should be evaluated to provide sufficient outreach and an optimal level of digital technology that provides adequate care and sufficient protection against the spread of COVID-19.
Technology advancements such as virtual platforms, digitalization methods, and improved connectivity will change the future of health care. Digital technology is transforming health care into a new normal and is being accelerated during the pandemic. This transformation is expected to continue in the years to come. The prosthetic and orthotic industry should keep an open mind and move toward creating the required infrastructure to support this digital transformation or risk being left behind.
ankle-foot orthosis
computer-aided design
computer-aided design and manufacturing
computed tomography
distributed care model
Institutional Review Board
information technology
lower limb amputees
magnetic resonance imaging
prosthetist and orthotist
P&O who are currently using digital technology
P&O who did not use digital technology
range of motion
The authors wish to acknowledge Alan Hutchison, CEO ProsFit Technologies, for assistance with the development of the survey.
None declared.