I want to thank the over 40 practitioners that responded to my inquiry about the testing of prosthetic products and have been requested by many to provide a follow up posting with an overview of the comments I received.
I want to preface my posting by qualifying that as a patient I have the greatest possible respect for the prosthetic industry, after all, I have received quality care and have always been satisfied with the products and treatment I have received over the years.
As an engineer however, I am shocked at the complete lack of clinical, scientific, empirical, controlled or technical data that is available with regard to prosthetics. I am even more surprised that this issue appears to be well accepted in the industry and yet the industry appears to have done very little to rectify the situation.
Virtually every e-mail I received had the theme of trust your practitioner, try different products and see what you like, find out what is right for you, be an educated patient and stay informed. This is all good advice, but these types of comments reflect the style of conversation regarding a hobby or a past time, not a science. We could have been talking about prosthetic components or what kind of pie is better, apple pie or key-lime. Yes, we all have our opinions based upon our experience and the variables, who was the cook, what was the recipe what did you have with the meal, but as an engineer and scientist, I want to know facts.
I was looking for the hard data and facts, not opinions based upon limited personal experience and personal insight. No disrespect, opinions have a place in every conversation, but hard facts and figures are the foundation of science.
It is one thing to have and share an opinion of what you believe is better based upon your personal experience, but it is something quite different for a profession to suggest a statement of fact that one product is better than another when the facts show there is actually not even a foundation or benchmark as to what better really is or means.
To suggest one product is better means nothing without some irrefutable, quantifiable or scientifically based evidence. I would be satisfied if at least I could review some theoretical based data or documentation, but none of this seems to be available.
I did receive two responses from manufactures, Otto Bock and Freedom Foot, that both acknowledged that lack of data and both companies confirmed that they were investing time and energy to rectify the situation. I also had contacts from a few universities and the VA, all of which confirmed that they were initiating various and limited studies to address this long overdue situation.
If I may be so bold as to share my personal opinions with this group, what I find disturbing is the way that some providers at the ACA meeting promoted their products and components as superior to other products and services. One booth even promoted that if I went to one of their affiliated member clinics that I would receive better care and a superior prosthesis. As a consumer and as an engineer, I find this practice to be questionable at the very least. I am puzzled why a profession would allow the practice of allowing component suppliers the ability to make blanket and un-validated claims about their products. Where are the standards of care and products for this profession?
If an engineer wants to purchase a simple bolt, there are industry standards to identify numerous aspects of the bolt based upon universally accepted criteria. But for the prosthetic industry, no such benchmarks or criteria appear to exist for a foot or a knee. One foot appears to be better based upon the fact that someone likes it better and has had better luck with it last time they used it. Next time you drive over a bridge, be thankful that the engineer that designed the bridge used criteria other than he likes certain materials better than others and had better luck with those materials last time he used them. I respectfully suggest that prosthetic industry has a ways to go to be considered a science.
In closing, I want to confirm that I have always had good luck with my prosthetic care, I trust my prosthetist and i believe we have a good relationship and I feel like I have been receiving very good care, I like my prosthesis and I am pretty sure it is the best design for me and it appears to provide me with fairly good comfort, but I guess I will never know for sure. But one thing is for sure, I like my prosthesis as much as I like apple pie.
Harold Powell
www.globalsecurity.org
Newport News VA
[email protected]
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