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Title: Prosthetic Best Practice Guidelines
Editors: Vicky Jarvis and Tim Verrall Publisher: RSL Steeper; Number of pages: 125 Reviewed by: Phil Stevens MEd, CPO, FAAOP
The ambitiously titled Prosthetic Best Practice Guidelines is an unusual reference text. Unlike most textbooks and atlases, it is not an engaging read. Rather, it is a series of structured outlines listing the indications and contraindications for the various components and techniques used in prosthetic rehabilitation.
The editors explain that these guidelines were derived from a critical appraisal of the available literature followed by the collection of a consensus of clinical opinions from prosthetists within the RSL Steeper organization and rehabilitation consultants across the United Kingdom. The intention of the text is to provide a series of guidelines that "are intended to help you, the clinician, to provide the best possible prescription for your patients."
The text is confined to lower limb applications and begins with more distal amputation levels (i.e., partial foot and ankle disarticulations), proceeding to considerations at the more commonly encountered transtibial and transfemoral levels, and continuing to the more proximal hip disarticulation and hemipelvectomy amputation levels. These sections focus predominantly on socket design, interface options, and suspension techniques. The final section is described as "Hardware Guidelines" and considers various feet, knees, and functional adapters.
The majority of the text is a series of short outlines. For example, the reader will find a single page listing the indications and contraindications for PTB sockets, supracondylar suspension, suprapatellar suspension, elastic sleeve suspension, cuff strap suspension, and joint and corset suspension respectively. Each of these are preceded by a carefully worded guideline statement and a series of definitions and followed by a series of exceptions to the guidelines statements that, as the observant reader will notice, are exactly the same for every proposed intervention. This format is broken up only periodically by brief "educational pages" that provide the only narrative text of the book.
These practice guidelines represent a great deal of effort on the part of the editors and the publisher. Additionally, with the increasing emphasis on evidence-based practice across all medical disciplines, there may be increasing value to such guidelines.
However, there are some limitations of which prospective readers should be aware. While there are occasional references to literature published after the year 2000, the vast majority of the referenced literature precedes this date with routine references from the 1950s and 1960s and occasional references dating back to the 1940s. As an example, the guidelines for the management of partial feet at the chopart and lisfranc level state that a silicone partial foot prosthesis should be provided. This is based in part on a journal article from 1965, but fails to recognize the important observations of Dillon and Barker from 2006 that would question the accuracy of this recommendation.
Perhaps because of these older references and the fact that the consensus opinions were gathered from practitioners outside the United States, U.S. clinicians may find that some the guidelines and recommendations feel somewhat unfamiliar and occasionally outdated.
In summary: Prospective buyers of Prosthetic Best Practices Guidelines should be aware that it is exactly what it professes to be-a series of brief, structured guidelines that may serve as a good reference resource to confirm or redirect a given course of care. However, because of the genesis of these recommendations, they may occasionally be at odds with some of the currently preferred treatments in your practice environment.