VA DR.... the backup leg can be a manual wheelchair...
Thomas Cutler
Description
Collection
Title:
VA DR.... the backup leg can be a manual wheelchair...
Creator:
Thomas Cutler
Date:
7/9/2020
Text:
Hey folks,
How many of you have been incorrectly told that a manual wheelchair is sufficient for the “backup” prosthesis? And if so, from which VA hospital did you get this feedback? I will post responses. Suffice it to say, I’ll provide a VA reference that shows it’s wrong.
I had heard rumors of this from other VA locations, but this was my first direct experience with it. Telehealth means having physicians from other areas graciously stepping in to provide coverage where needed. If you think about it, this presents an excellent opportunity for our profession to identify counterproductive inconsistencies that complicate efforts to deliver effective and appropriate care.
The physician wasn’t belligerent or aggressive, simply sharing his experience and I’d like to know how many prosthetists in other areas have encountered the same mistake. The TF patient had been enduring care in a geographic area that didn’t believe in a backup leg. This resulted in a lot of confusion since the patient’s prior prosthetist was constantly striving to keep the leg in working order.
VA/DoD Upper Extremity Amputation Rehabilitation guideline, page 71:
Recommendation 22. The care team should offer active prosthesis users at least one back up device to ensure consistency with function. [EO]
Discussion: It is strongly advocated that the care team physician prescribe at least one back up prosthesis prior to discharge from training to any patient who uses upper extremity prostheses. This is particularly important for active and rugged users/wearers. The second prosthesis, in addition to serving a primary role in certain settings (if it is of a different design/type than the first prosthesis), can serve as an alternate device if the first prosthesis breaks down or requires maintenance…. Given these scenarios, it is essential that each patient has at least one additional prosthesis to ensure continued use in daily functional activities and quality of life, should such repairs be needed.
Web address: <URL Redacted>
(I removed the hyperlink, so cut and paste the website)
NOTE: Look carefully… The recommendation itself doesn’t specify only upper extremity prosthesis users. And… active isn’t a reference to a K3 patient. If they are actively using the prosthesis, they need a backup. They use words like “essential”, “strongly advocated”, and the word “should” implies a moral imperative. If people don’t do this, you have ethical problems… and that, my friends, means a discussion with HR.
THE ISSUE: Because this section on “backup prostheses” was overlooked in the VA/DoD Lower Extremity Amputation Rehabilitation guideline, some VA hospitals have apparently misinterpreted the oversight as a directive to assume they should not get one. Despite nowhere stating explicitly in the Lower Extremity guideline that the appropriate backup is a manual wheelchair, they have apparently defaulted to this inferior practice.
In the absence of any explicit policy to the contrary about legs, a universally referenced practice in the upper extremity guideline would supersede any one person’s presumptive authority.
Should folks in your particular area diminish your input on the matter and state that they need to “Stick with the guidelines on lower extremity amputation rehabilitation”, feel free to refer them to page 101 where it states “Patients consider the most important care team relationship is with their prosthetist.” According to the Focus Group of amputees, this was listed first as an “important and needed aspect” of their healthcare. While this is the full text of the Focus Group found in Appendix E of the document, this message get misrepresented in the main document where the authors expressed the finding in terms of the importance of patients having a trusting relationship with us. Rather than accurately conveying the primacy that the patient puts on the prosthetist’s role, they appear to infer potential insidious motives that require the oversight of others to ensure that the prosthetist is trustworthy. If they persist on the wheelchair, you might ask them if they feel comfortable putting that assertion in writing since everyone can agree that authority must come with accountability. Without that value, nobody is in a position to make health decisions on behalf of another human being.
Here’s the web address (hyperlink removed to make this readable) <URL Redacted>
Please note that I really like my local VA folks. It’s one of the rare locations (Fresno, CA) that doesn’t have certified practitioners running it. Each medical center is allowed to choose, and they have done a great job learning from both the local providers and the Palo Alto VA CPOs. Just like being an amputee doesn’t make you a great prosthetist, being a prosthetist doesn’t make you a great VA P&O department head. Their values make them good…
Thanks,
Tom Cutler, CPO, FAAOP
Limb.itless LLC,
Visalia, CA
Sent from Mail< <URL Redacted> > for Windows 10
How many of you have been incorrectly told that a manual wheelchair is sufficient for the “backup” prosthesis? And if so, from which VA hospital did you get this feedback? I will post responses. Suffice it to say, I’ll provide a VA reference that shows it’s wrong.
I had heard rumors of this from other VA locations, but this was my first direct experience with it. Telehealth means having physicians from other areas graciously stepping in to provide coverage where needed. If you think about it, this presents an excellent opportunity for our profession to identify counterproductive inconsistencies that complicate efforts to deliver effective and appropriate care.
The physician wasn’t belligerent or aggressive, simply sharing his experience and I’d like to know how many prosthetists in other areas have encountered the same mistake. The TF patient had been enduring care in a geographic area that didn’t believe in a backup leg. This resulted in a lot of confusion since the patient’s prior prosthetist was constantly striving to keep the leg in working order.
VA/DoD Upper Extremity Amputation Rehabilitation guideline, page 71:
Recommendation 22. The care team should offer active prosthesis users at least one back up device to ensure consistency with function. [EO]
Discussion: It is strongly advocated that the care team physician prescribe at least one back up prosthesis prior to discharge from training to any patient who uses upper extremity prostheses. This is particularly important for active and rugged users/wearers. The second prosthesis, in addition to serving a primary role in certain settings (if it is of a different design/type than the first prosthesis), can serve as an alternate device if the first prosthesis breaks down or requires maintenance…. Given these scenarios, it is essential that each patient has at least one additional prosthesis to ensure continued use in daily functional activities and quality of life, should such repairs be needed.
Web address: <URL Redacted>
(I removed the hyperlink, so cut and paste the website)
NOTE: Look carefully… The recommendation itself doesn’t specify only upper extremity prosthesis users. And… active isn’t a reference to a K3 patient. If they are actively using the prosthesis, they need a backup. They use words like “essential”, “strongly advocated”, and the word “should” implies a moral imperative. If people don’t do this, you have ethical problems… and that, my friends, means a discussion with HR.
THE ISSUE: Because this section on “backup prostheses” was overlooked in the VA/DoD Lower Extremity Amputation Rehabilitation guideline, some VA hospitals have apparently misinterpreted the oversight as a directive to assume they should not get one. Despite nowhere stating explicitly in the Lower Extremity guideline that the appropriate backup is a manual wheelchair, they have apparently defaulted to this inferior practice.
In the absence of any explicit policy to the contrary about legs, a universally referenced practice in the upper extremity guideline would supersede any one person’s presumptive authority.
Should folks in your particular area diminish your input on the matter and state that they need to “Stick with the guidelines on lower extremity amputation rehabilitation”, feel free to refer them to page 101 where it states “Patients consider the most important care team relationship is with their prosthetist.” According to the Focus Group of amputees, this was listed first as an “important and needed aspect” of their healthcare. While this is the full text of the Focus Group found in Appendix E of the document, this message get misrepresented in the main document where the authors expressed the finding in terms of the importance of patients having a trusting relationship with us. Rather than accurately conveying the primacy that the patient puts on the prosthetist’s role, they appear to infer potential insidious motives that require the oversight of others to ensure that the prosthetist is trustworthy. If they persist on the wheelchair, you might ask them if they feel comfortable putting that assertion in writing since everyone can agree that authority must come with accountability. Without that value, nobody is in a position to make health decisions on behalf of another human being.
Here’s the web address (hyperlink removed to make this readable) <URL Redacted>
Please note that I really like my local VA folks. It’s one of the rare locations (Fresno, CA) that doesn’t have certified practitioners running it. Each medical center is allowed to choose, and they have done a great job learning from both the local providers and the Palo Alto VA CPOs. Just like being an amputee doesn’t make you a great prosthetist, being a prosthetist doesn’t make you a great VA P&O department head. Their values make them good…
Thanks,
Tom Cutler, CPO, FAAOP
Limb.itless LLC,
Visalia, CA
Sent from Mail< <URL Redacted> > for Windows 10
Citation
Thomas Cutler, “VA DR.... the backup leg can be a manual wheelchair...,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 5, 2024, https://library.drfop.org/items/show/255059.
