A major new international research programme will examine why the quality of amputation rehabilitation and prosthetic care can vary so significantly depending on where a patient lives — and how those inequalities can be reduced.
Led by Jönköping University in Sweden, the five-year ThRIVE project has a budget of almost €10 million and is being funded through Horizon Europe. The initiative brings together organisations from multiple countries spanning Europe and Asia, including partners in Nepal, Cambodia and Ukraine.
ThRIVE stands for Transforming Amputation Rehabilitation Through Inclusive, Value-Driven, Equitable Care, reflecting an ambition that extends well beyond evaluating prosthetic devices alone.
Researchers will look at entire rehabilitation systems: how services are organised, how care is financed, what outcomes are measured, what patients themselves value and why access to good-quality lifelong prosthetic care remains so uneven.
For CPOs, the project addresses a question that sits at the centre of modern prosthetic practice: how should success in amputee rehabilitation actually be measured?
Rehabilitation varies enormously between health systems
A person undergoing an amputation does not simply need a prosthesis.
They may require surgery, wound management, physiotherapy, psychological support, prosthetic assessment, socket fitting, gait rehabilitation and continuing access to adjustments and replacement components throughout their life.
Yet those services are delivered very differently around the world.
Jönköping University says people living with amputations currently experience significant disparities in access to rehabilitation, prosthetic provision and follow-up care depending on their location.
ThRIVE will study how different healthcare systems organise and deliver those services and identify the factors influencing quality, accessibility and patient experience.
This means examining not only clinical practice but also healthcare governance and financing.
For many CPOs, those structural issues are highly familiar.
A clinic may know what treatment a patient needs while still being constrained by reimbursement policies, limited component availability, travel distance, workforce shortages or a lack of structured follow-up.
Are prosthetic services measuring the right outcomes?
Professor Nerrolyn Ramstrand, Professor of Orthopaedic Technology at Jönköping University and project coordinator for ThRIVE, highlighted the lifelong nature of prosthetic rehabilitation.
She noted that people with amputations need long-term rehabilitation and continued prosthetic support, yet healthcare systems often lack effective ways of determining whether care is producing the outcomes that patients actually consider important.
This is a particularly important issue for the P&O profession.
Traditional measures may focus on whether a prosthesis has been delivered, whether a patient can walk a particular distance or whether technical goals have been achieved.
But patients may define successful rehabilitation differently.
For one person, success could mean returning to employment.
For another, it might mean being able to care for children, walk safely in the community, participate in sport or simply use the prosthesis comfortably for an entire day.
ThRIVE intends to develop common approaches for measuring and monitoring the quality and value of amputation rehabilitation internationally.
Patients will help define what good rehabilitation looks like
One of the project’s strongest features is that it will not rely solely on researchers and healthcare professionals to define best practice.
People living with amputations, policymakers and clinicians will all contribute their experiences and perspectives.
The project will combine that information with registry data and analysis of how healthcare systems are organised, governed and financed.
Researchers will then attempt to identify barriers to high-quality rehabilitation and translate their findings into practical tools that healthcare systems can use to improve services.
This person-centred approach could have important implications for prosthetists.
Socket fit, mobility and technical function remain critical, but the wider objective of prosthetic care is participation in life.
Understanding what patients value can help ensure clinical services are designed around that broader outcome.
Nepal brings a direct South Asian perspective
The consortium includes both Kathmandu University and Limb Care Nepal, bringing experience from a South Asian rehabilitation environment into a project otherwise involving several major European healthcare systems.
This is significant because many international rehabilitation studies are dominated by high-income health systems.
The realities confronting CPOs in Nepal can be very different.
Patients may travel long distances for care, financing options can be limited and access to specialist rehabilitation or replacement components may be uneven.
Including such perspectives can help ensure recommendations are not designed solely around well-funded hospital systems.
Exceed Prosthetics & Orthotics in Cambodia and Protez Hub in Ukraine further broaden the consortium to include organisations working in distinct rehabilitation environments.
14 organisations across eight countries
Jönköping University says the project brings together 14 organisations from eight countries.
Named partners include:
- Jönköping University and Uppsala University in Sweden
- INAIL Centro Protesi in Italy
- University Medical Center Groningen in the Netherlands
- University of Salford and University of Southampton in the UK
- Manchester University NHS Foundation Trust
- Sahlgrenska University Hospital/Västra Götaland Region
- Protez Hub in Ukraine
- Kathmandu University and Limb Care Nepal
- Exceed Prosthetics & Orthotics in Cambodia
The diversity of organisations should allow researchers to compare established rehabilitation systems with services operating under very different economic and healthcare conditions.
A question with major relevance across IMEA
Although the current consortium does not extend deeply across the Middle East and Africa, the questions being investigated are highly relevant to the wider IMEA region.
Many countries already have skilled CPOs and established prosthetic centres but still face major gaps in geographical access, reimbursement, workforce distribution and lifelong follow-up.
The growing number of people requiring prosthetic care because of diabetes, vascular disease, conflict and trauma makes those questions increasingly urgent.
For some health systems, the challenge is no longer simply creating a prosthetic service.
It is creating a system where a person fitted today can reliably return for adjustments, new sockets, replacement components and rehabilitation five, ten or twenty years later.
That is the difference between providing a prosthesis and providing lifelong prosthetic care.
ThRIVE will run for five years, with Jönköping University leading efforts to turn evidence from very different healthcare environments into common approaches for measuring and improving rehabilitation.
If successful, its greatest contribution may be giving CPOs and health systems a clearer way of answering a deceptively simple question:
Are we measuring success by the prosthesis we deliver — or by the life the person is able to live with it?
- Jönköping University – Major international project aims to improve conditions for amputees
- Jönköping University
- Horizon Europe
- Kathmandu University
- Limb Care Nepal
- Exceed Worldwide
- IMEA CPO