Eileen Levis is president of the Pennsylvania Orthotic and Prosthetic Society, based in Bethlehem.
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Regarding “A Hard Path to Walk: Startup Firm Wants to Bring Prosthetic Limbs Into the 21st Century” (Feb. 5) — published at post-gazette.com under the headline “Artificial Limbs, a Backwater of Medicine, Get a New Look”:
This article is flawed, erroneous and misleading in terms of prosthetists and prosthetic care.
Prosthetists in Pennsylvania are licensed under the Pennsylvania Board of Medicine, the same board that licenses medical doctors. To become a prosthetist, one must obtain a master’s degree in the field of prosthetics, complete a National Commission on Orthotic and Prosthetic Education-approved residency program, pass the rigorous testing to become certified by the American Board for Certification in Orthotics and Prosthetics and meet all educational and experiential requirements to apply for a license.
The prosthetist, many times along with a patient’s physician and/or physical therapist, conducts an evaluation that includes — at minimum — an assessment of patients’ physical and cognitive capabilities, medical histories and additional disorders as well as cardiopulmonary, musculoskeletal and neurological examinations. The prosthetist then conducts a mobility predictor test, in many cases the AMP PRO, which is a widely accepted tool used to assess the patient’s functional level and capabilities. The results of the evaluation and testing, not “intuition,” are what the prosthetist relies on in selecting appropriate prosthetic components.
The prosthetist will then, either by scan or mold (not “Play-Doh”), create the basis for the prosthetic socket to be fabricated. Fabrication is done by either the prosthetist, prosthetic technician or Food and Drug Administration-approved fabrication lab. Never is a “rubber” prosthesis pulled “off a shelf” and put on a patient.
Once completed, a series of fittings is needed to achieve the best fit. Many issues impact the fit of a prosthesis. The patient’s overall health condition, the condition of the residual limb (stump), stabilization of weight gain/loss, medications, fluid retention and patient compliance.
Prosthetic care is just that. Patients are not dispensed devices and off they go. Their prosthetic care is ongoing. This often involves patient advocates or navigators and always includes the patients, their families and their rehabilitation teams in planning their care.
It is important to understand that the prosthetist is reimbursed only for the cost of the device and that all professional services, long- and short-term, are provided with no additional reimbursement.
The practice of prosthetics is subject to many of the same challenges faced in all health care specialties — reimbursement and regulation being at the top of the list. We are fortunate in Pennsylvania that most insurers will, in fact, pay for replacement limbs when medically necessary.
Technology and advances in prosthetics, just as in other areas of medicine, have been outstanding. Some of that technology can be very costly. But falls are a major costly health risk to amputees, and some of the newer technologies are proven to reduce these risks.
Moving forward, should the Post-Gazette choose to publish health care-related articles, perhaps the stories should be more fact-based and less used as an advertising tool for any given individual or company. Further, if the PG truly wants factual information about the practice of prosthetics, which I believe it owes its readership, I suggest you contact the American Board for Certification in Orthotics and Prosthetics, the American Orthotic and Prosthetic Association, and the National Association for the Advancement of Orthotics and Prosthetics.
First Published: February 15, 2018, 5:00 a.m.
