Transcript Slide 1

Interview Analysis
• Notes from the interviews were analyzed using
inductive thematic analysis
• common method for interpreting qualitative data
• identify and describe themes represented by text
• assignment of theme-based codes to text
• analyze frequency of codes; co-occurrence or other
relationships between coded text
- quantification minimizes investigator bias
• conducted separately by two investigators (Boyatzis, 1998)
- additional check against investigator bias
- discrepancies in interpretation resolved through discussion
©2012 Northwestern University Prosthetics-Orthotics Center for Education and Research
AgrAbility NTW — 1
Common Themes
ENVIRONMENT
DURABILITY/
UTILITY
EDUCATION
ADAPTATION
COST
©2012 Northwestern University Prosthetics-Orthotics Center for Education and Research
AgrAbility NTW — 2
Common Themes
• Farmers and prosthetists
perceive that farmers’
prostheses deteriorate faster
and fail more frequently
than
DURABILITY/
those of the general population
UTILITY
of persons with amputations
• Farmers use their prostheses as
tools to carry out farm work
•
Compared to having an intact limb,
performance of many farm tasks is
“Ifimpeded
a manufacturer
says
or limited by use
of a a component should last
oneprosthesis
year, for me it lasts about 3 months.” — farmer
• Prosthesis better than no prosthesis
©2012 Northwestern University Prosthetics-Orthotics Center for Education and Research
AgrAbility NTW — 3
Common Themes
ENVIRONMENT
• Farmers use prostheses under harsh
environmental conditions
• Weather, dirt, and rough terrain are hard
on prostheses, leading them to break
more frequently
• Dust and dirt interferes with motion of
movable parts
• Wet and dirty conditions can be damaging to electricpowered devices
•
6/17 farmers with upper limb amputations owned a myoelectric
prosthesis but none used them for farm tasks
©2012 Northwestern University Prosthetics-Orthotics Center for Education and Research
AgrAbility NTW — 4
Common Themes
• Choosing to use a prosthesis is an adaptation to address
the challenges of farming with an amputation
• Other adaptations are necessary to compensate for
deficiencies in contemporary prosthetic technology:
• routines
ADAPTATION
• farm equipment
• prosthesis – self modifications
• attitudes
“First, you must have a good attitude,
otherwise, you won’t use the device."— farmer
©2012 Northwestern University Prosthetics-Orthotics Center for Education and Research
AgrAbility NTW — 5
Common Themes
• Adaptations to farm equipment and routines are costly
• Prostheses are expensive, high failure rate further
increases costs
•
High costs lead to self-repairs, self-maintenance or going without
a replacement prosthesis
COST
“An item that costs so much should last longer than it
does. Everything is so expensive.” — farmer
©2012 Northwestern University Prosthetics-Orthotics Center for Education and Research
AgrAbility NTW — 6
Common Themes
• Adaptations to farm equipment and routines are costly
• Prostheses are expensive, high failure rate further
increases costs
• Traveling long distances to see prosthetists with the
expertise they need further increases out-of-pocket cost
COST
©2012 Northwestern University Prosthetics-Orthotics Center for Education and Research
AgrAbility NTW — 7
Cost
Insurance coverage status (N=30)
• 15 (50%) - Private insurance
• 6 (20%) - No insurance
• 5 (17%) - Worker’s comp
• 3 (10%) - Medicare/Medicaid
• 1 (3%) - VA
©2012 Northwestern University Prosthetics-Orthotics Center for Education and Research
AgrAbility NTW — 8
Common Themes
• Prosthetists are typically not educated about the
specific needs of farmers with amputations
• Can lead to inappropriate prosthetic designs (poor
utility)
• Many farmers reported that
they felt prosthetists did not
listen to their concerns and did
not understand their daily routine
EDUCATION
• Farmers were not consistently educated and
trained in the operation of their prostheses
©2012 Northwestern University Prosthetics-Orthotics Center for Education and Research
AgrAbility NTW — 9
Discussion
• Good agreement in responses between farmers
and prosthetists with regard to most themes
Farmers considered
modifying their own
devices to be an
indicator of ingenuity
Prosthetists occasionally
referred to these types
of modifications as
examples of misuse
• Prosthetists need to work closely with farmers
to specially configure their prostheses to
minimize the probability of device failure
©2012 Northwestern University Prosthetics-Orthotics Center for Education and Research
AgrAbility NTW — 10
Publication
©2012 Northwestern University Prosthetics-Orthotics Center for Education and Research
AgrAbility NTW — 11
September 2012
News Coverage
©2012 Northwestern University Prosthetics-Orthotics Center for Education and Research
AgrAbility NTW — 12
Current Work
• Expanded survey
• Education materials
• Device evaluation / design
©2012 Northwestern University Prosthetics-Orthotics Center for Education and Research
AgrAbility NTW — 13
Expanded Survey
• A larger sample of subjects is needed to
appropriately capture diversity and understand
challenges of farming with an amputation
• Increase representation of:
• Types and levels of
amputation
• Types of farming
• Specific prosthetic
components used
• Geographic regions
• Ranchers
©2012 Northwestern University Prosthetics-Orthotics Center for Education and Research
AgrAbility NTW — 14
Expanded Survey
©2012 Northwestern University Prosthetics-Orthotics Center for Education and Research
AgrAbility NTW — 15
AgrAbility Projects & Programs
USDA-funded state projects
Affiliate programs
©2012 Northwestern University Prosthetics-Orthotics Center for Education and Research
AgrAbility NTW — 16
Education
• Webinar for experienced CPs and CPOs
• Focus on “best practices” for farmer /
rancher
• Available through NUPOC and National
AgrAbility Project websites
©2012 Northwestern University Prosthetics-Orthotics Center for Education and Research
AgrAbility NTW — 17
Device Evaluation / Design
Simplicity is preferred:
• More complicated equipment is generally viewed as not
durable
• “parts that are too complicated fail”
• Mechanical devices are preferred because they can be
cleaned with soap and hot water
• Most farmers interviewed do some of their own repairs or
modifications
• When parts need to be repaired “time is money”
• can’t send prosthesis away because they don’t have a back-up
©2012 Northwestern University Prosthetics-Orthotics Center for Education and Research
AgrAbility NTW — 18
Design Criteria
• durable materials and construction
• socket design maintains health of limb
• consistent performance within wide temperature
range
• resist exposure to corrosive or damaging liquids
• resist exposure to airborne particulates
• withstand cleansing of biological and chemical
contaminants
• maintainable by farmer or rancher
• cosmetic
©2012 Northwestern University Prosthetics-Orthotics Center for Education and Research
AgrAbility NTW — 19
Device Evaluation
laminated frame socket
IPT
Tomm Kristensen
Champaign, IL
Oslo, Norway
OpenSocket
CJ Socket Technologies
Beverly, MA
CJ Socket
ToughWare Prosthetics
Westminster, CO
ITAL
©2012 Northwestern University Prosthetics-Orthotics Center for Education and Research
AgrAbility NTW — 20
Wider Application
More durable and adaptable prosthetic
components for farmers and ranchers
may also benefit persons with amputations
who work in other physically demanding
occupations such as:
construction
forestry
fishing
mining
©2012 Northwestern University Prosthetics-Orthotics Center for Education and Research
AgrAbility NTW — 21
Acknowledgements
• This research was funded by the National Institute on
Disability and Rehabilitation Research (NIDRR) of the
U.S. Department of Education under Grant
No. H133E080009. The opinions contained in this
publication are those of the grantee and do not
necessarily reflect those of the Department of Education.
• The National AgrAbility Project and Breaking New
Ground Resource Center at Purdue University
(supported under USDA Special Project 2008-4159004796) for assistance with this study.
• State and regional AgrAbility Projects and Affiliated
Programs for assistance in contacting farmers and
ranchers.
©2012 Northwestern University Prosthetics-Orthotics Center for Education and Research
AgrAbility NTW — 22
References
Boyatzis, R. (1998). Transforming Qualitative Information: Thematic Analysis and
Code Development. Thousand Oaks: SAGE Publications.
Brown, J. (2003). Amputations: A Continuing Workplace Hazard.
http://www.bls.gov/opub/cwc/sh20030114ar01p1.htm. Access Date: 03/21/12.
Bureau of Labor Statistics (2012). National Census of Fatal Occupational Injuries in
2011 (Preliminary Results). USDL-12-1888. News Release, September 20, 2012.
Kircher, R. (2003). Farming with an arm amputation. Oklahoma AgrAbility Newsletter,
2(2), 1-8.
Office of Special Education and Rehabilitative Services (2008). National Institute on
Disability and Rehabilitation Research—Disability and Rehabilitation Research
Projects and Centers Program—Disability Rehabilitation Research Projects (DRRPs),
Rehabilitation Research and Training Centers (RRTCs), and Rehabilitation
Engineering Research Centers (RERCs). Federal Register, 73(22), 6132–6146.
Prosthetic Limbs Inadequate for Farmer, Rancher Use. O&P Business News, 21(10),
31-32, Fall 2012.
Waldera, K., Heckathorne, C., Parker, M., Fatone, S (2012). Assessing the prosthetic
needs of farmers and ranchers with amputations. Disability and Rehabilitation:
Assistive Technology, Early Online.
©2012 Northwestern University Prosthetics-Orthotics Center for Education and Research
AgrAbility NTW — 23
circa 1918
©2012 Northwestern University Prosthetics-Orthotics Center for Education and Research
AgrAbility NTW — 24
Contact Info
Craig Heckathorne
680 North Lake Shore Dr.
NUPOC, Suite 1100
Chicago, IL 60611
phone: 312-503-5723
email: [email protected]
©2012 Northwestern University Prosthetics-Orthotics Center for Education and Research
AgrAbility NTW — 25
High Fatal Work Injury Rates
By Occupation – Preliminary 2011 Data
source: U.S. Bureau
of Labor Statistics
©2012 Northwestern University Prosthetics-Orthotics Center for Education and Research
AgrAbility NTW — 26