title: Delivery of cosmetic covers to persons with transtibial and transfemoral amputations in an outpatient prosthetic practice.
abstract: BACKGROUND
  Limb loss negatively impacts body image to the extent that functional activity and societal participation are affected. Scientific literature is lacking on the subject of cosmetic covering for prostheses and the rate of cosmetic cover utilization by cover type, gender, amputation level, and type of healthcare reimbursement.
  
  
  OBJECTIVE
  To describe the delivery of cosmetic covers in lower limb prostheses in a sample of people with lower extremity amputation.
  
  
  METHODS
  Cross-sectional design
  
  
  METHODS
  Patient records from an outpatient practice were reviewed for people who received a transtibial or transfemoral prosthesis within a selected 2-year period.
  
  
  RESULTS
  A total of 294 records were reviewed. Regardless of the amputation level, females were significantly (p ≤ 0.05) more likely to receive a cover. Type of insurance did not affect whether or not a cover was used, but Medicare reimbursed more pull-up skin covers.
  
  
  CONCLUSIONS
  There were differences regarding cosmetic cover delivery based on gender, and Medicare reimbursed for more pull-up skin covers at the transtibial level than other reimbursors did. This analysis was conducted in a warm, tropical geographic region of the United States. Results may differ in other parts of the world based on many factors including climate and local views of body image and disability.
  
  
  CONCLUSIONS
  Cosmetic covering rates are clinically relevant because they provide insight into which gender is utilizing more cosmetic covers. Furthermore, it can be determined which type of covers are being utilized with greater frequency and which insurance type is providing more coverage for them.
authors.affiliation: University of South Florida, Tampa, FL, USA mhighsmi@health.usf.edu.
authors.forename: M Jason
authors.initials: MJ
authors.lastname: Highsmith
authors.affiliation: University of South Florida, Tampa, FL, USA.
authors.forename: Jason T
authors.initials: JT
authors.lastname: Kahle
authors.affiliation: University of South Florida, Tampa, FL, USA.
authors.forename: Molly
authors.initials: M
authors.lastname: Knight
authors.affiliation: University of South Florida, Tampa, FL, USA.
authors.forename: Ayla
authors.initials: A
authors.lastname: Olk-Szost
authors.affiliation: University of South Florida, Tampa, FL, USA.
authors.forename: Melinda
authors.initials: M
authors.lastname: Boyd
authors.affiliation: University of South Florida, Tampa, FL, USA.
authors.forename: Rebecca M
authors.initials: RM
authors.lastname: Miro
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D000674:Amputees / Q000523:psychology / Q000534:rehabilitation*; D001186:Artificial Limbs / Q000191:economics*; D001828:Body Image / Q000523:psychology*; D003358:Cosmetics; D003430:Cross-Sectional Studies; D004954:Esthetics; D005260:Female; D005269:Femur / Q000601:surgery; D006801:Humans; D008297:Male; D006278:Medicare / Q000191:economics; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011474:Prosthesis Design / Q000379:methods*; D012051:Reimbursement Mechanisms; D012189:Retrospective Studies; D012737:Sex Factors; D013977:Tibia / Q000601:surgery; D014481:United States
chemical_list: D003358:Cosmetics
keywords: Aesthetic prosthesis; body image; cosmesis; foam cover; pull-up skin; reimbursement