A180 modern prosthetics – an interdisciplinary approach engaging the public and service users in design

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Finally, on behalf of the Institute for Life Sciences at the University of Southampton, I
would like to tell you about how we are using this interdisciplinary model to
coordinate our musculoskeletal research activities across the University.
FortisNet is a unique network connecting clinicians, researchers and enterprise to
end-users, to improve musculoskeletal health, and this talk will cover how we
developed the model, and an example of some of the prosthetic and orthotic work
we have underway.

2. We are faced with a major challenge in musculoskeletal disease.
This is a burden on society, the economy, and individuals of all ages, around the
world. Conditions including osteoarthritis, osteoporosis and diabetes are common,
and growing problems for an aging population. For example:…
The University of Southampton and nearby Hospital Trust have a unique capability in
our strong, and extremely broad background in musculoskeletal health research.
Our target was to coordinate around 50 researchers and clinicians at the University
and Hospital, along with many more in the local area.
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3. At the Institute for Life Sciences, University of Southampton, our response to these
challenges is to launch FortisNet: an interdisciplinary and vocational network in
regenerative medicine, orthopaedics, prosthetics and assistive technologies.
First, we mapped our musculoskeletal health expertise at the University.
We have researchers across Engineering, Health Sciences, Medicine and Electronics
and Computer Science working in areas with direct or indirect benefit to
musculoskeletal disease.
We grouped the research activities into those representing ‘Components’, at the most
fundamental science level; ‘Limbs’, at the technological level; and ‘Individual’, at the
Human-Device interactions level.
Key activities include…
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4. Next, we conducted a mapping exercise, to understand the musculoskeletal
landscape in the wider world, within one hour of Southampton.
We found the Central South of England to have a thriving set of activities. This
includes over 30 companies, five larger governmental research organisations, and a
range of bodies providing enterprise support and investment, and incubation for
startup businesses.
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5. To try to harness this local network, we designed FortisNet. This is an ecosystem with
which we intend to coordinate user-needs-driven musculoskeletal health product
development. We wanted to create a virtuous circle of feedback, to link users,
clinicians, academics and industry:
1) We talk to service users and clinicians to understand their needs.
2) We link these needs to the expertise at the University, Hospital and in local
industry.
3) Finally, we exploit a broad range of funders and enabling organisations to ensure
translation of the results to clinicians and service users. These contacts include
policymakers and professional bodies to make sure that the full potential
socioeconomic benefits are achieved.
All these activities are interconnected, through mechanisms like the patient and
public involvement concept Jo told us about – we keep iterating to ensure that we are
working towards meeting the user need.
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6. To establish the network, we contacted the local companies, and
surveyed the University’s researchers to understand their local and
international collaborative links, and invited them to a launch event in
January 2016.
This map shows the organisations who have given letters of support,
been listed as project partners, or have indicated they wish to be part
of FortisNet, and the momentum we were able to build within the first
six months.
The centre of gravity might be in Southampton, but we have partners
across Europe and have already reached central and South East Asia,
South America.
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7. With input from our network, we identified these key workstreams as the core of
what FortisNet will do:
These themes give us the flexibility to address new problems, but retain focus to
ensure that we remain driven by our translational objective, for the benefit of the
service users.
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8. We were approached by the lower limb prosthetics industry with a project idea I
would like to give as an example. The industry and clinicians had identified the need
for an evidence base around prosthetic limb componentry.
This is needed by all parties involved. As our previous speakers have explained, limb
fitting is a highly skill- and experience-based process, and very subjective. There is
great variation in the users’ requirements and the prosthetic components used, so it
is difficult to untangle the benefits of different technologies, and to take a more
objective approach.
A big-data registry for lower limb prosthetics would:
- Help clinicians to optimise their practice, by quantifying and recording current
treatments, enabling them to monitor their practice and be more informed in
treatment selection for new patients;
- Help industry to iterate design with fewer human trials
- Help healthcare providers to assess the benefits of more advanced prosthetic
components, so that the case can be made for funding more advanced limbs; and
- Help users to monitor their progress through rehabilitation, and engage in new
developments; and
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9. Our industrial advisors recognised that this needs to be an independent exercise, so
that the results are trusted by healthcare providers, funders and users. “No single
group or research team has all the expertise. The problems users face are so complex
and multifaceted that we really need to pull in all the expertise for the delivery of
new technology.”
This made FortisNet the ideal organisation to address the problem.
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10. So far we have mapped the problem out, and identified the system requirements,
and how they vary for the different contributors and users. This forms part of a much
more complicated system diagram, but that is the point – an effective solution to this
problem will be complicated, but depends on the buy-in of all participants, and the
clear focus on the user requirements.
We envisage a database with four portals, for the user, the clinician, the industry, and
the researcher.
1) This database is an easy means for the user to provide feedback on their
experience, individually and as user groups, and to view larger population reports
so they can understand their rehabilitation progress, and take ownership of their
prosthetic treatment.
2) The clinician and industry portals are linked. Clinicians would be able to appraise
their practice, and take an evidence-based approach to what they do. The
industry could obtain large cohort, independent performance appraisal of their
products, and help to justify the cost to healthcare providers and funders.
3) Finally, there is a huge research value to such a database, and researchers often
struggle to access such information. This database would also provide a
repository for these research reports, for all users to access.
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This project, and FortisNet as a whole, are both at an early stage of development.
However, it all shows the fundamental importance of combining the involvement of
End Users with Enterprise and Clinicians, to shape the future directions of our
research.
If we keep our activities linked to input from the community, we will be able to
remain focussed and maximise our impact and the return on our funders’ investment.
This quotation, from one of our FortisNet members at the launch event, sums up the
spirit of our approach.

12. And that is where you come in.
We welcome new members. If you are a researcher, clinician, member of the public,
charity, donor, policy maker or work in industry; if you share our collegiate,
interdisciplinary vision and want to help shape the future of musculoskeletal research
we would like to hear from you.
Please come to visit us on Stand 9 to talk to us, and to leave us your details.
Thank you very much indeed for listening, and again to all of our presenters today.
We have half an hour remaining for discussion, and are keen to answer your
questions. To chair the discussion I now hand over to our moderator Alison Raw,
Professional Adviser for Allied Health Professions at UK Department of Health.
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