Reverse innovation in western healthcare: a randomised crossover trial comparing the ReMotion prosthetic knee with the current standard of care

Abstract

Introduction Healthcare expenses are reaching unaffordable levels worldwide and reverse innovation could play a role in decreasing these expenses and improving healthcare accessibility. The ReMotion Knee, a prosthetic knee primarily developed for low-income countries, could serve as a reverse innovation for people with a lower limb amputation. This study aimed to evaluate the ReMotion Knee as a potential reverse innovation in high-income countries, specifically in terms of functional mobility. Methods Nine participants with a transfemoral amputation or knee exarticulation were included in this randomised crossover trial. The ReMotion Knee was compared with the participants’ current prosthetic knee in terms of functional mobility and subjective experiences. The primary outcome in this study was the L test for functional mobility. Secondary outcomes were additional clinical performance tests and subjective experiences (balance confidence, walking comfort, test performance and fatigue). Results Participants scored significantly better using their current prosthetic knee than using the ReMotion Knee on primary outcome, the L test (p<0.01, median difference 7.5 s, IQR 6.1–10.6) and all secondary outcomes except experienced test performance and fatigue. All participants were able to safely perform all clinical tests with the ReMotion Knee, even after a short familiarisation period. Conclusions The ReMotion Knee has the potential to become a reverse innovation after modifications improving velocity, walking comfort and weight limit. Collaboration between high-income and low-income countries can facilitate further development of the ReMotion Knee and could result in alternative products and treatments that could reduce healthcare costs while still providing a good quality of care. Trial registration number NCT04700085.