Strategic Integration of Orthotic and Prosthetic Solutions in Disaster Risk Management: A Multi-method Study Protocol

Strategic Integration of Orthotic and Prosthetic Solutions in Disaster Risk Management: A Multi-method Study Protocol | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Study protocol Strategic Integration of Orthotic and Prosthetic Solutions in Disaster Risk Management: A Multi-method Study Protocol Farhoud Saeid Ershadi, Hamidreza Khankeh, Fatemeh Hosseinzadeh Khankahi, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6200926/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Physical injuries after disasters often result in a high volume of casualties with fractures, lacerations, and amputations, which can disrupt emergency care for those in need. Providing primary care through orthotic and prosthetic solutions can effectively manage these injuries, reducing the need for emergency surgery and preventing subsequent injuries and complications. This necessitates a comprehensive framework for preparedness before disasters occur, as well as a timely response during and after the event. This study aims to develop such a framework for the strategic integration of orthotic and prosthetic solutions in disaster risk management, thereby enhancing preparedness and response, preventing further injuries, and facilitating rehabilitation. Methods This multimethod study protocol encompasses a systematic scoping review, qualitative content analysis, and the Delphi method, each phase targeting specific research goals to achieve a unified approach. The initial phase involves a systematic scoping review adhering to the Arksey and O'Malley five-step framework and PRISMA-ScR reporting guidelines, identifying key studies related to the integration of orthoses and prostheses across disaster risk management stages. The second phase employs qualitative content analysis through semi-structured interviews with healthcare providers, policymakers, and service providers, capturing their perspectives on the use of orthotic and prosthetic solutions in disaster emergency situations. The final phase utilizes the Delphi method to iteratively refine and develop comprehensive recommendations for integrating orthotic and prosthetic solutions into disaster management. Discussion Developing a framework for the management of orthotic and prosthetic treatments, guided by a structured study protocol, can help researchers recognize evidence and gaps in international research. Integrating existing evidence with the experiences of rehabilitation specialists enriches the findings of studies in the field of accidents and disasters. The results of this study will acquaint researchers and stakeholders with the critical role of rehabilitation in disaster risk management. Orthoses Prostheses Disasters Natural Disasters Rehabilitation Disaster Risk Management Background Due to climate change and dynamic climatic variations, natural disasters and various incidents occur frequently around the world, resulting in irreparable consequences, including physical injuries and loss of life for global communities ( 1 , 2 ). Furthermore, the financial losses resulting from these events are also very significant and impose a heavy economic burden on governments and communities ( 3 ). Consequently, various countries strive to minimize the damage caused by such events by utilizing disaster risk management ( 4 ). A key aspect of this process is effective and timely crisis disaster risk management, which not only helps mitigate risks but also ensures preparedness for natural disasters ( 5 ).This includes a rapid and efficient response to the needs of affected individuals during incidents, restoring communities to their pre-disaster state, or even improving conditions beyond what they were before ( 6 ). Meanwhile, rehabilitation is recognized as a fundamental pillar in the disaster management cycle. This area plays a vital role in preventing the long-term consequences of injuries and complications resulting from disasters, significantly contributing to the recovery of affected individuals and the improvement of their quality of life ( 6 ). Effective rehabilitation strategies, including early interventions and multidisciplinary care, have been shown to enhance functional outcomes and reduce long-term disability among disaster survivors ( 1 , 7 ). During natural disasters, people suffer a range of physical injuries, among which are amputations, fractures, crush injuries, and other physical traumas ( 3 ). These injuries necessitate expert management and multifaceted therapeutic interventions delivered by rehabilitation teams comprising professionals like occupational therapists, physiotherapists, and orthotics and prosthetics specialists ( 2 , 8 ). Orthotists and prosthetists are essential members of the rehabilitation team and play a vital role in the recovery of disaster victims. While their expertise is valuable across all phases of disaster management, it is especially critical in the immediate aftermath ( 6 , 9 ). Many physical injuries sustained during disasters require rapid, specialized interventions to prevent further complications. The use of orthoses and prostheses is a key strategy for mitigating these complications and accelerating recovery ( 1 , 10 ). These devices enable timely rehabilitation and significantly enhance the quality of care in post-disaster crisis situations. During crises where surgical capacity is constrained, orthoses can be utilized as temporary or permanent substitutes in the therapeutic process ( 11 ). In particular, temporary orthoses are crucial in the management of patients presenting with both open and closed fractures, aiding in the minimization of secondary sequelae ( 3 , 12 ). Moreover, when immediate surgery is not feasible, orthoses afford a critical window for the treatment team to carefully formulate and execute surgical management plans. These applications demonstrate the significance of the specialized and evidence-based application of orthoses and prostheses in improving the efficacy of rehabilitation services in disaster contexts. In the context of natural disasters, minimizing complications and secondary trauma during patient transport is of utmost importance ( 6 , 13 ). The implementation of lightweight, low-profile, and portable orthoses and splints can facilitate this goal ( 1 , 14 ). Subsequently, during the rehabilitation phase, the provision of assistive mobility devices, including crutches, walkers, and wheelchairs, is essential for enabling the resumption of daily activities by affected individuals. In general, the strategic use of orthoses and prostheses in these settings can contribute to increased survival rates and a reduction in the strain on medical resources ( 15 ). A review of existing research indicates that despite considerable attention given to injury management and post-disaster rehabilitation, notable knowledge gaps persist ( 16 ). A critical limitation is the inadequate reporting of the specific tools and techniques utilized in therapeutic interventions. In particular, detailed information concerning the specific type of orthoses, splints, or fracture classifications is frequently lacking ( 2 , 10 ). Moreover, key aspects of the rehabilitation process, such as amputation level, the nature of prescribed prosthetic devices, and the long-term outcomes of rehabilitation interventions, are often incompletely documented ( 7 ). Furthermore, while some studies have acknowledged the role of a team-based approach in rehabilitation, the challenges associated with this collaboration, such as funding, workforce training, and interdisciplinary coordination, have not been comprehensively addressed ( 3 ). These gaps are particularly prominent within the four key phases of disaster risk management: mitigation/prevention, preparedness, response, and reconstruction/recovery ( 6 ). Specifically, the need for cohesive teamwork at each stage, from preventative planning and needs assessment to the implementation of therapeutic interventions and long-term follow-up, is a critical requirement for improving rehabilitation outcomes ( 1 ). Therefore, future research should focus on addressing these shortcomings and, by providing operational and implementation details, develop more comprehensive and effective approaches ( 16 , 17 ) . The study by Turgut et al. (2024) examined musculoskeletal injuries resulting from the Kahramanmaraş earthquakes in Turkey, providing a comprehensive overview of the types of injuries, therapeutic interventions, and associated challenges ( 6 ). The study revealed that common injuries included fractures, crush syndrome, and compartment syndrome, with therapeutic interventions such as fasciotomy, amputation, and fracture stabilization employed for their management ( 3 ). However, several key gaps exist in the study's findings that warrant attention in future research. One such gap is the absence of standardized and clear criteria for the timing and execution of fasciotomy in disaster settings, with many cases resulting in a shift towards amputation due to delays in rescue efforts ( 2 )​. The lack of precise documentation regarding injury classification, particularly in fractures, and details concerning the devices used in injury stabilization is another limitation of the study ( 16 ). Furthermore, the research addressed the long-term outcomes of treatments and patients’ quality of life post-intervention only minimally ( 1 ). These gaps underscore the need for more comprehensive planning and the development of standardized guidelines in the management of disaster-related injuries to not only enhance treatment efficacy but also improve patient quality of life ( 3 ). Accordingly, this study aims to develop a protocol through a mixed-methods approach to examine existing evidence and gaps, utilizing a scoping review to investigate the evidence and gaps within the disaster risk management cycle ( 6 ). The findings of this research can contribute to providing a comprehensive framework for the optimal utilization of orthoses and prostheses in natural disaster management, particularly in emergency situations and natural disasters ( 2 ). By enhancing preparedness and timely response, and through the application of orthotic and prosthetic technologies, further injuries can be effectively prevented and the rehabilitation process facilitated ( 1 ). Therefore, this study aims to develop a strategic framework for integrating orthotic and prosthetic solutions into disaster risk management, thereby enhancing the effectiveness of preparedness, response, and rehabilitation efforts. Methods/Design This protocol for a multi-method study will proceed in three phases: A systematic scoping review, qualitative content analysis, and the Delphi method. Also, every phase is aimed to achieve a specific research goal thus, strengthening the unified approach targeted to achieving the study objectives. A Systematic Scoping Review The scoping review will follow the established five-step framework proposed by Arksey and O'Malley (2005) ( 18 ), which includes: Developing a research question Identifying relevant studies Selecting studies based on inclusion/exclusion criteria Organizing and charting data Collating, summarizing, and reporting the results The reporting of the review will follow the PRISMA extension for Scoping Reviews (PRISMA-ScR) to enhance transparency and reproducibility. 1–1 Research Question Development These research questions will be raised regarding the integration of orthoses and prostheses across all stages of disaster risk management: Are established pre-disaster prevention guidelines and plans implemented, and what protocols exist for the storage and maintenance of relevant resources? What types of orthotic and prosthetic solutions are utilized during disaster response? What is the established referral system for orthotic and prosthetic services, and what are the follow-up procedures for patients receiving such devices? How do orthotic and prosthetic interventions impact patient outcomes in disaster-affected regions? 1-2 Identifying Relevant Studies The search strategy will involve conducting literature searches using keywords and medical subject headings (MeSH) terms. Various database sources will be explored, such as PubMed, Embase, Web of Science, and Scopus. Additionally, a hand search will be performed, including searches in Google Scholar and the reference lists of key studies. Articles will be organized using EndNote. A sample of the search strategy employed across the databases is provided in Table 1 . Table 1 Example of Search Strategy for PubMed Database ("Emergencies"[MeSH Terms] OR ("Disasters"[MeSH Terms] OR "Disaster Victims"[MeSH Terms] OR "Natural Disasters"[MeSH Terms] OR "Earthquakes"[MeSH Terms] OR "Floods"[MeSH Terms] OR "Mass Casualty Incidents"[MeSH Terms])) AND ("wounds and injuries/rehabilitation"[MeSH Terms] OR ("fractures, bone/epidemiology"[MeSH Terms] OR "fractures, bone/rehabilitation"[MeSH Terms]) OR ("Orthotic Devices"[MeSH Terms] OR "Self-Help Devices"[MeSH Terms] OR "Artificial Limbs"[MeSH Terms] OR "Braces"[MeSH Terms] OR "Walkers"[MeSH Terms] OR "Crutches"[MeSH Terms] OR "Canes"[MeSH Terms] OR "Foot Orthoses"[MeSH Terms] OR "Splints"[MeSH Terms] OR "Prostheses and Implants"[MeSH Terms] OR "prosthesis"[Title/Abstract] OR "prosthetics"[Title/Abstract] OR "amputation, surgical"[MeSH Terms] OR "amputation, traumatic"[MeSH Terms] OR "Amputation Stumps"[MeSH Terms])) 1-3 Study Selection The selection process will involve two rounds of screening. Initially, titles and abstracts will be independently screened by two reviewers for relevance. Subsequently, full-text articles meeting the inclusion criteria (English language and accessible) will be thoroughly reviewed. Any disagreements will be resolved through discussion until consensus is reached, and inter-rater reliability will be assessed using Cohen's kappa coefficient. 1-4 Organizing and Charting Data The charting process will be guided by the research questions, ensuring that data is collected and organized in a way that directly addresses the objectives of the study. 1-5 Collating, summarizing, and reporting the results Collating, summarizing, and reporting the results involves gathering all extracted data, distilling it into key findings and insights, and presenting it in a structured format. This process highlights common themes, gaps, and trends, and discusses the implications for practice, policy, and future research. 2- Qualitative Content Analysis In this phase, the experiences of researchers in integrating orthotic and prosthetic solutions into disaster risk management will be explored using a conventional content analysis study following Graneheim and Lundman's (2004) approach. This will include discussions on existing practices and challenges in disaster risk management and rehabilitation. Additionally, recommendations and solutions proposed by the researchers to address these challenges will be extracted( 19 , 20 ). 2-1 Study Population The study population comprises healthcare providers, policymakers, and service providers with experience in disaster risk management and rehabilitation involving orthotic and prosthetic solutions ( 19 , 20 ). 2-2 Selection of Participants Participants will be purposefully selected based on inclusion criteria such as experience in disaster risk management and rehabilitation, willingness to participate in the study, and the ability to articulate their experiences and insights.( 19 , 20 ). 2-3 Data Collection Data will be collected through in-depth, semi-structured interviews. An interview guide will be developed and calibrated through preliminary interviews, containing opening, main, probe, and follow-up questions based on participants' responses. For example, participants might be asked, “In the disaster scenarios you have experienced, what practices have you used to effectively integrate orthotic and prosthetic solutions?” or “What challenges have you faced in incorporating these solutions during different stages of disaster management?” Interviews will be scheduled after obtaining necessary permits and coordinating with participants on timing and location. Before starting an interview, the researcher will introduce themselves to the interviewee and explain the research purpose, the possibility of recording the participant’s voice, the principle of information confidentiality, and the participant’s right to withdraw from the study. Informed consent will be obtained in written or oral form (along with recording the participant’s voice). Informed consent will be ensured throughout the research process, from the beginning of an interview, during and after an interview, and until the research ends, if needed, to ensure the participant’s willingness to continue. Data collection and interviews will continue until data saturation occurs, meaning the categories are sufficiently enriched, and no new concepts are emerging ( 19 , 20 ). 2-4 Data Analysis Data analysis will follow Graneheim and Lundman's (2004) approach. Concurrently with data collection, data analysis will begin. Each recorded interview will be transcribed word by word, with attention to the participant’s tone. The researcher will read the interview text multiple times to gain a general understanding of the study atmosphere. The analysis will involve a line-by-line examination of the text, dividing it into meaning units related to the study’s purpose. Condensation and coding will then be performed. After coding, the codes will be sorted into sub-categories based on their differences and similarities, named based on their content. These sub-categories will be grouped into categories. As the analysis progresses, the researcher will move towards latent content analysis to identify underlying themes ( 19 , 20 ). 3- Delphi Method In the final phase of this study, the Delphi method will be employed to develop and refine comprehensive recommendations for the integration of orthotic and prosthetic solutions into disaster risk management. The Delphi method is a structured communication technique that relies on a panel of experts. Through multiple rounds of questioning, the method aims to achieve consensus on key issues related to the research objectives ( 20 ). 3-1 Selection of Experts Experts will be selected based on their extensive experience and knowledge in disaster risk management, orthotic and prosthetic rehabilitation, and related fields. Inclusion criteria will include recognized expertise, a track record of relevant publications, and a willingness to participate in multiple rounds of surveys ( 20 ). 3-2 Data Collection The Delphi process will begin with an initial questionnaire, designed based on the findings from the scoping review and qualitative content analysis. The questionnaire will seek expert opinions on the integration of orthotic and prosthetic solutions in disaster risk management, including best practices, challenges, and potential strategies. Round 1: In the first round, experts will be asked to provide their insights and suggestions in response to open-ended questions. Their responses will be analyzed and summarized to identify common themes and areas of agreement. Round 2: In the second round, a refined questionnaire will be distributed, incorporating the summarized findings from the first round. Experts will be asked to review and rate the importance of each item using a Likert scale. Additional comments and suggestions will be encouraged. Round 3 and Beyond: Subsequent rounds will involve further refining and narrowing down the recommendations based on expert feedback. Consensus will be sought on the key recommendations and strategies for integrating orthotic and prosthetic solutions into disaster risk management. The process will continue until a stable level of agreement is achieved. 3-3 Data Analysis The responses from each round will be analyzed using descriptive statistics to measure the level of consensus among experts. Themes and patterns will be identified to develop a comprehensive set of recommendations. The final set of recommendations will be synthesized and validated by the expert panel. Ethical Considerations Participation This study will adhere to strict ethical standards throughout all phases. Key ethical considerations include: Informed Consent : Participants will be fully informed about the purpose, methods, and potential benefits and risks of the study. Informed consent will be obtained before participation, either in written or oral form, with the recording of the participant’s voice. Participants will be made aware of their right to withdraw from the study at any time without consequences. Confidentiality and Anonymity : Confidentiality and anonymity of participants will be maintained throughout the study. Personal identifiers will be removed from transcripts and reports, and data will be stored securely to prevent unauthorized access. Voluntary Participation : Participation in the study will be entirely voluntary. Participants will not receive any compensation for their involvement and will be free to withdraw at any point without providing a reason. Data Protection : All data collected during the study will be securely stored and only accessible to authorized members of the research team. Data will be anonymized to protect participants' identities, and any identifying information will be kept separate from the research data. Minimizing Harm : The study will be designed to minimize any potential harm or discomfort to participants. Researchers will be sensitive to participants' well-being and will take steps to address any concerns or issues that arise during the study. Ethical Approval : The study protocol will be reviewed and approved by an appropriate ethics committee of the University of Social Welfare and Rehabilitation Sciences to ensure that it meets ethical standards and guidelines for conducting research involving human participants. Transparency and Honesty : The researchers will maintain transparency and honesty in reporting the study's aims, methods, findings, and potential conflicts of interest. Any limitations of the study will be openly discussed. By adhering to these ethical principles, the study aims to protect the rights and well-being of all participants while ensuring the integrity and validity of the research findings. Discussion This protocol outlines a comprehensive multi-method study designed to strategically integrate orthotic and prosthetic solutions into disaster risk management. By employing a systematic scoping review, qualitative content analysis, and the Delphi method, the study aims to develop a robust framework to enhance service delivery, address existing gaps, and respond effectively to user needs. The findings will inform the creation of context-specific action plans that improve disaster preparedness, response, and rehabilitation efforts. Ultimately, this study aspires to optimize the utilization of orthotic and prosthetic devices, elevate the quality of care, and reinforce disaster management systems on a global scale. Declarations Ethics approval and consent to participate This study will be conducted with the approval of the Ethics Committee of the University of Rehabilitation Sciences and Social Health. Consent for publication Not applicable Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request. Competing interests The authors declare that they have no Conflict of interest. Funding There is no funding for this project. Authors' contributions FSE: Conceptualization, Methodology, Project administration, Writing – original draft, Writing - review & editing. HKh: Conceptualization, Methodology FHkh: Drafting of the Protocol, Writing – original draft MM: Drafting of the Protocol, Writing – original draft MS: Methodology, Writing - review & editing, and supervision ShSh:, Methodology, Writing - review & editing, and supervision All authors gave final approval for publication and agreed to be held accountable for the work performed therein. Acknowledgements We would like to thank the University of Social Welfare and Rehabilitation Sciences for their support, without which this study would not have been possible. References Naidu P, Dominguez LB, Trelles M, Chu KMJWjos. Traumatic injuries are the main indication for limb amputations during and after humanitarian crises. 2021;45:1021-5. Sermonesi G, Bertelli R, Pieracci FM, Balogh ZJ, Coimbra R, Galante JM, et al. Surgical stabilization of rib fractures (SSRF): the WSES and CWIS position paper. 2024;19(1):33. Gökmen MY, Uluöz M, Pazarcı Ö, Çiloğlu O, Varmış HOJSJoT, Resuscitation, Medicine E. Aftermath Türkiye’s double earthquake: detailed analysis of fracture characteristics and acute management from a level I trauma center. 2024;32(1):43. Redmond AD, Mardel S, Taithe B, Calvot T, Gosney J, Duttine A, et al. A qualitative and quantitative study of the surgical and rehabilitation response to the earthquake in Haiti, January 2010. 2011;26(6):449-56. Burns AS, O'Connell C, Rathore FAJJoRM. Meeting the challenges of spinal cord injury care following sudden onset disaster–lessons learned. 2012;44(5):414-20. Turgut N, Özgözen AL, Beyaz SJQMJ. Evaluation of musculoskeletal system injuries after the 2023 Kahramanmaraş Turkey earthquakes: Our single-center experience. 2024;2024(1):10. Gosney J, Reinhardt J, Von Groote P, Rathore F, Melvin JJSc. Medical rehabilitation of spinal cord injury following earthquakes in rehabilitation resource-scarce settings: implications for disaster research. 2013;51(8):603-9. Mallick M, Aurakzai J, Bile K, Ahmed NJE-EMHJ, 16 , 98-105,. Large-scale physical disabilities and their management in the aftermath of the 2005 earthquake in Pakistan. 2010. Wong CN-C, Yu JM-K, Law S-W, Lau HM-C, Chan CK-MJJoos, research. Bilateral transtibial amputation with concomitant thoracolumbar vertebral collapse in a Sichuan earthquake survivor. 2010;5:1-9. Li Y, Pan F, Li YJJoEBM. Analysis of rehabilitation needs, measures taken, and their effectiveness for the wounded following the Wenchuan Earthquake. 2009;2(4):258-64. Demey DJIo. Post-amputation rehabilitation in an emergency crisis: from preoperative to the community. 2012;36:2003-5. Wolfson NJIo. Orthopaedic triage during natural disasters and mass casualties: do scoring systems matter? 2013;37:1439-41. Telefon AH, Çelik Ü, Afat Turgut E, Kandemir Gülmez T, Kılıç Çil M, Sönmez G, et al. 2023 catastrophic Turkey earthquake: clinical outcomes of pediatric patients rescued under the rubble. 2024(just-accepted). Guner S, Guner SI, Isik Y, Gormeli G, Kalender AM, Turktas U, et al. Review of Van earthquakes form an orthopaedic perspective: a multicentre retrospective study. 2013;37:119-24. Rauch A, Baumberger M, Moise F-G, von Elm E, Reinhardt Jan DJJorm. Rehabilitation needs assessment in persons with spinal cord injury following the 2010 earthquake in Haiti: a pilot study using an ICF-based tool. 2011;43(11):969-75. Asfuroğlu ZM, Gökosmanoğulları SF, Çolak M, Yılmaz C, Eskandari MMJTJoT, Surgery E. First 10 days after the 6th of February 2023 earthquake disaster: experience of an orthopedic clinic on the border of the disaster zone. 2023;29(10):1191. Awais SM, Dar UZ, Saeed AJIo. Amputations of limbs during the 2005 earthquake in Pakistan: a firsthand experience of the author. 2012;36:2323-6. Arksey H, O'malley L. Scoping studies: towards a methodological framework. International journal of social research methodology. 2005;8(1):19-32. Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse education today. 2004;24(2):105-12. Khankeh H, Shirozhan S. Applied Qualitative research in healthcare: Jame-e-Negar. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6200926","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Study protocol","associatedPublications":[],"authors":[{"id":427148149,"identity":"2f123087-a27f-4cf6-b89b-f679a3742c26","order_by":0,"name":"Farhoud Saeid Ershadi","email":"","orcid":"","institution":"University of Social Welfare and Rehabilitation Sciences","correspondingAuthor":false,"prefix":"","firstName":"Farhoud","middleName":"Saeid","lastName":"Ershadi","suffix":""},{"id":427148150,"identity":"93796b76-9650-4ea4-8d85-dca9cda89a2b","order_by":1,"name":"Hamidreza Khankeh","email":"","orcid":"","institution":"Berlin Institute of Health at Charité","correspondingAuthor":false,"prefix":"","firstName":"Hamidreza","middleName":"","lastName":"Khankeh","suffix":""},{"id":427148151,"identity":"f12c423d-52ca-4548-9e04-3bde82939ee4","order_by":2,"name":"Fatemeh Hosseinzadeh Khankahi","email":"","orcid":"","institution":"University of Social Welfare and Rehabilitation Sciences","correspondingAuthor":false,"prefix":"","firstName":"Fatemeh","middleName":"Hosseinzadeh","lastName":"Khankahi","suffix":""},{"id":427148152,"identity":"90234cae-1c67-42b8-9d17-c55105d34d25","order_by":3,"name":"Mahdieh Motie","email":"","orcid":"","institution":"University of Social Welfare and Rehabilitation Sciences","correspondingAuthor":false,"prefix":"","firstName":"Mahdieh","middleName":"","lastName":"Motie","suffix":""},{"id":427148153,"identity":"5b056ca3-7b60-4abb-8d43-2b31bbcc96a0","order_by":4,"name":"Mohammad Saatchi","email":"","orcid":"","institution":"University of Social Welfare and Rehabilitation Sciences","correspondingAuthor":false,"prefix":"","firstName":"Mohammad","middleName":"","lastName":"Saatchi","suffix":""},{"id":427148154,"identity":"b46f5ded-887e-4dc8-9254-5dc028ef7487","order_by":5,"name":"Shima Shirozhan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/ElEQVRIiWNgGAWjYBAC+RmMDUDqAA+QYANiGyBmbDyAT4vBDVQtaSAtDfi1SIApsBqQlsMILk4t0s2tG378uSNj3t7+7MHPHeft1rYfBtpSYxON0y9zDrbd7G17xiNz5kC6Ye+Z28nbziQCtRxLy23ApedGYtsN3obDPBISCcckeNtuJ5sdAGphbDiMV8vNP39AWhLbJP+2nUs2O/+QsJbbPGwgLcls0rxtB+zMbhCwxQCkRbYNqIXnGJu0bFtygtkNoC0JePwiPyP92c03fw7bS7C3P5N822Znb3Y+/eGDDzU2uB2GDhLBKhOIVQ4C9qQoHgWjYBSMgpEBAPweajhl2BaoAAAAAElFTkSuQmCC","orcid":"","institution":"University of Social Welfare and Rehabilitation Sciences","correspondingAuthor":true,"prefix":"","firstName":"Shima","middleName":"","lastName":"Shirozhan","suffix":""}],"badges":[],"createdAt":"2025-03-11 07:38:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6200926/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6200926/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":78446081,"identity":"33d7ede2-1499-4e97-9a2c-8bf1f08b1d23","added_by":"auto","created_at":"2025-03-13 10:01:56","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":656273,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6200926/v1/3f27944d-080d-475c-b8e9-c7a45bf9c160.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Strategic Integration of Orthotic and Prosthetic Solutions in Disaster Risk Management: A Multi-method Study Protocol","fulltext":[{"header":"Background","content":"\u003cp\u003eDue to climate change and dynamic climatic variations, natural disasters and various incidents occur frequently around the world, resulting in irreparable consequences, including physical injuries and loss of life for global communities (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Furthermore, the financial losses resulting from these events are also very significant and impose a heavy economic burden on governments and communities (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eConsequently, various countries strive to minimize the damage caused by such events by utilizing disaster risk management (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). A key aspect of this process is effective and timely crisis disaster risk management, which not only helps mitigate risks but also ensures preparedness for natural disasters (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).This includes a rapid and efficient response to the needs of affected individuals during incidents, restoring communities to their pre-disaster state, or even improving conditions beyond what they were before (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMeanwhile, rehabilitation is recognized as a fundamental pillar in the disaster management cycle. This area plays a vital role in preventing the long-term consequences of injuries and complications resulting from disasters, significantly contributing to the recovery of affected individuals and the improvement of their quality of life (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Effective rehabilitation strategies, including early interventions and multidisciplinary care, have been shown to enhance functional outcomes and reduce long-term disability among disaster survivors (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDuring natural disasters, people suffer a range of physical injuries, among which are amputations, fractures, crush injuries, and other physical traumas (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). These injuries necessitate expert management and multifaceted therapeutic interventions delivered by rehabilitation teams comprising professionals like occupational therapists, physiotherapists, and orthotics and prosthetics specialists (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOrthotists and prosthetists are essential members of the rehabilitation team and play a vital role in the recovery of disaster victims. While their expertise is valuable across all phases of disaster management, it is especially critical in the immediate aftermath (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Many physical injuries sustained during disasters require rapid, specialized interventions to prevent further complications. The use of orthoses and prostheses is a key strategy for mitigating these complications and accelerating recovery (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). These devices enable timely rehabilitation and significantly enhance the quality of care in post-disaster crisis situations.\u003c/p\u003e \u003cp\u003eDuring crises where surgical capacity is constrained, orthoses can be utilized as temporary or permanent substitutes in the therapeutic process (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). In particular, temporary orthoses are crucial in the management of patients presenting with both open and closed fractures, aiding in the minimization of secondary sequelae (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Moreover, when immediate surgery is not feasible, orthoses afford a critical window for the treatment team to carefully formulate and execute surgical management plans. These applications demonstrate the significance of the specialized and evidence-based application of orthoses and prostheses in improving the efficacy of rehabilitation services in disaster contexts.\u003c/p\u003e \u003cp\u003eIn the context of natural disasters, minimizing complications and secondary trauma during patient transport is of utmost importance (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). The implementation of lightweight, low-profile, and portable orthoses and splints can facilitate this goal (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Subsequently, during the rehabilitation phase, the provision of assistive mobility devices, including crutches, walkers, and wheelchairs, is essential for enabling the resumption of daily activities by affected individuals. In general, the strategic use of orthoses and prostheses in these settings can contribute to increased survival rates and a reduction in the strain on medical resources (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA review of existing research indicates that despite considerable attention given to injury management and post-disaster rehabilitation, notable knowledge gaps persist (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). A critical limitation is the inadequate reporting of the specific tools and techniques utilized in therapeutic interventions. In particular, detailed information concerning the specific type of orthoses, splints, or fracture classifications is frequently lacking (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Moreover, key aspects of the rehabilitation process, such as amputation level, the nature of prescribed prosthetic devices, and the long-term outcomes of rehabilitation interventions, are often incompletely documented (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFurthermore, while some studies have acknowledged the role of a team-based approach in rehabilitation, the challenges associated with this collaboration, such as funding, workforce training, and interdisciplinary coordination, have not been comprehensively addressed (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). These gaps are particularly prominent within the four key phases of disaster risk management: mitigation/prevention, preparedness, response, and reconstruction/recovery (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Specifically, the need for cohesive teamwork at each stage, from preventative planning and needs assessment to the implementation of therapeutic interventions and long-term follow-up, is a critical requirement for improving rehabilitation outcomes (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Therefore, future research should focus on addressing these shortcomings and, by providing operational and implementation details, develop more comprehensive and effective approaches (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) .\u003c/p\u003e \u003cp\u003eThe study by Turgut et al. (2024) examined musculoskeletal injuries resulting from the Kahramanmaraş earthquakes in Turkey, providing a comprehensive overview of the types of injuries, therapeutic interventions, and associated challenges (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). The study revealed that common injuries included fractures, crush syndrome, and compartment syndrome, with therapeutic interventions such as fasciotomy, amputation, and fracture stabilization employed for their management (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHowever, several key gaps exist in the study's findings that warrant attention in future research. One such gap is the absence of standardized and clear criteria for the timing and execution of fasciotomy in disaster settings, with many cases resulting in a shift towards amputation due to delays in rescue efforts (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)​. The lack of precise documentation regarding injury classification, particularly in fractures, and details concerning the devices used in injury stabilization is another limitation of the study (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Furthermore, the research addressed the long-term outcomes of treatments and patients\u0026rsquo; quality of life post-intervention only minimally (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). These gaps underscore the need for more comprehensive planning and the development of standardized guidelines in the management of disaster-related injuries to not only enhance treatment efficacy but also improve patient quality of life (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAccordingly, this study aims to develop a protocol through a mixed-methods approach to examine existing evidence and gaps, utilizing a scoping review to investigate the evidence and gaps within the disaster risk management cycle (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). The findings of this research can contribute to providing a comprehensive framework for the optimal utilization of orthoses and prostheses in natural disaster management, particularly in emergency situations and natural disasters (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). By enhancing preparedness and timely response, and through the application of orthotic and prosthetic technologies, further injuries can be effectively prevented and the rehabilitation process facilitated (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Therefore, this study aims to develop a strategic framework for integrating orthotic and prosthetic solutions into disaster risk management, thereby enhancing the effectiveness of preparedness, response, and rehabilitation efforts.\u003c/p\u003e"},{"header":"Methods/Design","content":"\u003cp\u003eThis protocol for a multi-method study will proceed in three phases: A systematic scoping review, qualitative content analysis, and the Delphi method. Also, every phase is aimed to achieve a specific research goal thus, strengthening the unified approach targeted to achieving the study objectives.\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eA Systematic Scoping\u0026ensp;Review\u003c/b\u003e \u003c/p\u003e \u003c/li\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eThe scoping review will follow the established five-step framework proposed by Arksey and O'Malley (2005) (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e), which includes:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eDeveloping a research question\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eIdentifying relevant studies\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eSelecting studies based on inclusion/exclusion criteria\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eOrganizing and charting data\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eCollating, summarizing, and reporting the results\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eThe reporting of the review will follow the PRISMA extension for Scoping Reviews (PRISMA-ScR) to enhance transparency and reproducibility.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e1\u0026ndash;1 Research Question Development\u003c/h2\u003e \u003cp\u003eThese research questions will be raised regarding the integration of orthoses and prostheses across all stages of disaster risk management:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eAre established pre-disaster prevention guidelines and plans implemented, and what protocols exist for the storage and maintenance of relevant resources?\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eWhat types of orthotic and prosthetic solutions are utilized during disaster response?\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eWhat is the established referral system for orthotic and prosthetic services, and what are the follow-up procedures for patients receiving such devices?\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eHow do orthotic and prosthetic interventions impact patient outcomes in disaster-affected regions?\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003e1-2 Identifying Relevant Studies\u003c/h3\u003e\n\u003cp\u003eThe search strategy will involve conducting literature searches using keywords and medical subject headings (MeSH) terms. Various database sources will be explored, such as PubMed, Embase, Web of Science, and Scopus. Additionally, a hand search will be performed, including searches in Google Scholar and the reference lists of key studies. Articles will be organized using EndNote. A sample of the search strategy employed across the databases is provided in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eExample of Search Strategy for PubMed Database\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"1\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(\"Emergencies\"[MeSH Terms] OR (\"Disasters\"[MeSH Terms] OR \"Disaster Victims\"[MeSH Terms] OR \"Natural Disasters\"[MeSH Terms] OR \"Earthquakes\"[MeSH Terms] OR \"Floods\"[MeSH Terms] OR \"Mass Casualty Incidents\"[MeSH Terms])) AND (\"wounds and injuries/rehabilitation\"[MeSH Terms] OR (\"fractures, bone/epidemiology\"[MeSH Terms] OR \"fractures, bone/rehabilitation\"[MeSH Terms]) OR (\"Orthotic Devices\"[MeSH Terms] OR \"Self-Help Devices\"[MeSH Terms] OR \"Artificial Limbs\"[MeSH Terms] OR \"Braces\"[MeSH Terms] OR \"Walkers\"[MeSH Terms] OR \"Crutches\"[MeSH Terms] OR \"Canes\"[MeSH Terms] OR \"Foot Orthoses\"[MeSH Terms] OR \"Splints\"[MeSH Terms] OR \"Prostheses and Implants\"[MeSH Terms] OR \"prosthesis\"[Title/Abstract] OR \"prosthetics\"[Title/Abstract] OR \"amputation, surgical\"[MeSH Terms] OR \"amputation, traumatic\"[MeSH Terms] OR \"Amputation Stumps\"[MeSH Terms]))\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003e1-3 Study Selection\u003c/h3\u003e\n\u003cp\u003eThe selection process will involve two rounds of screening. Initially, titles and abstracts will be independently screened by two reviewers for relevance. Subsequently, full-text articles meeting the inclusion criteria (English language and accessible) will be thoroughly reviewed. Any disagreements will be resolved through discussion until consensus is reached, and inter-rater reliability will be assessed using Cohen's kappa coefficient.\u003c/p\u003e\n\u003ch3\u003e1-4 Organizing and Charting Data\u003c/h3\u003e\n\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe charting process will be guided by the research questions, ensuring that data is collected and organized in a way that directly addresses the objectives of the study.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003e1-5 Collating, summarizing, and reporting the results\u003c/h3\u003e\n\u003cp\u003eCollating, summarizing, and reporting the results involves gathering all extracted data, distilling it into key findings and insights, and presenting it in a structured format. This process highlights common themes, gaps, and trends, and discusses the implications for practice, policy, and future research.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2- Qualitative Content Analysis\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eIn this phase, the experiences of researchers in integrating orthotic and prosthetic solutions into disaster risk management will be explored using a conventional content analysis study following Graneheim and Lundman's (2004) approach. This will include discussions on existing practices and challenges in disaster risk management and rehabilitation. Additionally, recommendations and solutions proposed by the researchers to address these challenges will be extracted(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003e2-1 Study Population\u003c/h3\u003e\n\u003cp\u003eThe study population comprises healthcare providers, policymakers, and service providers with experience in disaster risk management and rehabilitation involving orthotic and prosthetic solutions (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003e2-2 Selection of Participants\u003c/h3\u003e\n\u003cp\u003eParticipants will be purposefully selected based on inclusion criteria such as experience in disaster risk management and rehabilitation, willingness to participate in the study, and the ability to articulate their experiences and insights.(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e2-3 Data Collection\u003c/h2\u003e \u003cp\u003eData will be collected through in-depth, semi-structured interviews. An interview guide will be developed and calibrated through preliminary interviews, containing opening, main, probe, and follow-up questions based on participants' responses. For example, participants might be asked, \u0026ldquo;In the disaster scenarios you have experienced, what practices have you used to effectively integrate orthotic and prosthetic solutions?\u0026rdquo; or \u0026ldquo;What challenges have you faced in incorporating these solutions during different stages of disaster management?\u0026rdquo; Interviews will be scheduled after obtaining necessary permits and coordinating with participants on timing and location. Before starting an interview, the researcher will introduce themselves to the interviewee and explain the research purpose, the possibility of recording the participant\u0026rsquo;s voice, the principle of information confidentiality, and the participant\u0026rsquo;s right to withdraw from the study. Informed consent will be obtained in written or oral form (along with recording the participant\u0026rsquo;s voice). Informed consent will be ensured throughout the research process, from the beginning of an interview, during and after an interview, and until the research ends, if needed, to ensure the participant\u0026rsquo;s willingness to continue. Data collection and interviews will continue until data saturation occurs, meaning the categories are sufficiently enriched, and no new concepts are emerging (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e2-4 \u003cb\u003eData Analysis\u003c/b\u003e\u003c/h2\u003e \u003cp\u003eData analysis will follow Graneheim and Lundman's (2004) approach. Concurrently with data collection, data analysis will begin. Each recorded interview will be transcribed word by word, with attention to the participant\u0026rsquo;s tone. The researcher will read the interview text multiple times to gain a general understanding of the study atmosphere. The analysis will involve a line-by-line examination of the text, dividing it into meaning units related to the study\u0026rsquo;s purpose. Condensation and coding will then be performed. After coding, the codes will be sorted into sub-categories based on their differences and similarities, named based on their content. These sub-categories will be grouped into categories. As the analysis progresses, the researcher will move towards latent content analysis to identify underlying themes (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e3- Delphi Method\u003c/h2\u003e \u003cp\u003eIn the final phase of this study, the Delphi method will be employed to develop and refine comprehensive recommendations for the integration of orthotic and prosthetic solutions into disaster risk management. The Delphi method is a structured communication technique that relies on a panel of experts. Through multiple rounds of questioning, the method aims to achieve consensus on key issues related to the research objectives (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e3-1 Selection of Experts\u003c/h2\u003e \u003cp\u003eExperts will be selected based on their extensive experience and knowledge in disaster risk management, orthotic and prosthetic rehabilitation, and related fields. Inclusion criteria will include recognized expertise, a track record of relevant publications, and a willingness to participate in multiple rounds of surveys (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e3-2 Data Collection\u003c/h2\u003e \u003cp\u003eThe Delphi process will begin with an initial questionnaire, designed based on the findings from the scoping review and qualitative content analysis. The questionnaire will seek expert opinions on the integration of orthotic and prosthetic solutions in disaster risk management, including best practices, challenges, and potential strategies.\u003c/p\u003e \u003cp\u003eRound 1: In the first round, experts will be asked to provide their insights and suggestions in response to open-ended questions. Their responses will be analyzed and summarized to identify common themes and areas of agreement.\u003c/p\u003e \u003cp\u003eRound 2: In the second round, a refined questionnaire will be distributed, incorporating the summarized findings from the first round. Experts will be asked to review and rate the importance of each item using a Likert scale. Additional comments and suggestions will be encouraged.\u003c/p\u003e \u003cp\u003eRound 3 and Beyond: Subsequent rounds will involve further refining and narrowing down the recommendations based on expert feedback. Consensus will be sought on the key recommendations and strategies for integrating orthotic and prosthetic solutions into disaster risk management. The process will continue until a stable level of agreement is achieved.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e3-3 Data Analysis\u003c/h2\u003e \u003cp\u003eThe responses from each round will be analyzed using descriptive statistics to measure the level of consensus among experts. Themes and patterns will be identified to develop a comprehensive set of recommendations. The final set of recommendations will be synthesized and validated by the expert panel.\u003c/p\u003e \u003c/div\u003e \u003cp\u003e\u003cstrong\u003eEthical Considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipation This study will adhere to strict ethical standards throughout all phases. Key ethical considerations include:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eInformed Consent\u003c/strong\u003e: Participants will be fully informed about the purpose, methods, and potential benefits and risks of the study. Informed consent will be obtained before participation, either in written or oral form, with the recording of the participant\u0026rsquo;s voice. Participants will be made aware of their right to withdraw from the study at any time without consequences.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eConfidentiality and Anonymity\u003c/strong\u003e: Confidentiality and anonymity of participants will be maintained throughout the study. Personal identifiers will be removed from transcripts and reports, and data will be stored securely to prevent unauthorized access.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eVoluntary Participation\u003c/strong\u003e: Participation in the study will be entirely voluntary. Participants will not receive any compensation for their involvement and will be free to withdraw at any point without providing a reason.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eData Protection\u003c/strong\u003e: All data collected during the study will be securely stored and only accessible to authorized members of the research team. Data will be anonymized to protect participants\u0026apos; identities, and any identifying information will be kept separate from the research data.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eMinimizing Harm\u003c/strong\u003e: The study will be designed to minimize any potential harm or discomfort to participants. Researchers will be sensitive to participants\u0026apos; well-being and will take steps to address any concerns or issues that arise during the study.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eEthical Approval\u003c/strong\u003e: The study protocol will be reviewed and approved by an appropriate ethics committee of the University of Social Welfare and Rehabilitation Sciences to ensure that it meets ethical standards and guidelines for conducting research involving human participants.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eTransparency and Honesty\u003c/strong\u003e: The researchers will maintain transparency and honesty in reporting the study\u0026apos;s aims, methods, findings, and potential conflicts of interest. Any limitations of the study will be openly discussed.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eBy adhering to these ethical principles, the study aims to protect the rights and well-being of all participants while ensuring the integrity and validity of the research findings.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis protocol outlines a comprehensive multi-method study designed to strategically integrate orthotic and prosthetic solutions into disaster risk management. By employing a systematic scoping review, qualitative content analysis, and the Delphi method, the study aims to develop a robust framework to enhance service delivery, address existing gaps, and respond effectively to user needs. The findings will inform the creation of context-specific action plans that improve disaster preparedness, response, and rehabilitation efforts. Ultimately, this study aspires to optimize the utilization of orthotic and prosthetic devices, elevate the quality of care, and reinforce disaster management systems on a global scale.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study will be conducted with the approval of the Ethics Committee of the University of Rehabilitation Sciences and Social Health.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no Conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere is no funding for this project.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFSE: Conceptualization, Methodology, Project administration, Writing \u0026ndash; original draft, Writing - review \u0026amp; editing.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHKh: Conceptualization, Methodology\u003c/p\u003e\n\u003cp\u003eFHkh: Drafting of the Protocol, Writing \u0026ndash; original draft\u003c/p\u003e\n\u003cp\u003eMM: Drafting of the Protocol, Writing \u0026ndash; original draft\u003c/p\u003e\n\u003cp\u003eMS: Methodology, Writing - review \u0026amp; editing, and supervision\u003c/p\u003e\n\u003cp\u003eShSh:, Methodology, Writing - review \u0026amp; editing, and supervision\u003c/p\u003e\n\u003cp\u003eAll authors gave final approval for publication and agreed to be held accountable for the work performed therein.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank the University of Social Welfare and Rehabilitation Sciences for their support, without which this study would not have been possible.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eNaidu P, Dominguez LB, Trelles M, Chu KMJWjos. Traumatic injuries are the main indication for limb amputations during and after humanitarian crises. 2021;45:1021-5.\u003c/li\u003e\n\u003cli\u003eSermonesi G, Bertelli R, Pieracci FM, Balogh ZJ, Coimbra R, Galante JM, et al. Surgical stabilization of rib fractures (SSRF): the WSES and CWIS position paper. 2024;19(1):33.\u003c/li\u003e\n\u003cli\u003eG\u0026ouml;kmen MY, Ulu\u0026ouml;z M, Pazarcı \u0026Ouml;, \u0026Ccedil;iloğlu O, Varmış HOJSJoT, Resuscitation, Medicine E. Aftermath T\u0026uuml;rkiye\u0026rsquo;s double earthquake: detailed analysis of fracture characteristics and acute management from a level I trauma center. 2024;32(1):43.\u003c/li\u003e\n\u003cli\u003eRedmond AD, Mardel S, Taithe B, Calvot T, Gosney J, Duttine A, et al. A qualitative and quantitative study of the surgical and rehabilitation response to the earthquake in Haiti, January 2010. 2011;26(6):449-56.\u003c/li\u003e\n\u003cli\u003eBurns AS, O\u0026apos;Connell C, Rathore FAJJoRM. Meeting the challenges of spinal cord injury care following sudden onset disaster\u0026ndash;lessons learned. 2012;44(5):414-20.\u003c/li\u003e\n\u003cli\u003eTurgut N, \u0026Ouml;zg\u0026ouml;zen AL, Beyaz SJQMJ. Evaluation of musculoskeletal system injuries after the 2023 Kahramanmaraş Turkey earthquakes: Our single-center experience. 2024;2024(1):10.\u003c/li\u003e\n\u003cli\u003eGosney J, Reinhardt J, Von Groote P, Rathore F, Melvin JJSc. Medical rehabilitation of spinal cord injury following earthquakes in rehabilitation resource-scarce settings: implications for disaster research. 2013;51(8):603-9.\u003c/li\u003e\n\u003cli\u003eMallick M, Aurakzai J, Bile K, Ahmed NJE-EMHJ, 16 , 98-105,. Large-scale physical disabilities and their management in the aftermath of the 2005 earthquake in Pakistan. 2010.\u003c/li\u003e\n\u003cli\u003eWong CN-C, Yu JM-K, Law S-W, Lau HM-C, Chan CK-MJJoos, research. Bilateral transtibial amputation with concomitant thoracolumbar vertebral collapse in a Sichuan earthquake survivor. 2010;5:1-9.\u003c/li\u003e\n\u003cli\u003eLi Y, Pan F, Li YJJoEBM. Analysis of rehabilitation needs, measures taken, and their effectiveness for the wounded following the Wenchuan Earthquake. 2009;2(4):258-64.\u003c/li\u003e\n\u003cli\u003eDemey DJIo. Post-amputation rehabilitation in an emergency crisis: from preoperative to the community. 2012;36:2003-5.\u003c/li\u003e\n\u003cli\u003eWolfson NJIo. Orthopaedic triage during natural disasters and mass casualties: do scoring systems matter? 2013;37:1439-41.\u003c/li\u003e\n\u003cli\u003eTelefon AH, \u0026Ccedil;elik \u0026Uuml;, Afat Turgut E, Kandemir G\u0026uuml;lmez T, Kılı\u0026ccedil; \u0026Ccedil;il M, S\u0026ouml;nmez G, et al. 2023 catastrophic Turkey earthquake: clinical outcomes of pediatric patients rescued under the rubble. 2024(just-accepted).\u003c/li\u003e\n\u003cli\u003eGuner S, Guner SI, Isik Y, Gormeli G, Kalender AM, Turktas U, et al. Review of Van earthquakes form an orthopaedic perspective: a multicentre retrospective study. 2013;37:119-24.\u003c/li\u003e\n\u003cli\u003eRauch A, Baumberger M, Moise F-G, von Elm E, Reinhardt Jan DJJorm. Rehabilitation needs assessment in persons with spinal cord injury following the 2010 earthquake in Haiti: a pilot study using an ICF-based tool. 2011;43(11):969-75.\u003c/li\u003e\n\u003cli\u003eAsfuroğlu ZM, G\u0026ouml;kosmanoğulları SF, \u0026Ccedil;olak M, Yılmaz C, Eskandari MMJTJoT, Surgery E. First 10 days after the 6th of February 2023 earthquake disaster: experience of an orthopedic clinic on the border of the disaster zone. 2023;29(10):1191.\u003c/li\u003e\n\u003cli\u003eAwais SM, Dar UZ, Saeed AJIo. Amputations of limbs during the 2005 earthquake in Pakistan: a firsthand experience of the author. 2012;36:2323-6.\u003c/li\u003e\n\u003cli\u003eArksey H, O\u0026apos;malley L. Scoping studies: towards a methodological framework. International journal of social research methodology. 2005;8(1):19-32.\u003c/li\u003e\n\u003cli\u003eGraneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse education today. 2004;24(2):105-12.\u003c/li\u003e\n\u003cli\u003eKhankeh H, Shirozhan S. Applied Qualitative research in healthcare: Jame-e-Negar.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Orthoses, Prostheses, Disasters, Natural Disasters, Rehabilitation, Disaster Risk Management","lastPublishedDoi":"10.21203/rs.3.rs-6200926/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6200926/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePhysical injuries after disasters often result in a high volume of casualties with fractures, lacerations, and amputations, which can disrupt emergency care for those in need. Providing primary care through orthotic and prosthetic solutions can effectively manage these injuries, reducing the need for emergency surgery and preventing subsequent injuries and complications. This necessitates a comprehensive framework for preparedness before disasters occur, as well as a timely response during and after the event. This study aims to develop such a framework for the strategic integration of orthotic and prosthetic solutions in disaster risk management, thereby enhancing preparedness and response, preventing further injuries, and facilitating rehabilitation.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis multimethod study protocol encompasses a systematic scoping review, qualitative content analysis, and the Delphi method, each phase targeting specific research goals to achieve a unified approach. The initial phase involves a systematic scoping review adhering to the Arksey and O'Malley five-step framework and PRISMA-ScR reporting guidelines, identifying key studies related to the integration of orthoses and prostheses across disaster risk management stages. The second phase employs qualitative content analysis through semi-structured interviews with healthcare providers, policymakers, and service providers, capturing their perspectives on the use of orthotic and prosthetic solutions in disaster emergency situations. The final phase utilizes the Delphi method to iteratively refine and develop comprehensive recommendations for integrating orthotic and prosthetic solutions into disaster management.\u003c/p\u003e\u003ch2\u003eDiscussion\u003c/h2\u003e \u003cp\u003eDeveloping a framework for the management of orthotic and prosthetic treatments, guided by a structured study protocol, can help researchers recognize evidence and gaps in international research. Integrating existing evidence with the experiences of rehabilitation specialists enriches the findings of studies in the field of accidents and disasters. The results of this study will acquaint researchers and stakeholders with the critical role of rehabilitation in disaster risk management.\u003c/p\u003e","manuscriptTitle":"Strategic Integration of Orthotic and Prosthetic Solutions in Disaster Risk Management: A Multi-method Study Protocol","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-13 04:10:43","doi":"10.21203/rs.3.rs-6200926/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2785b316-49f7-42f6-bc47-ec86b8af1488","owner":[],"postedDate":"March 13th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-03-13T09:53:49+00:00","versionOfRecord":[],"versionCreatedAt":"2025-03-13 04:10:43","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6200926","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6200926","identity":"rs-6200926","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}