Table 3.
Empirical Evidence Statements
| Category | Empirical Evidence Statement (EES) | Supporting Studies |
|---|---|---|
| Care Models | (EES 1) In socialized healthcare systems, patients with unilateral transtibial amputation may experience similar clinical outcomes from the interim to definitive prosthetic stages of rehabilitation with lower average per-patient labor costs and higher satisfaction when managed in a public sector care model compared with a private sector care model. |
High/Fair(22) |
| Prosthetic Treatment |
(EES 2) Patients having experienced lower limb trauma requiring limb salvage or transtibial amputation will likely experience similar hospitalization duration regardless of the choice of surgical procedure. However, the two-year costs, on average, will be approximately 6% higher for TTA versus limb salvage. In some situations, the limb trauma and type of limb salvage procedure can necessitate up to 5% higher costs compared with TTA. |
Moderate/High (23) |
| Prosthetic Treatment |
(EES 3) Patients with Charcot foot arthropathy and multiple comorbidities will likely experience up to 13% increased one-year costs (including hospitalization, device provision, therapy) if limb salvage is selected as opposed to transtibial amputation. |
Moderate/Fair (24) |
| Prosthetic Sockets |
(EES 4) Provision of patella tendon bearing (PTB) sockets for patients with transtibial amputation costs 40% less than total contact socket alternatives however PTB sockets require up to three-times longer to achieve a proper fit with no clinical performance differences between the alternatives. |
Moderate/Fair Two studies (25,26) |
| Prosthetic Sockets |
(EES 5) Compared with traditional plaster casting fabrication, the direct manufacturing method of providing prosthetic sockets for patients with transtibial amputation have 32% higher provision costs but are delivered to patients up to 58% faster and in fewer visits. |
Moderate/Fair (27) |
Supporting Studies rated by AAOP tool/QHES. The Level of Confidence for EESs 1–3 and 5 is Insufficient based on limited evidence (i.e. a single study per topic). The fourth statement (EES 4) is supported by sufficient evidence to support a Moderate level of confidence in the statement.