A Step Change in LMIC Prosthetics Provision through Computer Aided Design, Actimetry and Database Technologies

通过计算机辅助设计、活动测量和数据库技术，LMIC 假肢供应发生巨大变化

• 批准号: EP/R014213/1
• 负责人: Alexander Dickinson
• 金额: $ 115.89万
• 依托单位: University of Southampton
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2018
• 资助国家: 英国
• 起止时间: 2018 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=EP%2FR014213%2F1
• 关键词: Step; Change; LMIC; Prosthetics; Provision

Approximately 100M people worldwide need prosthetic and orthotic (P&O) devices [1]. Low-cost, robust devices are only half the story; an estimated 80-90% do not have access to P&O services "due to a shortage of personnel, service units and health rehabilitation infrastructures" [2]. All three barriers could be addressed by data, so we propose research into novel tools to enhance P&O data.Access is particularly poor for people in Lower and Middle Income Countries (LMICs) such as Cambodia with its landmine legacy, who are typically young and live longer lives of more physical work than in the developed world, for whom most prosthetics technology has been developed. LMICs have higher levels traumatic amputation from accidents, conflict and landmine injuries, and humanitarian crises present particular access challenges [3]. Services are set up primarily for trauma injuries but by 2035 it is estimate diabetes may affect over 500M people, and is growing fastest in LMICs [4].Through the International Society for Prosthetics and Orthotics (ISPO), substantial improvements have been made in P&O design and training for LMICs [2,5]. An overwhelming patient:clinician ratio remains and "the development of the sector is too slow ... to meet existing needs or keep pace with the growing populations of people with disabilities" [2]. Even with ISPO accredited training, in South East Asian LMICs it is estimated that three times the current number of clinician is required for the current amputee population [6].We will conduct two data-technology research studies, to develop tools to improve P&O service access, train clinicians and improve efficiency of service funding use. With a team of expert clinicians, academics and policy makers in Cambodia, we will investigate:1) digital measurement tools to assess a user's residual limb anatomy, biomechanics of gait, typical daily prosthetic limb use, and health status; and2) the architecture for a portable digital patient casenote system: a robust and secure IT network for travelling prosthetists to visit provincial areas to provide evidence-based treatment for those in remote communities who cannot afford to travel.Beside these scientific challenges, the context makes this work highly ambitious. Experience shows that care must be taken in applying P&O from Western countries directly in LMICs. As well as users' different needs, their relationship with clinicians and prosthetics are different for complex cultural, social and environmental reasons. We frame our scientific research using a first-of-kind ethnographic study of P&O service providers and users to ensure the developed technologies are practical. We will also conduct business modelling research, producing tools to ensure the technologies are cost effective and can be implemented sustainably.These technologies have the potential to transform the quality of life of prosthetic limb users worldwide and are required today. A more portable P&O service would enable people to access provision, fitting, adjustment and repair of their prosthetics with reduced time off work - essential where an agricultural worker spends their day's earnings on the same day's food. Prosthetists would access and update casenotes for their patients, provide a repository for clinician training, and enable users to access information regarding their progress and report problems to obtain critical treatment.Longer term the project results will enable a valuable database to become established. The data will enable selection of technology that delivers greatest quality of life benefit, making best use of limited budgets [7]. It will support academics and trainee healthcare providers in research and education. We have a network of Asia's most influential clinicians, educators and policymakers to help achieve these ambitious benefits. Finally, the research will return benefits to the UK - we do not yet have a unified P&O digital record system and database.

全球约有1亿人需要假肢和矫形器（P&O）设备[1]。低成本、强大的设备只是故事的一半;估计有80-90%的人无法获得P&O服务，“因为人员、服务单位和健康康复基础设施短缺”[2]。所有这三个障碍都可以通过数据来解决，因此我们建议研究新的工具来增强P&O数据。对于中低收入国家（LMICs）的人来说，获得这些数据的机会尤其少，例如柬埔寨的地雷遗留问题，他们通常年轻，比发达国家的人活得更长，体力劳动更多，大多数假肢技术都是为他们开发的。中低收入国家因事故、冲突和地雷伤害而造成的创伤性截肢率较高，人道主义危机带来了特别的准入挑战[3]。服务主要针对创伤，但到2035年，估计糖尿病可能影响超过5亿人，并且在中低收入国家增长最快[4]。通过国际假肢和矫形学会（ISPO），对中低收入国家的P&O设计和培训进行了实质性改进[2，5]。压倒性的病人：临床医生比例仍然存在，“该部门的发展过于缓慢.以满足现有需求或跟上残疾人人口增长的步伐”[2]。即使有ISPO认证的培训，在东南亚的中低收入国家，据估计，目前截肢者人口所需的临床医生数量是目前的三倍[6]。我们将进行两项数据技术研究，以开发工具来改善P&O服务的获取，培训临床医生并提高服务资金的使用效率。我们将与柬埔寨的专家临床医生、学者和政策制定者一起研究：1）数字测量工具，以评估用户的残肢解剖结构、步态生物力学、典型的日常假肢使用和健康状况;以及2）便携式数字患者病历系统的架构：一个强大而安全的IT网络，供流动假肢专家访问各省地区提供证据-为那些在偏远社区谁负担不起旅行的基础治疗。除了这些科学挑战，背景使这项工作非常雄心勃勃。经验表明，在对中低收入国家直接适用西方国家的保护和责任时必须谨慎。除了用户的不同需求外，由于复杂的文化、社会和环境原因，他们与临床医生和假肢的关系也不同。我们使用P&O服务提供商和用户的第一种人种学研究来构建我们的科学研究，以确保开发的技术是实用的。我们还将进行商业模型研究，生产工具，以确保技术具有成本效益，并可持续实施。这些技术有可能改变世界各地假肢使用者的生活质量，今天需要。一个更便携的P&O服务将使人们能够在减少下班时间的情况下获得假肢的提供、装配、调整和修理-这对农业工人将一天的收入用于当天的食物至关重要。修复师将访问和更新他们的病人的病历，为临床医生培训提供一个存储库，并使用户能够访问有关他们的进展和报告问题，以获得关键的治疗信息。长期的项目结果将使一个有价值的数据库成为建立。这些数据将使选择的技术，提供最大的生活质量的好处，最好地利用有限的预算[7]。它将支持学者和实习医疗保健提供者的研究和教育。我们拥有一个由亚洲最具影响力的临床医生、教育工作者和政策制定者组成的网络，以帮助实现这些雄心勃勃的目标。最后，这项研究将给英国带来好处--我们还没有统一的P&O数字记录系统和数据库。

项目成果

Flat-pack, rapid production powered air purifying respirators for Low-Resource Settings amid the SARS-CoV-2 pandemic

适用于 SARS-CoV-2 大流行期间资源匮乏环境的扁平包装、快速生产动力空气净化呼吸器

• DOI: 10.31224/osf.io/56q87
• 发表时间: 2020
• 作者: De Grazia A

Activity, socket fit, comfort and community participation in lower limb prosthesis users: a Cambodian cohort study.

• DOI: 10.1186/s12984-022-01021-7
• 发表时间: 2022-05-02
• 期刊: JOURNAL OF NEUROENGINEERING AND REHABILITATION
• 影响因子: 5.1
• 作者: Diment, Laura;Nguon, RaksmeyMutta;Seng, Sovansereyrathna;Sit, Vannsnavy;Lors, Ply;Thor, Phearsa;Srors, Samedy;Kheng, Sisary;Granat, Malcolm;Donovan-Hall, Maggie;Worsley, Peter;Dickinson, Alex
• 通讯作者: Dickinson, Alex

Widening Access to Sustainable Prosthetics Services: a Global Challenge

扩大可持续假肢服务的获取范围：全球挑战

• 发表时间: 2018
• 作者: Dickinson AS

Learning about the changing needs for prosthetics service provision from routinely collected digital centre management data: An exemplar study across three clinics in Cambodia.

• DOI: 10.7189/jogh.12.04083
• 发表时间: 2022-10-30
• 期刊: Journal of global health
• 影响因子: 7.2
• 作者: Dickinson A;Gates L;Metcalf C;Owen C;Kheng S;Harte C;Bunthoeun S;Simpson S;Worsley P;Ostler C;Donovan-Hall M;Channon A
• 通讯作者: Channon A

Selecting Appropriate 3D Scanning Technologies for Prosthetic Socket Design and Transtibial Residual Limb Shape Characterization

• DOI: 10.1097/jpo.0000000000000350
• 发表时间: 2022-01-01
• 期刊: JOURNAL OF PROSTHETICS AND ORTHOTICS
• 影响因子: 0.6
• 作者: Dickinson, Alexander S.;Donovan-Hall, Maggie K.;Worsley, Peter R.
• 通讯作者: Worsley, Peter R.