A scoping review of digital fabrication techniques applied to prosthetics and orthotics: Part 1 of 2—Prosthetics
Ben Oldfrey, Dafne Zuleima Morgado Ramírez, Mark Miodownik, Matthew Wassall, Nerrolyn Ramstrand, Man Sing Wong, Jamie Danemayer, Alex Dickinson, Laurence Kenney, Christopher Nester, Edward D. Lemaire, Hossein Gholizadeth, Laura Diment, Margaret Donovan-Hall, Catherine Holloway
Abstract
BACKGROUND: Traditionally, the manufacture of prostheses is time-consuming and labor-intensive. One possible route to improving access and quality of these devices is the digitalizing of the fabrication process, which may reduce the burden of manual labor and bring the potential for automation that could help unblock access to assistive technologies globally. OBJECTIVES: To identify where there are gaps in the literature that are creating barriers to decision-making on either appropriate uptake by clinical teams or on the needed next steps in research that mean these technologies can continue on a pathway to maturity. STUDY DESIGN: Scoping literature review. METHODS: A comprehensive search was completed in the following databases: Allied and Complementary Medicine Database, MEDLINE, Embase, Global Health Archive, CINAHL Plus, Cochrane Library, Web of Science, Association for Computing Machinery, Institute of Electrical and Electronics Engineers, and Engineering Village, resulting in 3487 articles to be screened. RESULTS: After screening, 130 lower limb prosthetic articles and 117 upper limb prosthetic articles were included in this review. Multiple limitations in the literature were identified, particularly a lack of long-term, larger-scale studies; research into the training requirements for these technologies and the necessary rectification processes; and a high range of variance of production workflows and materials which makes drawing conclusions difficult. CONCLUSIONS: These limitations create a barrier to adequate evidence-based decision-making for clinicians, technology developers, and wider policymakers. Increased collaboration between academia, industry, and clinical teams across more of the pathway to market for new technologies could be a route to addressing these gaps.