What is the project about?

Approximately 100M people worldwide need prosthetic and orthotic (P&O) devices (WHO World Report on Disability, 2011). Low-cost, robust devices are only half the story; an estimated 80-90% do not have access to P&O services "due to a shortage of personnel, service units and health rehabilitation infrastructures" (Sexton, 2016, ISPO). All three barriers could be addressed by data, and our project aims to develop new data technologies which can improve access to P&O services.


Why work with Lower & Middle Income Countries?


P&O access is particularly poor for people in Lower and Middle Income Countries (LMICs) such as Cambodia with its landmine legacy. People using prosthetics in LMICs are typically young and live longer lives of more physical work than those in high income countries, for whom most prosthetics technology has been developed. LMICs have higher levels traumatic amputation from accidents, conflict and landmine injuries, and humanitarian crises present particular access challenges. Services are set up primarily for trauma injuries but by 2035 it is estimate diabetes may affect over 500M people, and is growing fastest in LMICs (Guariguata et al, 2014).

Through the International Society for Prosthetics and Orthotics (ISPO), substantial improvements have been made in P&O design and training for LMICs. An overwhelming patient:clinician ratio remains and "the development of the sector is too slow... to meet existing needs or keep pace with the growing populations of people with disabilities" (Sexton, 2016, ISPO). Even with ISPO accredited training, in South East Asian LMICs it is estimated that three times the current number of clinician is required for the current amputee population (Sexton 2015, USAID/ISPO).

What are we doing?

We are conducting two data-technology research studies, to develop tools to improve P&O service access, train clinicians and improve efficiency of service funding use. With a team of expert clinicians, academics and policy makers in Cambodia, we are investigating:

  1. digital measurement tools to assess a user's residual limb anatomy, biomechanics of how they use their prosthetic limb in gait and typical daily activities, and health status; and
  2. the architecture for collecting and synchronising the data from these tools with their digital patient casenotes, across different clinics and in rural communities: a robust and secure method for travelling prosthetists & community workers to provide services to people who cannot afford to travel to centres.
Meet the team

How do you know if you will develop the right technologies? Will it be useful?


Experience shows that care must be taken in applying advanced P&O technologies directly in LMICs. As well as users' different needs, their relationship with clinicians and prosthetics are different for complex cultural, social and environmental reasons. To address this:

  1. we are framing our scientific research using a thorough ethnographic study of P&O service providers and users to ensure the developed technologies are practical; and
  2. we are conducting business modelling research, producing tools to ensure the technologies are cost effective and can be implemented sustainably.

What benefits do you hope the project will deliver?

These technologies have the potential to transform the quality of life of prosthetic limb users worldwide and are required today. A more portable P&O service would enable people to access provision, fitting, adjustment and repair of their prosthetics with reduced time off work - essential where an agricultural worker spends their day's earnings on the same day's food. Prosthetists would access and update casenotes for their patients, provide a repository for clinician training, and enable users to access information regarding their progress and report problems to obtain critical treatment.


Longer term the project results will enable a valuable database to become established. The data will enable selection of technology that delivers greatest quality of life benefit, making best use of limited budgets (Ndabarora et al, 2014). It will support academics and trainee healthcare providers in research and education, and finally, the research will return benefits to the UK taxpayers who are funding this work - we do not yet have a unified P&O digital record system and database.

See our publications

Project Aims

Aim 1

Investigate users' cultural and social needs in Cambodia, to ensure the developed technologies are practical and fit for purpose.

Aim 2

Develop digital tools to collect and analyse biomechanical data which indicate how people use their prosthetic limbs in community settings;

Aim 3

Develop a secure and consent-driven method of collecting and synchronising digital patient records, to enable secure access to digital services in remote or isolated communities;

Aim 4

Conduct business modelling research, producing tools to ensure the technologies are cost effective and can be implemented sustainably both in this project, and for the future to support health research in other countries.

This project is funded by


Grant Reference: EP/RO14213/1


Grant Reference: RF/130