ORIGINAL POST
Before posting this to the list, I searched in past OandP-List postings and
didn’t find much recent discussion about IPOP or early fit post-op
prosthetics. We have had very few requests in recent years. How about you?
Are you aware of recent impartial articles about the actual (not
theoretical) benefits/outcomes? I know that the candidate needs to be able
to control WB through the prosthesis and have consistent PT when ambulating.
The way patients are being expediently discharged from hospital causes me
concern about consistent PT follow up. Thanks for your input! I’ll post
responses. Randy McFarland, CPO Fullerton, CA
RESPONSES
I do quite a few post op casts but rarely do any with weight bearing
anymore. I have 2 physicians who do like the rigid dressing and one who
uses a Pal Guard consistently. I have seen very good healing and shrinking
with the casts and inconsistent use of the Pal Guard. My usual procedure is
to do about 4 post op casts then do a thermoplastic copoly prep socket with
pin lock and liner without a test socket. I expect them to shrink out of
the prep in about 1 to 2 months then I do a laminated definitive socket. If
they shrink out of the prep in a week or 2, I just do it over and charge for
a test socket procedure. Hope that helps.
I’ve been involved with IPPMs since the days of Zettle/Burgess (Seattle
1964-), Snelson/Mooney,Nickels (Rancho 1966-) etc. All these people (to
include Barnhart, Haslam, Cooley, Sarmiento) reported accelerated healing
and enhanced somatosensation and proprioception in the sensory modality
being substituted. In short, vastly enhanced rehabilitation with
correspondingreduction in overall prosthetics monetary expenditure. IPPMs
were immediately and permanently discredited in 1983 with the advent
of DRGs and bundling. Acute care hospital were (and are) unwilling to
absorb the cost of such immediate post-operative procedures, and the
profession of clinical prosthetics has never been the same. It is a truly
tragic loss.
We still do IPOPs and early fittings but we have modified our procedures to
accommodate the changes in hospital and rehab stays. We use both weight
bearing and non weight bearing systems for these patients depending on the
facility they are in and the therapy they are getting. Follow up is always a
concern and we have increased our follow up schedule to make sure these
patients do not fall through the cracks. It does put pressure on the
prosthetists schedule but the results are much better. The majority of
Physical Therapists are not well versed in the benefits of IPOP and early
fitting in that they seem too busy to take the time for close work and
examination. A lot is left to PT Assistants which is sometimes problematic.
For those facilities that have prosthetic clinics it is much less of an
issue.
While working in Houston Texas 5+ years ago, I fit hundreds of iPops. Since
moving back to New Hampshire five years ago I have fit two. It appears to be
a regional issue and definitely physician preference. If you contact Art
Shea, CPO in Worcester Mass. NEOPS, he could give you some great reference
material. He did a bunch of research and has presented to numerous doctors
and hospitals in that area and now does a lot of IPops weekly. Check
ABCOP.ORG for his info.
