In the United States, the number of major limb amputees is predicted to exceed several million in the coming decades. For those amputees using a prosthesis, their quality of life (QoL) is often modulated by residuum limb problems resultant from its use. Multiple factors preclude quality evidence-based medicine (EBM) research in the field of prosthetics, leading to greater health risk from prosthetic prescription ambiguity. Positive social change is integral to good QoL; studies support administrative healthcare (AHc) as useful to support such, especially in the absence of EBM. This study utilized Veterans Healthcare Administration (VHA) AHc data to discriminate determinants of residual limb skin problem severity (RLSPS), relative to the artificial limb configuration (ALC) used through a retrospective, longitudinal study of a cohort of U.S.Veteran dysvascular amputees. The dataset was derived from multiple archival VHA AHc databases from which 279 Cohort members were identified who underwent amputation surgery during the fiscal year (FY) 2007 were dispensed a prosthesis, and had clinical records through FY 2011. ICD-9-CM and HCPCS codes were used to identify categories of RLSPS and ALC, respectively, with generalized estimating equations modeling to identify likelihood associations of parameters. Derivation of the study cohort dataset was encumbered by data integrity issues and coding system limitations; significant associations were detected for RLSPS with chronic obstructive pulmonary disease, substance use disorder, and major depressive disorder, regardless of the ALC dispensed. The findings support the utility of an amputee-prosthesis AHc database to drive product, policy, and medical decisions toward an improved QoL for this vulnerable population.

Prosthetic alignment is the principle of the position and orientation and of the components in a lower limb prosthesis to achieve desirable biomechanical characteristics. Poor alignment of lower limb prostheses is related to decreased balance, knee and hip arthritis, and higher energy expenditure for the user. Clinicians, the prosthetists, have declared they need better tools and increased knowledge in how to perform lower limb prosthetic alignments. Therefore, the aim was to develop a tool concept for clinicians to use in the prosthetic alignment process. This thesis mapped out most of the variables a clinician must consider in the alignment process, identified the clinicians needs of an alignment tool, and screened the market for existing solutions. A systematic approach was applied to develop a conceptual tool from the gathered information. The needs of the customer were based on interviews with clinicians and competing products were benchmarked. Two different conceptual tools were developed, tested with clinicians with promising results, and presented in this thesis. Due to confidentiality agreements with the cooperating company, the designs and functions of the final concepts cannot be shown in the report and are therefore covered in the publication. / Protesuppställning är principen av att orientera och positionera komponenterna i en benprotes för att uppnå önskvärda biomekaniska egenskaper. Undermålig protesuppställning är relaterat till försämrad balans, knä- och höftartros, samt högre energiförbrukning hos användaren. Ortopedingenjörer har uttalat att de behöver bättre verktyg och ökad kunskap kring hur man bäst utför uppställning för benproteser. Uppsatsen ämnade därför att utveckla ett verktygskoncept för ortopedingenjören att använda i protesuppställningen. Den här uppsatsen har kartlagt de flesta variabler som en ortopedingenjör behöver överväga i uppställningsprocessen, identifierat ortopedingenjörers behov i ett uppställningsverktyg, samt undersökt marknaden för existerande lösningar. Ett systematiskt tillvägagångsätt användes för att utveckla ett konceptuellt verktyg baserat på den insamlade informationen. Kundens behov identifierades genom intervjuer med ortopedingenjörer och konkurrerande lösningar sammanställdes i en konkurrensanalys. Två olika konceptuella verktyg utvecklades, testades tillsammans med ortopedingenjörer med lovande resultat, samt har presenterats i denna uppsats. På grund av sekretessavtal med företaget som ingått i samarbetet kunde designen och funktioner, som ingår i de slutliga koncepten och resultatet, inte visas i denna rapport och är därmed övertäckta vid publicering.

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