Agency for Healthcare Research and Quality Releases its Draft Systematic Review of Lower Limb Prostheses Research

October 24, 2017

The Agency for Healthcare Quality Research (AHRQ), in conjunction with a contractor known as an Evidence-based Practice Center, has released a draft systematic review of current scientific literature that address the use of lower limb prostheses in the United States. The Systematic review was originally announced in September of 2016 with a request for additional comments in December of 2016 on the “key questions” that would be used in the systematic review. AOPA provided significant comments on the systematic review itself as well as on the key questions issue.

While the complete systematic review document is 440 pages and is currently under review by AOPA, the abstract of the systematic review indicates the following:

92 studies were identified that assessed performance characteristics of lower limb prostheses
29 of the 92 studies were deemed valid and reliable by the researchers
19 of the 29 studies were generally applicable to Medicare aged populations
11-22% of amputees abandon their lower limb prosthesis within one year of delivery
Unilateral trans-femoral amputees are twice as likely to abandon their prosthesis than unilateral trans-tibial amputees
Currently, there is not evidence to support the selection of specific components for patient subgroups to maximize ambulation, function, and quality of life or to minimize abandonment or limited use

While AOPA supports the need to review the current research that addresses lower limb prostheses, we do not agree with much in the conclusions, and particularly its final abstract conclusion noted above, as there is clear evidence, apparently not considered by AHRQ or its contractor to support specific components for patient subgroups for maximizing favorable patient outcomes. It is important to recognize that the draft systematic review did not include recent research by the RAND Corporation and the health economics firm Dobson DaVanzo that specifically studied both the clinical and cost effectiveness of the provision of higher technology prosthetic limbs, despite AOPA’s having submitted BOTH preliminary findings of both studies before the December, 2016 AHRQ deadline, as well as the final study results of both being submitted to AHRQ as soon as the first became available seven (7) weeks ago. It is particularly unfortunate to see a purportedly current literature review be deficient in not reflecting the latest determinative scientific findings.

AOPA will be preparing extensive comments on the draft systematic review and encourages its members to review the document and provide comments as appropriate.

View the draft Systematic Review document.