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

全球约有1亿人需要假肢和矫形器[1]。低成本、坚固耐用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，“由于人员、服务单位和医疗康复基础设施的短缺”[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。对于柬埔寨等拥有地雷遗产的中低收入国家(LMIC)的人来说，访问权限尤其差，他们通常年轻，与发达国家相比，他们的寿命更长，体力工作更多，大多数假肢技术都是为发达国家开发的。小岛屿发展中国家因事故、冲突和地雷伤害而致创伤性截肢的比例较高，人道主义危机带来了特别的准入挑战[3]。医疗服务主要针对创伤伤害，但据估计，到2035年，糖尿病可能会影响超过5亿人，而且在LMICs中增长最快[4]。通过国际假肢矫形学协会(ISPO)，LMICs的P&O设计和培训已有实质性改进[2，5]。压倒性的病人：临床医生比例仍然存在，“该部门的发展太慢……无法满足现有需求或跟上不断增长的残疾人人口的步伐”[2]。即使有ISPO认证的培训，在东南亚LMICs，估计目前截肢者需要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服务的可及性，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业临床医生、学者和政策制定者团队一起调查：1)评估用户残肢解剖、步态生物力学、典型日常假肢使用和健康状况的数字测量工具；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，供出差的假肢医生访问省级地区，为那些负担不起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，这项工作的背景使这项工作非常雄心勃勃。经验表明，在LMIC中直接应用西方国家的P&O时必须谨慎。除了用户的不同需求，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。我们通过对P&O服务提供商和用户进行的第一次人种学研究来构建我们的科学研究框架，以确保所开发的技术是实用的。我们还将进行商业建模研究，生产工具，以确保这些技术具有成本效益并可持续实施。这些技术具有改变全球假肢使用者生活质量的潜力，是当今所需的。更便携的P&O服务将使人们能够在减少工作时间的情况下获得假肢的供应、装配、调整和维修--这对于农业工人将一天的收入花在当天的食物上至关重要。假肢医生将为他们的患者访问和更新病例记录，为临床医生培训提供存储库，并使用户能够访问关于他们的进展的信息并报告问题以获得关键治疗。从长远来看，该项目的结果将使一个有价值的数据库得以建立。这些数据将使人们能够选择能够提供最大生活质量效益的技术，从而最大限度地利用有限的预算[7]。它将在研究和教育方面支持学者和见习医疗保健提供者。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好处。最后，这项研究将给英国带来好处--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.