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As a nation and as a field, we have not developed a strong, sustainable prosthetics research framework, nor sufficiently transitioned the results of recent research into tangible results that impact patients' daily lives. The window of attention and resources for prosthetics created by the wars in Iraq and Afghanistan remains open, but it will not stay that way forever. Improved linkages among federal researchers, academia, clinicians, and industry are urgently needed to transfer the results of research activities into clinical practice and produce the results that justify continued investments.
The ebb and flow of federal R&D investment associated with military efforts has typically resulted in periods of intense investment and innovation, followed by years of limited attention and fewer advances. As a signature injury of the current war efforts, amputation has seen a level of attention, awareness, and investment that hasn't been experienced in decades. But over time, the profile of injured servicemen and women will subside, federal budget deficits will force a re-prioritization of funds, and support for prosthetics research will be reduced—maybe slowly, maybe quickly.
The O&P field is facing a critical decision. Do we accept the traditional trajectory? Or can we develop a sustainable research agenda that will support continued innovation long after the heightened awareness dissipates?
Recent establishment of new organizations to advance O&P research suggests that the answer to the second question is yes. But further action must be taken, and taken quickly before our window of opportunity closes. What can we do to take advantage of current policy dynamics and position O&P research as an ongoing activity? I propose a two-part approach.
First, we must demonstrate accountability and results—in the form of enhanced clinical care and improved patient function—from recent federal research investments, and in particular, the $100+ million Defense Advanced Research Projects Agency's (DARPA) upper-extremity research programs. Otherwise, this nine-figure investment will sit on the shelf as a costly academic exercise. That will significantly reduce, or perhaps eliminate, this administration's and Congress's appetite to support O&P research in the near term.
Next, the field needs an aggressive, compelling, and actionable ten-year research plan to expand resources, maximize the impact of whatever funds are appropriated, and preclude the likely diminution of support. Early in the current war effort, funding was readily available for prosthetics research based on the images of servicemen and women losing limbs in the course of duty. Emotion is not a sustainable, long-term strategy for success.
This is not a novel concept. John Michael, MEd, CPO, FISPO, FAAOP, in a Journal of Prosthetics and Orthotics (JPO) summary of the 1992 conference sponsored by the National Center for Medical Rehabilitation Research (NCMRR), wrote that a comprehensive national plan for O&P research was essential and that it should include a list of priorities for research and development and a formal method for coordinating activities in the field.
One important element of this plan is federal-agency accountability. During the period from 1945–65, referred to by Dudley Childress, PhD, as the "golden era of prosthetics research," the federal Committee for Prosthetics Research and Development (CPRD) was responsible for leading and coordinating American prosthetics research. The work directed by CPRD, an activity of the National Academy of Sciences, resulted in findings that paved the way for major leaps forward and created a period of innovation in fundamental O&P science that has not since been replicated. One key factor in its success: CPRD enjoyed a budget that roughly corresponded to seven percent of the total federal expenditure on orthotic and prosthetic services.
Today, there is no lead agency or program responsible for coordination of research activities at the federal agencies and private sector. The NCMRR is responsible for coordinating activities only within the NIH. Despite a mandate to coordinate all aspects of federal rehabilitation research, the National Institute on Disability Rehabilitation Research has been largely ineffective in this regard, and an Institute of Medicine evaluation found it to be ill-equipped to serve in this capacity.
We have a limited time remaining to us when Congress is still willing to dedicate significant funds for prosthetics research based on veterans' and military needs. This is the time to create and promote a coherent research agenda that can produce compelling results—and then market those results in the context of increasing numbers of amputations due to diabetes and other health conditions, to sustain the funding.
A well-coordinated campaign that unites the various interests and organizations in a common purpose of improved clinical care through increased federal investment in research is essential. Now is the time to act to realize this vision.
Doug McCormack is co-founder and CEO of Orthocare Innovations, Oklahoma City, Oklahoma, and chairs the OI Foundation, organizer of the Limb Restoration Institute's Vision 2020 conference. Previously, he spent 17 years representing healthcare, public health, and research interests in Washington DC. He may be contacted at