Van Der Linde H, Geertzen J H B, Hofstad C J, Van Limbeek J, Postema K
Rehabilitation Centre Sint Maartenskliniek, Nijmegen, The Netherlands.
Prosthet Orthot Int. 2003 Dec;27(3):170-8. doi: 10.1080/03093640308726679.
Prosthetic prescription for lower limb amputees and the methodology used are primarily based on empirical knowledge. Clinical expertise plays an important role that can lead to an adequate prescription; however, a clear evidence based motivation for the choices made cannot be given. This can lead to local prescription variations with regard to overuse or underuse of prosthetic care and a lack of transparency for consumers and health insurance companies. Hence a clinical guideline may lead to a more consistent and efficient clinical practice and thus more uniformly high quality care. The purpose of this study was to get insight into potential similarities in prescription criteria in clinical practice in the Netherlands. Secondly, the authors were interested to know if prosthetic prescription was primarily based on the level of activity or intended use of the prosthesis. As part of the development of a consensus-based clinical guideline a multi-centred, cross-sectional study was carried out in order to observe the prosthetic prescription for a group of lower limb amputees. Therefore prescription data were collected from 151 amputees with trans-femoral amputation, knee disarticulation or trans-tibial amputation. Results of the multiple logistic regression show no relationship between the activity level and any of the variables included in the equation such as the hospital or medical doctor in Physical and Rehabilitation Medicine (MD in P&RM), prosthetic components, age of the amputee or reason of amputation. The criteria used are merely based on the clinical expertise and local experience whereas the actual prescriptions differ from location to location. In conclusion the development of a clinical guideline for prosthetic prescription in lower limb amputation is recommended. The information gained from this observational study will be used in a clinical guideline procedure for prosthetic prescription in the Netherlands.
下肢截肢者的假肢处方及所采用的方法主要基于经验知识。临床专业知识发挥着重要作用，能够促成合适的处方；然而，对于所做选择却无法给出基于明确证据的依据。这可能导致在假肢护理的过度使用或使用不足方面出现局部处方差异，并且对消费者和健康保险公司缺乏透明度。因此，临床指南可能会带来更一致且高效的临床实践，从而实现更统一的高质量护理。本研究的目的是深入了解荷兰临床实践中处方标准的潜在相似之处。其次，作者想知道假肢处方是否主要基于活动水平或假肢的预期用途。作为基于共识的临床指南制定的一部分，开展了一项多中心横断面研究，以观察一组下肢截肢者的假肢处方情况。因此，收集了151例经股骨截肢、膝关节离断或经胫骨截肢患者的处方数据。多元逻辑回归结果显示，活动水平与方程中包含的任何变量之间均无关联，这些变量如物理医学与康复医学领域的医院或医生（物理医学与康复医学医生）、假肢组件、截肢者年龄或截肢原因等。所采用的标准仅仅基于临床专业知识和当地经验，而实际处方因地点而异。总之，建议制定下肢截肢假肢处方的临床指南。从这项观察性研究中获得的信息将用于荷兰假肢处方的临床指南制定过程。
