The objective of this dissertation is to inform clinicians, researchers and policy makers of the potential value of prosthesis intervention for individuals who experience a lower limb amputation. In addition, this dissertation supports the call for more studies of high methodological quality to provide evidence of the functional and economic value associated with prostheses intervention post lower limb amputation.
The first chapter (study 1) measured the time to prosthesis receipt for based on different demographic (e.g. amputation level and sex) and personal health factors (e.g. diabetes or vascular disease and age) using administrative claims data. Kaplan-Meir method and log-rank tests were used to examine overall survival based on covariates. Multivariable cox proportional hazard models were fit to assess the overall risk of prosthesis receipt after amputation.
The second chapter (study 2 and 3) investigated the cost and utilization of prosthesis receipt stratified by time from surgery up to 12 months post-amputation using administrative claims data. The adjusted analysis was performed using general linear modeling with log transformed cost and logistic regression models assessed healthcare utilization.
The third chapter (study 4) assessed the relationship between injurious falls and self-perceived functional mobility. Multivariable logistic regression was applied to a cross-sectional sample using clinical outcomes data.
As demonstrated in this dissertation, earlier provision of prosthetic devices is associated with lower direct costs and reduced healthcare utilization. For those who are currently using a prosthesis, maintaining and improving mobility may help to reduce the burden and risk of injurious falls.