EPSRC Centre for Doctoral Training in Prosthetics & Orthotics

The World Health Organisation says that there are about 100 million people globally who need prosthetic or orthotic (P&O) services and as populations age, more than two billion people are expected to require health-related assistive devices by 2030. In the UK the Disabled Living Foundation estimates that 6.5 million people live with mobility disablement, with many reliant on P&O services, including an estimated two million orthotic users. In parts of the developing world the aftermath of conflict, such as land mines, and greater rates of traumatic injuries from accidents, means there is a growing need for prosthetics and orthotics for younger people living in poor social and economic circumstances. Often they need P&O devices to stay at work and sustain their families. Poor devices, services and access to these contravene their basic human rights.
In the context of this need, we want to establish the EPSRC Centre for Doctoral Training in P&O. This will address the national, and global, shortage of suitably skilled engineers and scientists to become future innovators in P&O technologies. Current academia, industry and care centres have limited researchers, and research activity has lagged behind rapid technology advancements. The Centre will support a minimum of 58 doctoral students whose studies will enable them to become leaders of the future. The Centre will bring together the only two P&O undergraduate education facilities in the UK (Salford and Strathclyde) with P&O research centres of excellence at Imperial College and the University of Southampton.
Our vision is for the Centre to become the national and global leader in P&O research training, and the translation of research into innovation that impacts on the lives of people each day, in developed and developing countries. The Centre will work to support training for students from low and middle-income countries (LMIC). Our students will be immersed in industry and real-world experiences which will equip them to lead the P&O sector across technology, social or economic contexts. Our aims are to:
1. Develop a new model of P&O research training and translation of research into innovation. In addition to the doctoral training, this will result in Master's programmes operating across Institutions.
2. Produce ambitious PhD research projects that will be grounded in real-world challenges, but at the cutting-edge of new biomedical science and technologies.
3. Produce a significant impact on the UK P&O industry sector by leading innovation.
4. Have an international impact by attracting an increasing number of CDT students from overseas.
5. Establish a P&O student society which will have matured into a lasting doctoral community with international reach.
6. To have a significant impact on the training of doctoral candidates from LMIC.
7. Attract additional external funding for P&O research.
Creating a new generation of P&O research leaders will, over time, have a significant economic, societal and health impact. For users, it will mean access to improved generations of assistive devices which will match the users' needs resulting in a better quality of life. Clinical services will benefit from improved service data, superior products and improved user outcomes. For industry, it will open up new market opportunities, nationally and globally. For the students themselves, they will have access to careers that have a real purpose, enabling them and their future teams to make a difference in the lives of people with disabilities.

The CDT students will help create solutions for amputees and people with debilitating conditions such as stroke and diabetes, reducing mortality and enabling them to live more satisfying, productive and fulfilling lives. These solutions, co-created with industry and people living with disabilities, will have direct economic and societal benefits. The principal beneficiaries are industry, P&O service delivery, people who need P&O devices, and society in general.
Industry
The novel methods, devices and processes co-created with users and industry will have a direct economic value to our industry partners (by the creation of IP, new products, and improved industry and academic links). Our CDT graduates will be the natural potential employees of our industry partners and for companies in the wider healthcare technology sector. This will help address the identified critical skills need and shortage leading to improvement in the UK's competitiveness in this rapidly developing and growing global market. The CDT outcomes will help UK businesses spread risk (because new developments are well founded) and more confidently enter new markets with highly skilled employees (CDT graduates).

P&O service delivery
Doctoral engineering graduates with clinical knowledge are needed to improve the deployment of advanced technologies in practice. Our main UK industry partner, Blatchford, stated: "As technology develops it will become easier for the end-user (the patient), but the providers (the clinicians) are going to need to have a higher level of engineering training, ideally to PhD level". The British Association of Prosthetists and Orthotists estimates that no more than ten practising P&O clinicians have a PhD in the UK. Long-term P&O clinical academic leadership will be substantially improved by the CDT supporting a select number of clinically qualified P&O professionals to gain doctorates.

Users
The innovation of devices, use of device and patient monitoring, and innovation approaches in LMIC should not only lead to improved care but also lower healthcare costs. Diabetes UK estimates that the total healthcare expenditure related to foot ulceration and amputation in diabetes was £1billion (2014-15), with 2/3 of this related to foot ulceration. Small innovations could lead to large cost savings if targeted at the right aspects of care (e.g. earlier adoption, and reducing device abandonment).
An ability to work is fundamental to a person's place in society and their sense of purpose and has a significant societal impact in all territories. This is perhaps greatest in LMIC where attitudes towards disability may still be maturing, and appropriate social care infrastructure is not always in place. In these cases, an ability to work is essential for survival.
Improved design approaches will impact on all users regardless of context, since the device solutions will better match local and individual user needs. Addressing issues related to prosthetic/orthotic device abandonment (e.g. cosmesis) and improved adherence should also lead to greater social participation. Improved device solutions will shift focus from what users "cannot do" to what they now "can do", and help progress attitudes towards acceptance of disability.
Societal
The majority of the global P&O users are of working age, and a key economic impact will be keeping users in work. The average age at amputation due to diabetes is just 52 in the USA but much younger in countries with less well-developed health care and trauma services (e.g. 38 in Iran). Diabetes UK reports that 35-50% of people are of working age at diagnosis and that there are around 70,000 foot ulcers in the UK, precursors to amputation. There is a similar concern for stroke survivors around a quarter of whom are of working age and are 2-3 times more likely to be out of work after eight years.