Prosthetic Components: Making the Right Choice in the 'Fitting Game'

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It's a little like a TV reality show: A customer comes to your facility to be fitted for a prosthesis, and his prescription is typically nonspecific. As a result, you're faced with choices, choices, choices & how do you make the call that will:

(a) make this person happiest, 
(b) serve his functional needs most effectively, 
(c) create the fewest reimbursement nightmares, or, if you're really ambitious,   
(d) accomplish all of the above, making you a genuine survivor?

To discover the answers, it's necessary to explore several questions. The first one is: Patient input is, of course, vital to the success of the fitting process--but what about the influence of marketing hype on patients? A little learning can be a good thing OR a dangerous thing! (Other relevant questions will be discussed in upcoming issues.)

Karl Fillauer, CPO, FAAOP, chairman and CEO of Fillauer, Inc., Chattanooga, Tennessee:

"I spend 80 percent of my time in patient care, and like other prosthetists, I've seen my share of patients who ask for inappropriate prosthetic choices--one of them just left my office. He had seen a film on the LuXon Max foot, and was impressed by how well and fast the wearer functioned. He saw the end results--how one can run faster than a speeding bullet and leap tall buildings in a single bound--and naturally he wanted one for himself, although his overweight condition, functional level, past history, and future goals did not indicate this was a reasonable choice. 

From the manufacturing/marketing side, I think it's beneficial for the consumer to have product knowledge; I've always been an advocate for consumer awareness. The good news is, there's a lot of choice today; the bad news is, there's a lot of choice today! Because of that we have to be very selective in what we choose; and what we choose must meet functional goals: In addition to range of motion, strength and all the standard evaluation points, our initial discussion covers what the patient wants to do with this device, and what his daily activities are going to consist of. The criteria that I use in determining components are based on my initial evaluation and the data that I receive from this interview.

Based on that data, I narrow the choices to what's acceptable and what I think fits their functional needs, and then let them help me choose what is best. If the patients are adamant about choosing inappropriate items, I simply work with them, as long as I don't think it's going to hurt them. If they need a Chevrolet, but they've decided they want a Ferrari, you simply tell them you think this is overkill, and you don't think they really need this item. If they persist in their request for the specific product, then ask them to sign off on a document that states that this is by their choice that they are mandating this particular component. However, I would not sign off if it were something dangerously inappropriate for them."

Todd F. Anderson, CP, director of professional services, Otto Bock Health Care, Minneapolis, Minnesota:

"Obviously when we put together a marketing package or ad, we're trying to appeal to the masses across the bell curve. If it's a patient-directed ad, we want them to know this technology is out there. The C-Leg® is probably a great example; myoelectrics would probably be another one: These allow us to demonstrate the things that can be done with prostheses. Unfortunately, manufacturers use athletes a lot, which I think is a little bit misleading because they're at the end of the bell curve. Otto Bock has been pretty good about trying to stay in the bulk of the bell curve, trying to design products for the K-2 and K-3 patient, not just the K-4 patient."

Meredy Fullen, public relations/marketing specialist, Ohio Willow Wood Co, Mount Sterling, Ohio:

"Ohio Willow Wood remains sensitive to the difficulties direct marketing to end-users can cause for prosthetists. In many ways, as end-users become better informed consumers, they are the ones ultimately responsible for raising the bar for the prosthetic community and practitioners. Consequently, while practitioners are our customers, as end users become more computer savvy, they demand more from us as manufacturers. We have the recent marketing moves in the pharmaceutical and contact lens industry to thank for this, but at the same time, it is a general trend for all consumer behavior. For us to want more choices is truly driven by society."

Frank Snell, CPO, FAAOP, president, Snell Laboratory, Little Rock, Arkansas, board chairman of PrimeCare O&P Network, LLC:

"Patients with preconceived ideas based on marketing hype? I've certainly faced this issue! You want to give customers an informed choice. First of all, you want to recognize their accomplishment and acknowledge that they are taking personal responsibility for their care by doing their homework. Then you want to speak with them about your responsibility as a provider. I always try to tell patients that they are the boss--I work for them, so to speak. At the same time, as a professional and as a business owner, I'm also responsible for the various contractual relationships and promises that we have made to our third-party payers.

It can be a little tricky to try to blend the two responsibilities together and balance the needs of both. If patients have made a good choice in their homework and you agree with them, you have an ideal situation--you applaud them for their accomplishment and tell them why you think their choice works for them. Rarely is there a case where you can't offer a tweaking of their particular selection to improve it for them.

If they choose a particular foot, and you decide that the foot might work, but it might work more appropriately with an ankle joint attached with it or another specific modification, you expand their knowledge as well as build trust and credibility through your professional input.

It gets stickier when they come in and they have a concept that simply is the wrong concept. At that time, you really have to choose your words carefully, you have to go back and do your homework and bring in data and proof that what they want does not fit their needs.

I'll give you a recent example: An elderly hip disarticulation amputee had been fit with her initial prosthesis about 40 years ago--a conventional hip disarticulation prosthesis which she never did successfully wear. She had heard the hype concerning the new microprocessor stance phase control knee joint, and she and her grandchildren knew that this was going to be the answer to all of Grandma's problems!

It took 30 to 45 minutes of very carefully explaining to her Medicare functional levels, discussing who was and was not a candidate for these types of knees, and why. I wasn't popular with her--even when I told her that I was basically cutting myself out of a sale. Obviously we both knew she could go down the street and go to my competitor, who might sell it to her. I hadn't helped myself, I've possibly alienated a patient and future client--but I know I've done the right thing, because in the case of this particular lady, she had rejected a prosthesis previously, she was 40 years older than when she had first rejected it, and my professional judgment told me this was going to be a futile effort."

Jose Dan Escarda, MD, medical director, Prosthetic Amputee Clinic, Department of Veterans Affairs (VA) Hospital, North Little Rock, Arkansas:

"Most of the patient population we see in the VA prosthetic clinic are experienced amputees and previous prosthetic wearers. In general, our patients prefer the features of their old prosthesis. The new ones are evaluated for the component parts of what would be an ideal socket type, what kind of suspension system, etc., they would need. This is discussed with the patients, and they are assisted in their choice by input from the prosthetic team and outside vendors, depending on the level of amputation and activity."


Judith Otto is a freelance writer based in Holly Springs, Mississippi.