Opening Remarks on Behalf of VA and NCMRR

Mindy L. Aisen, MD
Director of VA Rehabilitation Research and Development (RR&D)

Michael Weinrich, MD
Director of the National Center for Medical Rehabilitation Research (NCMRR)

     The aim of the VA is to enhance its own prosthetics research program while advancing the field in general, to benefit both America's veterans and the entire amputee community. As a healthcare system with 172 hospitals, central procurement, a technology transfer program, and a strong commitment to bringing new technology from bench to bedside, the VA provides the perfect venue for the establishment of a network for prosthetic and orthotic prescription, development, and manufacture.

     The VA has a rich history in prosthetics research and development, dating back to the post-World War II era, in addition to its current leadership in the field. However, there is still a need for increased cooperation between clinicians and researchers, along with a more integrated model of service delivery. The existing gap between good clinical people and good research people must be closed more effectively.

     Both the Director of VA Rehabilitation Research and Development (RR&D) and the Assistant Director of the VA's Cooperative Studies Program assert that the VA stands ready to fund large clinical trials of new technologies and devices for amputees. The need for such trials is underscored by a recent study by Bruce Sangeorzan, MD, Director of the RR&D Limb Loss Center of Excellence at the Puget Sound VA Healthcare System. This study found similar outcomes for diabetic patients at risk for foot ulcers regardless of whether orthotics were used. The lesson learned from this seemingly counterintuitive result reinforces the concept that the best guidepost for clinical practice is rigorous scientific evidence, as opposed to compassion, tradition, intuition, or "common sense."

     Any true impact on medicine and its practice must be based on a rigorously designed clinical trial, with a well-developed consensus about outcome measures, and results derived from statistically meaningful data.

     The National Center for Medical Rehabilitation Research (NCMRR) is also very interested in furthering the development and use of, as well as access to, advanced prosthetics. It seeks to gain expert advice on the identification of current gaps in knowledge and the establishment of priorities for a research agenda. NCMRR supports research on prosthetic development and evaluation, as well as investigations into the impact of amputation on quality of life and improved methods for social supports. The development of adaptive equipment for leisure and employment has also been supported by NCMRR.

     To these ends, NCMRR is very interested in supporting prosthetics trials, in cooperation with VA and other NIH institutes. Of particular importance are the needs of land mine survivors. NCMRR is calling for a national consortium of prosthetics experts to provide technical assistance for these populations, especially in foreign countries where vast numbers of such persons do not receive quality surgical and prosthetic treatment. Ideas and suggestions for funding sources, in addition to the NIH, are actively being solicited.