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

全球大约有1亿人需要假肢和矫形器（P&O）。低成本、强大的设备只是故事的一半；据估计，“由于人员、服务单位和保健康复基础设施短缺”，80-90%的人无法获得P&O服务。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。对于像柬埔寨这样的中低收入国家（LMICs）的人来说，获得假肢的机会尤其少。这些国家的人通常很年轻，寿命更长，体力劳动更多，而大多数假肢技术都是为发达国家开发的。中低收入国家因事故、冲突和地雷伤害造成的创伤性截肢发生率较高，人道主义危机也带来了特殊的准入挑战。这些服务主要针对外伤，但据估计，到2035年，糖尿病将影响超过5亿人，并且在中低收入国家增长最快。通过国际假肢和矫形学会（ISPO），对中低收入人群的P&O设计和培训进行了实质性的改进[2,5]。患者与临床医生的比例仍然是压倒性的，“该行业的发展太慢……以满足现有的需要或跟上不断增长的残疾人人口的步伐。即使有ISPO认可的培训，在东南亚的中低收入国家，据估计，目前的截肢者人口需要三倍于目前数量的临床医生。我们将开展两项数据技术研究，以开发工具，改善P&O服务的获取，培训临床医生，提高服务资金的使用效率。与柬埔寨的专家临床医生，学者和政策制定者一起，我们将研究：1)数字测量工具来评估用户的残肢解剖，步态的生物力学，典型的日常假肢使用和健康状况；2)便携式数字患者病例记录系统的架构：一个强大而安全的IT网络，供旅行的假肢医生访问省级地区，为那些无法负担旅行费用的偏远社区的人提供循证治疗。除了这些科学挑战外，环境也使这项工作雄心勃勃。经验表明，在将西方国家的P&O直接应用于中低收入国家时必须谨慎。由于复杂的文化、社会和环境原因，使用者的需求不同，他们与临床医生和假肢的关系也不同。我们利用对P&O服务提供商和用户的首次人种学研究来构建我们的科学研究框架，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，以确保这些技术具有成本效益，并可以可持续地实施。这些技术有可能改变全世界义肢使用者的生活质量，并且是当今所需要的。更便携的假肢修复服务将使人们能够在减少工作时间的情况下获得假肢的提供、安装、调整和修复——这对于农业工人将一天的收入用于当天的食物来说至关重要。义肢专家将为他们的病人访问和更新病例记录，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的信息，以获得关键的治疗。从长远来看，项目结果将使建立一个有价值的数据库成为可能。这些数据将有助于选择能够提供最大生活质量效益的技术，充分利用有限的预算。它将在研究和教育方面支持学者和实习医疗保健提供者。我们拥有一个由亚洲最有影响力的临床医生、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，这项研究将使英国受益——我们还没有一个统一的P&O数字记录系统和数据库。

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.