Stability + Dynamics = 3r80

There is no central database that records the changing provision of prostheses in the United Kingdom. Experience suggests there have been some shifts in the population, particularly in the past decade. Because the detailed records of these changes are contained in the patients' medical records it is difficult to assess the substance of these data except on an individual basis; the larger picture requires the sifting of a centre's or many centres ' data. This paper describes the analysis of one such set of records at the Oxford Limb Fitting Centre. It relates the profile of the population that attends the centre to the general population, and compares the information with that obtainable from other sources. The possible causes for the findings are discussed. Introduction Prostheses and related care are provided over many years. Patients may change geographic area, treatment form and medical team, many times. Their medical records often bear testimony to the changes that the individual and the prosthetic service have undergone. However, there is no central repository in the United Kingdom for detailed information concerning the limb deficient population. The information is spread throughout the service, in the localised databases for different aspects of the subjects' life. For example, the number of a certain type of prosthesis supplied in the area and its time of use is probably best found in the records of the supplier of the prosthesis and it is therefore commercially sensitive data. Some national data were previously available in the Amputation Statistics for England, Wales and Northern Ireland (Ministry of Health, 1967; Ministry of Health and Social Security, 19681979 and 1980-1988), but this ceased to be collected in 1989. So figures for the national population of prosthesis users are now difficult to obtain. In addition, there is no requirement to record any limb deficiencies at birth, and other sources of information, such as disability grants, do not report much details (McDonnell et al., 1988). Therefore, the review of the population (whether locally or nationally) can only be achieved by reviewing the records of individual patients. This is one such review. A second purpose for this audit was to establish if there were any patterns of prosthetic usage in the region. There are many factors that dictate if a person will use or reject a prosthesis. Though it is impossible to predict precisely why a person will find a prosthesis unhelpful, when a new design of prosthesis is contemplated it is important to gather as much information about use patterns as possible, in order to create a design that is widely acceptable. The study of the records of the user population of this particular centre formed part of a knowledge acquisition phase of a project to design an advanced prosthetic hand under the European Union's TIDE initiative (Technology Initiative for the Disabled and Elderly). It was made in the spring of 1992 in order to assess the utilisation of the service by patients, as well as All correspondence to be addressed to Peter J. Kyberd, Oxford Orthopaedic Engineering Centre, Nuffield Orthopaedic Centre, Headington, Oxford OX3 7LD, UK. Tel: +44 1865 2276451. Fax: +44 1865 742348. e-mail: OOEC@VAX.OXFORD. AC.UK. and WWW.TAGISH. CO.UK/LOSH