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Ridgewell, Emily, Michael Dillon, Jackie O'Connor, Sarah Anderson, and Leigh Clarke. "Demographics of the Australian orthotic and prosthetic workforce 2007–12." Australian Health Review 40, no. 5 (2016): 555. http://dx.doi.org/10.1071/ah15147.
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Objective Health workforce data are vital to inform initiatives to meet the future healthcare needs of our society, but there are currently no data describing the Australian orthotic and prosthetic workforce. The aim of the present study was to describe demographic changes in the Australian orthotic and prosthetic workforce from 2007 to 2012. Methods In the present retrospective time series study, data from the Australian Orthotic Prosthetic Association member database were analysed for trends from 2007 to 2012. Data describing the absolute number of practitioners, the number of practitioners per 100 000 population, age, gender, state or territory of residence and service location (i.e. metropolitan, regional and remote) were analysed for significant changes over time using linear regression models. Results Although the number of orthotist/prosthetists in Australia increased (P = 0.013), the number of orthotist/prosthetists per 100 000 population remained unchanged (P = 0.054). The workforce became younger (P = 0.004) and more female (P = 0.005). Only Victoria saw an increase in the proportion of orthotist/prosthetists in regional and remote areas. There was considerable state-to-state variation. Only Victoria (P = 0.01) and Tasmania (P = 0.003) saw an increase in the number of orthotist/prosthetists per 100 000 population. Conclusions The orthotic and prosthetic workforce has increased proportionately to Australia’s population growth, become younger and more female. The proportion of practitioners in regional and remote areas has remained unchanged. These data can help inform workforce initiatives to increase the number of orthotist/prosthetists relative to the Australian population and make the services of orthotist/prosthetists more accessible to Australians in regional and remote areas. What is known about the topic? Currently, there are no demographic data describing changes in the Australian orthotic and prosthetic workforce over time. These data are vital to inform initiatives to increase the size of the workforce, locate practitioners where health services are most needed and thereby plan to meet the future health care needs of our society. What does this paper add? This paper describes changes in the Australian orthotic and prosthetic workforce, where previously these data have not been available as part of federal initiatives to plan for future workforce needs. What are the implications for practitioners? Demographic data describing changes in the orthotic and prosthetic workforce are needed to inform workforce initiatives that improve access in regional and remote Australia, and retain a younger and more female workforce.
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Farahmand, Behshid, Maryam Mohammadi, Babak Hassanbeygi, Morteza Mohammadi, Hassan Saeedi, and Masumeh Bagherzadeh Cham. "Ergonomic Evaluation of Working Conditions in Orthotists and Prosthetists by Rapid Entire Body Assessment (REBA)." Function and Disability Journal 15, no. 3 (December 30, 2021): 169–78. http://dx.doi.org/10.32598/fdj.3.22.
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Background and Objectives: This study aimed to determine the prevalence rate of musculoskeletal disorders and evaluate the body position in routine tasks among orthotists and prosthetists. Methods: Forty orthotists and prosthetists were included. The scores of the Nordic Musculoskeletal Questionnaire and the Rapid Entire Body Assessment were used to determine the prevalence rate of musculoskeletal disorders and analyze the work position of orthotists and prosthetists, respectively. An examiner evaluated 10 working postures that were dominantly used every day, in each orthotist and prosthetist. Results: Among the orthotists, 55.6% of men and 47% of women suffered from pain in the trunk, neck, and lower limbs. Nearly similar results were seen in the upper limbs (74.1% men and 45.5% women). Such high prevalence rates were not seen in prosthetists. The analysis of the Rapid Entire Body Assessment scores based on the working task and gender of the orthotist and prosthetist showed that more than 60% of the workers achieved a score of 4 to 7 approximately in half of the tasks. It shows the medium risk of musculoskeletal disorders, thus, corrective action is necessary. Conclusion: Based on the findings, musculoskeletal disorders are highly prevalent among orthotists and prosthetists, especially in the orthotist workers. To reduce these disorders, it is recommended to add ergonomic topics and training courses for working with devices to increase the knowledge of specialists and apply and select practical tools based on the principles of ergonomics.
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Boone, David. "Prosthetists and orthotists: An evolution from mechanic to clinician." Prosthetics and Orthotics International 44, no. 6 (November 6, 2020): 368–72. http://dx.doi.org/10.1177/0309364620968643.
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Fifty years ago, the International Society for Prosthetics and Orthotics was founded in recognition that this unique niche in rehabilitation would benefit from multidisciplinary interactions between specialists in engineering, therapy, and medicine.Since then, field evolved from having a craft orientation toward a technology and clinical specialty. This anniversary provides an opportunity to look back on advances in prosthetics and orthotics, and the clear impact they have had on changing the skills needed by the prosthetist/orthotist as new technology and techniques have emerged. The balance has clearly shifted from mechanical skills to clinical care. The training and skills of the prosthetist/orthotist remain unique and valued in the rehabilitation team, and the primary motivation remains the same as it has been since the creation of the International Society for Prosthetics and Orthotics: the application of external devices where they are suitable to address the many varied needs of persons with disability. This historical perspective puts into context why and how the profession has changed, while also reinforcing that it is the goals set for restoring patient functions that best defines what it is to be a prosthetist/orthotist, not the means we use.
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Grobler, Ilzé, Gertina J. van Schalkwyk, and Claire Wagner. "The Application of Critical Psychology to Facilitate Reflective Clinical Practice in Orthotics/Prosthetics." Prosthetics and Orthotics International 30, no. 3 (December 2006): 237–45. http://dx.doi.org/10.1080/07434610500483794.
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The co-construction of a psychology module for a postgraduate training course in orthotics/prosthetics is socially constructed for the first time in Southern African history. This paper elucidates the integration of theory and practice in a model for the development of a professional identity as orthotist/prosthetist. In creating a context where trainees can learn to develop their practice while also enabling them to deconstruct notions of ‘expert knowledge’, orthotist/prosthetists move from a position of scientist-practitioner to negotiating an alternative position of reflective practitioner. In the process of co-constructing knowledge, an alternative story of teaching and learning evolves. The result is a celebration of life as it is really lived by health professionals.
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Magnusson, Lina. "Professionals’ perspectives of prosthetic and orthotic services in Tanzania, Malawi, Sierra Leone and Pakistan." Prosthetics and Orthotics International 43, no. 5 (July 15, 2019): 500–507. http://dx.doi.org/10.1177/0309364619863617.
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Background: Evidence-based recommendations are lacking for prosthetic and orthotic services in low- and lower-middle-income countries. Objectives: The aim of this study was to compare and synthesise findings related to experiences of prosthetic and orthotic service delivery in Tanzania, Malawi, Sierra Leone and Pakistan from the perspective of local professionals. Study design: This is a qualitative inductive study. Methods: A total of 49 associated prosthetists/orthotists and prosthetic/orthotic technicians participated in individual interviews. The second-order concept analysis was applied to the data. Results: Four common themes emerged: low awareness and prioritisation of prosthetic and orthotic services; difficulty managing specific pathological conditions and problems with materials; limited access to prosthetic and orthotic services; and the need for further education and desire for professional development. A further theme was unique to Sierra Leone: people with disabilities have low social status. Conclusion: Local professionals felt unable to deliver high-quality prosthetic and orthotic services. Prosthetic and orthotic education needs to be adjusted to various countries’ regulations to be recognised as allied health professions. Rehabilitation and prosthetic and orthotic service delivery need to be further integrated in low- and lower-middle-income countries’ regular health systems to increase effective person-centred rehabilitation and to address governments’ low awareness and low prioritisation of prosthetic and orthotic services. Clinical relevance The results can inform international guidelines and curriculum development for associate prosthetist/orthotist education to better prepare graduates for the clinical scenario and attempts to improve prosthetic and orthotic service delivery programmes in low- and lower-middle-income countries.
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Binedell, Trevor, Karupppasamy Subburaj, Yoko Wong, and Lucienne T. M. Blessing. "Leveraging Digital Technology to Overcome Barriers in the Prosthetic and Orthotic Industry: Evaluation of its Applicability and Use During the COVID-19 Pandemic." JMIR Rehabilitation and Assistive Technologies 7, no. 2 (November 5, 2020): e23827. http://dx.doi.org/10.2196/23827.
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Background The prosthetic and orthotic industry typically provides an artisan “hands-on” approach to the assessment and fitting of orthopedic devices. Despite growing interest in digital technology for prosthetic and orthotic service provision, little is known of the quantum of use and the extent to which the current pandemic has accelerated the adoption. Objective This study’s aim is to assess the use of digital technology in prosthetics and orthotics, and whether its use can help overcome challenges posed by the current COVID-19 pandemic. Methods A web-based survey of working prosthetists, orthotists, and lower limb patients was conducted between June and July 2020 and divided into three sections: lower limb amputees, prosthetist and orthotist (P&O) currently using digital technologies in their practice, and P&O not using any digital technology. Input was sought from industry and academia experts for the development of the survey. Descriptive analyses were performed for both qualitative (open-ended questions) and quantitative data. Results In total, 113 individuals responded to the web-based survey. There were 83 surveys included in the analysis (patients: n=13, 15%; prosthetists and orthotists: n=70, 85%). There were 30 surveys excluded because less than 10% of the questions were answered. Out of 70 P&Os, 31 (44%) used digital technologies. Three dimensional scanning and digital imaging were the leading technologies being used (27/31, 88%), primarily for footwear (18/31, 58%), ankle-foot orthoses, and transtibial and transfemoral sockets (14/31, 45%). Digital technology enables safer care during COVID-19 with 24 out of 31 (77%) respondents stating it improves patient outcomes. Singapore was significantly less certain that the industry's future is digital (P=.04). The use of virtual care was reported by the P&O to be beneficial for consultations, education, patient monitoring, or triaging purposes. However, the technology could not overcome inherent barriers such as the lack of details normally obtained during a physical assessment. Conclusions Digital technology is transforming health care. The current pandemic highlights its usefulness in providing safer care, but digital technology must be implemented thoughtfully and designed to address issues that are barriers to current adoption. Technology advancements using virtual platforms, digitalization methods, and improved connectivity will continue to change the future of health care delivery. The prosthetic and orthotic industry should keep an open mind and move toward creating the required infrastructure to support this digital transformation, even if the world returns to pre–COVID-19 days.
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Takizawa, Sachiko. "The viewpoint of a prosthetist/orthotist." Journal of Japanese Society of Limb Salvage and Podiatric Medicine 9, no. 3 (2017): 166–74. http://dx.doi.org/10.7792/jlspm.9.166.
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Michael, John W. "KAFOs for Ambulation: An Orthotist???s Perspective." JPO Journal of Prosthetics and Orthotics 18, Proceedings (June 2006): P187—P191. http://dx.doi.org/10.1097/00008526-200606001-00007.
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Anderson, Sarah, Rwth Stuckey, and Jodi R. Oakman. "Prosthetists’ and Orthotists’ experience of their work and workspace – characterising the physical and organisational environment: Focus group findings." Prosthetics and Orthotics International 40, no. 6 (July 10, 2016): 703–12. http://dx.doi.org/10.1177/0309364615592702.
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Background:Little research has been undertaken into occupational health and safety in the Prosthetics and Orthotics profession.Objectives:To identify physical, psychosocial and environmental workplace experiences of Prosthetists and Orthotists in organisational settings.Study design:Qualitative methodology, cross-sectional design, using thematically analysed data collected from focus groups.Methods:Focus groups explored workplace and work experiences across varied Prosthetic and Orthotic settings. Data were thematically analysed to identify physical, psychosocial and environmental workplace experiences.Results:Three major themes, Demands of Work Practice, Impacts on the Individual and Job Design, were identified as problematic. A latent theme Perceptions of Others of P&O highlighted a lack of understanding of the Prosthetics and Orthotics job role outside the profession.Conclusion:This first study of occupational health and safety in the Prosthetics and Orthotics profession identifies a number of important physical and psychosocial issues, including characteristics that have been previously identified as risk factors for work-related musculoskeletal disorders. Findings from the study indicate that some Australian organisations lack understanding of the Prosthetics and Orthotics job role, which results in inappropriate expectations of Prosthetics and Orthotics professionals. Preventing injuries and retaining experienced Prosthetists and Orthotists in the workplace is vital for the profession, and as a result, issues raised in this study require further exploration and then development of appropriate management strategies.Clinical relevanceThis is the first study characterising the experiences of work and risk of injuries in Prosthetists and Orthotists. Preventing injuries and retaining experienced Prosthetists and Orthotists in the workplace is vital for the international profession. Issues raised in this study require further exploration and then development of appropriate management strategies.
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Magnusson, Lina, and Nerrolyn Ramstrand. "Prosthetist/orthotist educational experience & professional development in Pakistan." Disability and Rehabilitation: Assistive Technology 4, no. 6 (January 2009): 385–92. http://dx.doi.org/10.3109/17483100903024634.
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Desmond, Deirdre, and Pamela Gallagher. "Reflections and future directions for psychological science in Prosthetics and Orthotics International." Prosthetics and Orthotics International 44, no. 6 (November 8, 2020): 402–7. http://dx.doi.org/10.1177/0309364620967780.
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In the inaugural edition of Prosthetics and Orthotics International in 1977, Dr Sidney Fishman identified the Psychological Sciences as one of six indispensable areas of skill and knowledge in professional prosthetic–orthotic practice. Since then, there have been substantial changes and developments in the complexity and capabilities of assistive technologies, greater emphasis on understanding the relationships between people and enabling technologies, growing recognition of the importance of the contexts and environments that support their use, and changes in both health care services and the professional development of prosthetists and orthotists. The aim of this narrative review is to reflect on the role of Prosthetics and Orthotics International in shaping the evolving understanding of psychology in prosthetics and orthotics. There remains considerable potential and opportunity for the development and application of psychology in addressing the challenges of disability globally. However, a broad interpretation and application of the principles of rehabilitation psychology are needed if we are to meaningfully incorporate psychological science into the knowledge that informs prosthetic and orthotic practice.
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Deppen, Robert J., and David M. Babins. "Indications for Referral: Orthotist, Physical Therapist, Podiatrist—What's the Difference?" Journal of Back and Musculoskeletal Rehabilitation 2, no. 4 (October 1, 1992): 63–69. http://dx.doi.org/10.3233/bmr-1992-2408.
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Chen, R. C.-C., and M. Lord. "A comparison of trial shoe and shell shoe fitting techniques." Prosthetics and Orthotics International 19, no. 3 (December 1995): 181–87. http://dx.doi.org/10.3109/03093649509168002.
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In Europe, bespoke orthopaedic shoes are usually sent for a trial fitting in order to check the fit and indicate any modifications required before final finishing. The use of shell shoes at the fit assessment stage, rather than the traditional alternative of partially or fully finished shoes, can offer service advantages, and is widely used for example in the Netherlands. However the comparability of shell fit assessment with the traditional method of trial shoe fit assessment has not been evaluated, either to assess its sensitivity or to elucidate any difference in assessment technique required of the orthotist. In this work, the results of fit assessments by both methods are compared. The trial involved a group of normal subjects wearing high street shoes of styles similar to those used for orthopaedic footwear. The results indicate that the shell fit assessments were in the main comparable to those for trial shoe fit. The only consistent area of deviation noted, in the heel at the topline, is attributable to a construction factor in shoe making. Apart from this area, the orthotist need not adjust his technique to make use of the shell method.
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Barber, Edward L. "Strength and Range-of-Motion Examination Skills for the Clinical Orthotist." JPO Journal of Prosthetics and Orthotics 5, no. 2 (April 1993): 49/37–51/39. http://dx.doi.org/10.1097/00008526-199304000-00006.
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Polliack, Adrian A., Sarah Elliot, Carin Caves, Donald R. McNeal, and Samuel E. Landsberger. "Lower Extremity Orthoses for Children with Myelomeningocele: User and Orthotist Perspectives." JPO Journal of Prosthetics and Orthotics 13, no. 4 (December 2001): 123–29. http://dx.doi.org/10.1097/00008526-200112000-00012.
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Forghany, Saeed, Ebrahim Sadeghi-Demneh, Ursula Trinler, Pornsuree Onmanee, Michael P. Dillon, and Richard Baker. "The influence of staff training and education on prosthetic and orthotic service quality: A scoping review." Prosthetics and Orthotics International 42, no. 3 (July 18, 2017): 258–64. http://dx.doi.org/10.1177/0309364617718412.
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Background: Education and training in prosthetics and orthotics typically comply with International Society for Prosthetics and Orthotics standards based on three categories of prosthetic and orthotic professionals. Objective: This scoping study sought to describe the evidence base available to answer the question, How are prosthetic and orthotic services influenced by the training of staff providing them? Study design: Scoping review. Methods: A structured search of the peer-reviewed literature catalogued in major electronic databases yielded 3039 papers. Following review of title and abstract, 93 articles were considered relevant. Full-text review reduced this number to 25. Results: Only two articles were identified as providing direct evidence of the effects of training and education on service provision. While both suggested that there was an impact, it is difficult to see how the more specific conclusions of either could be generalised. The other 23 articles provide a useful background to a range of issues including the specification of competencies that training programmes should deliver (3 articles), descriptions of a range of training programmes and the effects of training and education on student knowledge and skills. Conclusion: Although it is considered axiomatic, the service quality is dependent on practitioner education and training. There is insufficient evidence to establish whether levels of training and education in prosthetics and orthotics have an effect on the quality of prosthetic and orthotic services. Clinical relevance There is very little evidence about the effects of training and education of prosthetists and orthotists on service quality. While this is a somewhat negative finding, we feel that it is important to bring this to the attention of the prosthetics and orthotics community.
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May, C. S., M. J. Broadhurst, and R. E. Major. "Comparison of rocking edge spacing for two common designs of swivel walkers." Prosthetics and Orthotics International 28, no. 1 (April 2004): 75–80. http://dx.doi.org/10.3109/03093640409167930.
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Two commonly used designs of swivel walker are the Consort 800 and the ORLAU 1000. This paper examines how the footplate rocking edge spacing varies between these two designs and then considers how lateral stability might be influenced if reduced separation is introduced to facilitate ambulation for less able users. In general it is shown that there should be no obstacles to such variation on the part of an orthotist thereby improving access to these devices and function for disabled individuals.
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Ramstrand, Nerrolyn. "Translating research into prosthetic and orthotic practice." Prosthetics and Orthotics International 37, no. 2 (August 5, 2012): 108–12. http://dx.doi.org/10.1177/0309364612451268.
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Background: Evidence-based practice is commonly accepted as a means of improving patient outcomes; however, there is little understanding of the processes required to successfully implement it into prosthetic and orthotic practice. Objectives: To discuss factors affecting adoption of evidence-based practice and present a theoretical framework for its implementation into prosthetic and orthotic practice. Discussion: Numerous factors that affect adoption of evidence-based practice are discussed, ranging from individual factors to those that can be attributed to administrative and environmental issues. Specific factors are likely to be context specific and are influenced by the manner in which evidence-based practice is introduced into the working environment. It is argued that successful implementation of evidence-based practice requires consideration of numerous interrelated factors. A formal translating research into practice model is presented as a means of developing a strategic plan that considers all relevant factors and maximizes acceptance of evidence-based practice into prosthetics and orthotics clinical practice. Conclusions: The use of a theoretical model for implementation of evidence-based practice is likely to improve its adoption by prosthetic and orthotic clinicians. Clinical relevance The demand for prosthetists/orthotists to utilize evidence-based practice is increasing. Lack of strategic planning throughout the implementation phase is likely to compromise adoption of evidence-based practices by clinicians.
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Leung, A. K. L., J. C. Y. Cheng, and A. F. T. Mak. "Orthotic design and foot impression procedures to control foot alignment." Prosthetics and Orthotics International 28, no. 3 (December 2004): 254–62. http://dx.doi.org/10.3109/03093640409167757.
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The traditional theory on subtalar joint neutral position and intrinsic foot deformities for the evaluation and treatment of foot and ankle disorders has been the basis for foot orthotics for many years. Although clinical evaluations have suggested a relationship between subtalar pronation and a variety of lower limb problems, such as shin splints and anterior knee pain, recent research has raised serious concerns about the reliability and validity of the assessment and intervention methods. Results of recent studies in foot biomechanics suggest that the orthosis design to control foot alignment should stabilise the medial apical bony structure of the arch to control the first ray mobility and transmit load through the lateral support structures of the foot, locking the calcaneocuboid joint and decreasing strain in the plantar aponeurosis. The concept of “posting” according to a measured foot deformity is de-emphasised. Reliable foot impression procedures are required to provide appropriate orthotic design and thus management. A prone lying position manipulated foot impression method using polycaprolactone based low temperature thermoplastic material was introduced. Ten (10) subjects were recruited to participate in the reliability tests, which were conducted by 2 orthotists specialized in foot orthotics. Results showed high intrarater and interrater reliability of the measured forefoot width and the navicular height. The reliability of the forefoot-rearfoot relationship was demonstrated by the small variance of the root mean square calculation. Subsequently orthotic intervention can be done in a more consistent manner.
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Roberts, Andrew, Johanna Wales, Heather Smith, Christopher James Sampson, Peter Jones, and Marilyn James. "A randomised controlled trial of laser scanning and casting for the construction of ankle–foot orthoses." Prosthetics and Orthotics International 40, no. 2 (October 21, 2014): 253–61. http://dx.doi.org/10.1177/0309364614550263.
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Background: Three-dimensional laser scanning has been used for patient measurement for cranial helmets and spinal braces. Ankle–foot orthoses are commonly prescribed for children with orthopaedic conditions. This trial sought to compare ankle–foot orthoses produced by laser scanning or traditional plaster casting. Objectives: Assessment of the effectiveness and efficiency of using laser scanning to produce ankle–foot orthoses. Study design: Randomised controlled trial with blinding of orthotists and patients to the construction technique used. Methods: A randomised double-blind trial comparing fabrication of ankle–foot orthoses from casts or laser scans. Results: The time spent in the rectification and moulding of scanned ankle–foot orthoses was around 50% less than for cast ankle–foot orthoses. A non-significant increase of 9 days was seen in the time to delivery to the patient for laser scanning with computer-aided design and computer-aided manufacturing. There was a higher incidence of problems with the scan-based ankle–foot orthoses at delivery of the device, but no difference in how long the ankle–foot orthoses lasted. Costs associated with laser scanning were not significantly different from traditional methods of ankle–foot orthosis manufacture. Conclusion: Compared with conventional casting techniques, laser scan–based ankle–foot orthosis manufacture did not significantly improve either the quality of the final product or the time to delivery. Clinical relevance Ankle–foot orthoses (AFOs) are a common requirement for chronic neurological conditions during childhood. Improved efficiency of provision of AFOs would benefit children and families by reducing the delay in provision of devices and would benefit the health service by making best use of valuable orthotist time.
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Cappa, Paolo, Fabrizio Patanè, and Giuseppe Di Rosa. "A Continuous Loading Apparatus for Measuring Three-dimensional Stiffness of Ankle-Foot Orthoses." Journal of Biomechanical Engineering 127, no. 6 (July 11, 2005): 1025–29. http://dx.doi.org/10.1115/1.2049313.
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This paper describes a novel device to evaluate the mechanical properties of ankle foot orthoses (AFOs). The apparatus permits the application to AFOs of continuous three-dimensional (3D) movements between specified and settable endpoints. Using an x-y robot with a rotary stage and a six-component load cell, characteristic displacement versus reaction force curves can be generated and consequently the ankle moments can be determined as a function of dorsi/plantar flexion, inv/eversion and int/external rotation. Representative curves for two polypropylene lateral leaf AFOs, different in shape but produced for the same leg by a skilled orthotist, are presented to illustrate the capabilities of the novel testing system. The metrological investigation showed that the apparatus creates a highly repeatable data set (uncertainty ⩽1% FSO).
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DeZeeuw, Katrina G., and Nancy Dudek. "Orthosis Comfort Score: Establishing initial evidence of reliability and validity in ankle foot orthosis users." Prosthetics and Orthotics International 43, no. 5 (August 5, 2019): 478–84. http://dx.doi.org/10.1177/0309364619866611.
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Background: Comfort of an orthosis is an important characteristic that is likely to dictate use of and satisfaction with a device. However, instruments to assess only orthosis user comfort do not exist. The Prosthetic Socket Fit Comfort Score, developed previously for prosthesis users, may be adapted to serve this purpose. Objectives: This study’s purpose was to assess the validity and reliability of the Orthosis Comfort Score, a self-report instrument adapted from the Prosthetic Socket Fit Comfort Score. Study design: This is a prospective, observational study designed to establish initial evidence of validity and reliability for an outcome measure that assesses comfort. Methods: Ankle foot orthosis users completed the Orthosis Comfort Score and two validated patient satisfaction questionnaires. An orthotist documented an assessment of fit. Post-visit Orthosis Comfort Scores were documented after the appointment and 2–4 weeks later. Orthosis Comfort Scores were compared to the patient satisfaction questionnaires, assessment of fit and orthosis use (hours per week). Results: There were 46 study participants. Orthosis Comfort Scores had a moderate positive correlation with their orthotist’s assessment of fit, very strong positive correlations with patient satisfaction questionnaires and fair positive correlation with orthosis use (all correlations p < 0.05). Conclusion: This study demonstrates initial evidence for the validity and reliability of the Orthosis Comfort Score in ankle foot orthosis users. Clinical relevance The Orthosis Comfort Score is a simple patient-reported outcome measure that can be readily incorporated into clinical practice or research study to obtain a rapid assessment of comfort. It can be used to facilitate communication about device fit, evaluate comfort over time and/or assess changes in comfort with a new device.
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Ash, Susan, Jackie O’Connor, Sarah Anderson, Emily Ridgewell, and Leigh Clarke. "A mixed-methods research approach to the review of competency standards for orthotist/prosthetists in Australia." International Journal of Evidence-Based Healthcare 13, no. 2 (June 2015): 93–103. http://dx.doi.org/10.1097/xeb.0000000000000038.
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Stevens, Trenton T., Clayton C. Bettin, G. Andrew Murphy, David R. Richardson, Benjamin J. Grear, and Jacob T. Hartline. "Predictive Variables for Patient Compliance with Physician Prescribed Orthotics." Foot & Ankle Orthopaedics 5, no. 4 (October 1, 2020): 2473011420S0046. http://dx.doi.org/10.1177/2473011420s00460.
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Category: Other; Midfoot/Forefoot Introduction/Purpose: Custom and off-the-shelf orthotics frequently are prescribed by foot and ankle orthpaedic surgeons. This study aimed to quantify the rate at which patients receive their prescribed orthotic and explore the variables that could be predictive of patients’ receiving and using orthotics. Methods: We analyzed the demographics of 382 patients who received an orthotic prescription from a group of foot and ankle surgeons to assess variables predictive of patients receiving their prescribed orthotic. Of these 382 patients, 186 (49%) completed a survey regarding insurance status, cost of the orthotic, education, income, and satisfaction with the orthotic. This information was used to identify variables that may help identify patients who are at an increased risk of failing to receive their prescribed orthotic. Results: Patients received their orthotic at an overall rate of 61.2% (235/382). Patients with commercial insurance were more likely to receive their orthotic (67%) than patients with Medicaid (40%). Of the 186 patients who completed the survey, those whose insurance covered all or part of their orthotic were more likely to receive their orthotic (100% and 96%, respectively) compared to those whose insurance did not cover the orthotic (81.5%). Overall 86.5% reported being ‘better’ or ‘completely relieved’ with orthotic use, and 13.4% reported ‘no difference’ or ‘worse.’ There were no differences in receive rates according to age or gender, but there was a disparity in race, with 71% (155/219) of white and only 48% (72/151) of black patients receiving their orthotics. Conclusion: A substantial number of patients (38.8%) do not receive their physician-prescribed orthotic. Patients who do receive and use their orthotic report positive results. Insurance status, race, and coverage of costs by the insurance company play important roles in predicting which patients are at risk for failing to receive their orthotic.
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Jensen, J. Steen, Wilfried Raab, John Fisk, Christian Hartz, Ariel Saldana, and Carson Harte. "Quality of Polypropylene Sockets for Trans-Tibial Prostheses in Low-Income Countries." Prosthetics and Orthotics International 30, no. 1 (April 2006): 45–59. http://dx.doi.org/10.1080/03093640600568336.
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Based on six series of patients ( n = 198) participating in clinical field testing of prosthetic feet and all provided with trans-tibial prostheses in accordance with the polypropylene component and assembly system developed by the International Committee of the Red Cross (ICRC) follow-up studies by teams consisting of an orthopaedic surgeon and a Category-I prosthetist-orthotist were conducted. A series of quality measures were tested against previously published quality benchmarks. The polypropylene system gives a consistent product and allows for increased demands on quality benchmarks. The acceptance of discomfort and pain could be reduced to 5 ± 5%. The technical performance demands were reduced for misalignment to 10 ± 5%. In general for all quality measures the range could be reduced to ±5%. These new demands reflect what an orthopaedic workshop outside of a teaching system should be able to attain.
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Taylor, P. J., H. Vincent, S. Atkins, and J. Sinclair. "Acute exposure to foot orthoses affects joint stiffness characteristics in recreational male runners." Comparative Exercise Physiology 11, no. 3 (September 1, 2015): 183–90. http://dx.doi.org/10.3920/cep150006.
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Commercially available foot orthoses are advocated for the treatment of chronic running injuries, such as patellofemoral pain, yet the mechanisms behind their effects are not well understood. This study aimed to examine the limb and joint stiffness characteristics when running with and without orthotics. Twelve recreational runners ran at 4.0 m/s. Limb stiffness was obtained using a spring-mass model of running by dividing the peak vertical ground reaction force (GRF) by the amount of limb compression. Knee and ankle joint stiffness’s were calculated by dividing the peak sagittal plane joint moment by the joint angular excursion. Differences between orthotic and non-orthotic running conditions were contrasted using paired samples t-tests. The results indicate that both peak knee extensor moment (orthotic = 2.74±0.57 and no-orthotic = 3.12±0.62 Nm/kg) and knee stiffness (orthotic = 5.56±1.08 and no-orthotic = 6.47±1.40 Nm/kg rad) were significantly larger when running without orthotics. This study may give further insight into the mechanical effects of commercially available foot orthoses. The current investigation provides some evidence to suggest that orthoses may be able to improve patellofemoral pathologies in recreational runners although further investigation is required.
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Sinclair, J., J. Isherwood, and P. J. Taylor. "The Effects of Orthotic Intervention on Multisegment Foot Kinematics and Plantar Fascia Strain in Recreational Runners." Journal of Applied Biomechanics 31, no. 1 (February 2015): 28–34. http://dx.doi.org/10.1123/jab.2014-0086.
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Chronic injuries are a common complaint in recreational runners. Foot orthoses have been shown to be effective for the treatment of running injuries but their mechanical effects are still not well understood. This study aims to examine the influence of orthotic intervention on multisegment foot kinematics and plantar fascia strain during running. Fifteen male participants ran at 4.0 m·s−1 with and without orthotics. Multisegment foot kinematics and plantar fascia strain were obtained during the stance phase and contrasted using paired t tests. Relative coronal plane range of motion of the midfoot relative to the rearfoot was significantly reduced with orthotics (1.0°) compared to without (2.2°). Similarly, relative transverse plane range of motion was significantly lower with orthotics (1.1°) compared to without (1.8°). Plantar fascia strain did not differ significantly between orthotic (7.1) and nonorthotic (7.1) conditions. This study shows that although orthotics did not serve to reduce plantar fascia strain, they are able to mediate reductions in coronal and transverse plane rotations of the midfoot.
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Hodgson, Brad, Laurie Tis, Steven Cobb, Shawn McCarthy, and Elizabeth Higbie. "The Effect of 2 Different Custom-Molded Corrective Orthotics on Plantar Pressure." Journal of Sport Rehabilitation 15, no. 1 (February 2006): 33–44. http://dx.doi.org/10.1123/jsr.15.1.33.
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Context:Because of research variability and the increasing use of orthotics to manage lower extremity problems, further research is warranted.Objective:To investigate the effect of rear-foot- and forefoot-posted (PAL) and mediolongitu-dinal arch-supported (SOLE) orthotics on plantar pressure (PP) during walking.Design:Repeated measures.Setting:Laboratory.Participants:17 subjects with forefoot varus.Intervention:Data were collected at 0 and 6 weeks for no-orthotic and orthotic conditions.Measurements:PPs were collected with the EMED Pedar measurement system.Results:Zero weeks: PAL increased PP in lateral forefoot (LFF), middle toes (MT), and lateral toes (LT) and decreased PP in lateral heel (LH), medial forefoot (MFF), and central forefoot (CFF). SOLE increased PP for midfoot (MF) and LT and decreased PP in medial heel (MH), LH, and CFF. 6 weeks: PAL increased PP in LFF, MT, and LT and decreased PP in LH, MFF, and CFF. SOLE increased PP in MF and decreased PP in MH, LH, and LFF.Conclusion:The SOLE orthotic appeared to be more effective in attaining the goals of custom-molded-orthotic intervention.
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Henderson, Sarah Elizabeth, and Ian R. McMillan. "Pain and Function: Occupational Therapists' Use of Orthotics in Rheumatoid Arthritis." British Journal of Occupational Therapy 65, no. 4 (April 2002): 165–71. http://dx.doi.org/10.1177/030802260206500403.
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The use of orthotics in the management of rheumatoid arthritis appears to be relatively commonplace within occupational therapy departments. The aim of this study was to identify the frequency of orthotic use by occupational therapists, their beliefs about the efficacy of orthotic use, what they aimed to achieve by orthotic provision and any outcome measures used. The total membership of the British Association of Hand Therapists who were both occupational therapists and self-identified as working and/or having an interest in rheumatology (n = 132) were surveyed through a postal questionnaire. Of the responses received (n = 89, 67%), all the respondents (100%) were regular users of orthotics in the management of rheumatoid arthritis. The results showed that the most highly rated reasons for orthotic provision were to decrease hand and wrist pain and to improve hand function. Subjective comments from the respondents provided evidence of positive beliefs about the efficacy of orthotic use, despite a lack of objective outcome measures to support such comment. Given the complexity of the intervening variables that occur with orthotic use, perhaps there is no easy answer; however, with the expectation of evidence-based practice and intervention, it is suggested that an increased use of standardised outcome measures may provide additional strength in presenting, often subjective, evidence.
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Skoblin, Aleksey Anatolyevich. "ORTHOTICS IN THE COMPLEX TREATMENT OF IDIOPATHIC SCOLIOSIS." Hirurgiâ pozvonočnika, no. 4 (December 15, 2005): 025–31. http://dx.doi.org/10.14531/ss2005.4.25-31.
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The literature review is devoted to the important problem – orthotics in children and adolescents with idiopathic scoliosis (AIS). The main types of braces used in complex treatment of these patients are described. The indications for orthotic treatment and its results were analyzed. The orthotics potentialities in conservative correction of spinal deformities were shown.
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Bateni, Hamid. "Changes of Postural Steadiness Following Use of Prefabricated Orthotic Insoles." Journal of Applied Biomechanics 29, no. 2 (April 2013): 174–79. http://dx.doi.org/10.1123/jab.29.2.174.
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Orthoses are designed to assist a malaligned foot in adapting to the environment and reduce the frequency of injury. Literature is divided on the benefits of orthotics insoles for postural stability. The current study was conducted to determine the effect of prefabricated orthotic arch supports on postural stabilization. Twelve healthy young adults participated in this study and were tested with and without prefabricated orthotics. Different variables were computed from movement of center of pressure (COP) during orthotic use as suggested in the literature. The mean position of COP was significantly shifted forward and toward the dominant side. Neither the COP movement nor the velocity changes following the use of orthotics revealed significant differences. Mediolateral range of COP movement and the 95% confidence circle area of sway was significantly reduced (P = .022 and 0.048 respectively), but changes in 95% confidence circle and ellipse areas of fractal dimension were not significant (P = .053 and P = .057 respectively). In conclusion, orthotic insoles significantly improved postural sway initially by reducing mediolateral range of postural sway and 95% confidence circle area of sway at the cost of increased fractal dimension area variables and power.
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Ramstrand, Nerrolyn, and Simon Ramstrand. "Competency standards for newly graduated prosthetist/orthotists in Sweden." Prosthetics and Orthotics International 42, no. 4 (May 18, 2018): 387–93. http://dx.doi.org/10.1177/0309364618774056.
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Background: There are currently no national competency standards upon which to develop educational objectives for prosthetist/orthotists in Sweden. While standards have been developed in other countries, they cannot be applied without confirming their relevance in a Swedish context. Objectives: To describe and obtain consensus on core competencies required for newly graduated prosthetist/orthotists in Sweden. Study design: Modified Delphi process. Methods: A modified Delphi technique was carried out. Focus groups were initially used to identify core competency domains. Two consecutive questionnaires, containing a list of potential competency items, were sent to a group of stakeholders with ties to the prosthetic and orthotic profession. Stakeholders were requested to rate their level of agreement with each competency item and provide written comments. Finally, two focus groups were conducted to obtain feedback on the draft competency standards. Results: Forty-four competency items, listed under five key domains of practice, were identified as essential for newly graduated prosthetist/orthotists in Sweden. Conclusions: Many similarities exist in core competency descriptions for prosthetist/orthotists in Sweden when compared to other countries. Regional differences do however exist, and it is important to confirm the relevance of core competency items at a national level before they are applied. Clinical relevance Competency standards developed in this study can be used to guide development of learning objectives within an undergraduate prosthetic and orthotic program, provide a framework for workforce development, assist professional organizations in understanding the needs of their members, and prepare for international accreditation.
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Kobayashi, Toshiki, Aaron k. L. Leung, Yasushi Akazawa, Hisashi Naito, Masao Tanaka, and Stephen W. Hutchins. "Design of an Automated Device to Measure Sagittal Plane Stiffness of an Articulated Ankle-Foot Orthosis." Prosthetics and Orthotics International 34, no. 4 (December 2010): 439–48. http://dx.doi.org/10.3109/03093646.2010.495370.
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The purpose of this study was to design a new automated stiffness measurement device which could perform a simultaneous measurement of both dorsi- and plantarflexion angles and the corresponding resistive torque around the rotational centre of an articulated ankle-foot orthosis (AAFO). This was achieved by controlling angular velocities and range of motion in the sagittal plane. The device consisted of a hydraulic servo fatigue testing machine, a torque meter, a potentiometer, a rotary plate and an upright supporter to enable an AAFO to be attached to the device via a surrogate shank. The accuracy of the device in reproducing the range of motion and angular velocity was within 4% and 1% respectively in the range of motion of 30&dG (15&dG plantarflexion to 15&dG dorsiflexion) at the angular velocity of 10&dG /s, while that in the measurement of AAFO torque was within 8% at the 0&dG position. The device should prove useful to assist an orthotist or a manufacturer to quantify the stiffness of an AAFO and inform its clinical use.
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Murayama, Minoru, and Masazumi Mizuma. "Investigation of the Work Performed by a Full-time Prosthetist and Orthotist with Patients and Users at Our Hospital." Japanese Journal of Rehabilitation Medicine 58, no. 2 (February 18, 2021): 215–20. http://dx.doi.org/10.2490/jjrmc.20037.
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Spaulding, Susan Ewers, Sisary Kheng, Susan Kapp, and Carson Harte. "Education in prosthetic and orthotic training: Looking back 50 years and moving forward." Prosthetics and Orthotics International 44, no. 6 (November 8, 2020): 416–26. http://dx.doi.org/10.1177/0309364620968644.
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There is a long history of prosthetic and orthotic services helping to mitigate the impact of physical impairment by restoring function, and enabling and equipping the user. The training of health professionals who design, fit, and maintain prosthetic and orthotic devices has evolved over the centuries, reflecting an increase in knowledge, technology, understanding, and social attitudes in each era. Improvements in pedagogical thinking and biomechanical understanding, as well as the advent of new integrated technologies, have driven the profession over the past 50 years to modernize, evolve training and service delivery models in line with new attitudes toward clients, and search for new ways to improve users’ quality of life. In this narrative review, the authors examined the evolution of prosthetic and orthotic education, the impact of changing educational techniques and technologies, and the impact of the International Society for Prosthetics and Orthotics in that process. Through conversations with experts and review of peer-reviewed literature, accreditation documents, and the International Society for Prosthetics and Orthotics records and databases, the authors identified three areas of change in prosthetics and orthotics education over the past 50 years: (1) prosthetic/orthotic curriculum content, (2) pedagogy and course delivery, and (3) internships/residencies. This narrative review is a snapshot of a growing profession and we can only speculate where the next 50 years will lead us as we strive to serve patients, ever placing their needs and aspirations at the center of this professional service.
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Mahara, DP, A. Lamichhane, P. Acharya, and GC Shrestha. "Fracture Shaft of Femur in Children with Newly Designed Femoral Brace." Journal of Institute of Medicine Nepal 35, no. 1 (October 12, 2013): 18–22. http://dx.doi.org/10.3126/jiom.v35i1.8892.
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Introduction: With the initial traction and secondary hip spica conservative treatment of fracture shaft of femur in children is an established technique of management all over the world. Three-six weeks of traction followed by another 6-8weeks of immobilization in spica cast at home takes away precious school going time of the children and professional earning time of the parents in our part of the world. The situation compelled us to think and design an Orthosis that not only splints the fractured femur but also maintains the continuous traction and acceptable alignment right from the beginning and allows early mobilization thereby avoiding need of long hospital stay, immobilization on spica cast and abstinence from school. Methods: This Orthosis has been used successfully in 9 children with fractured shaft of femur, age ranged from 3 to 9 years with average age of 5 years. Initially the patients were put on skin traction. In the meantime, measurement of body parts was taken by an orthotist for fabrication of the brace, which was made available on second week. In presence of the orthotist the brace was applied and its fitting and pressure points were properly evaluated. The patients were discharged the next day and asked to follow up at 2,4,6,9 and 12 weeks with a roentgenogram at every visit. Patients were encouraged to bear weight with the affected limb with the brace on after achieving clinical union. Brace was removed after achieving radiological union. Results: One patient did not turn up for follow up after application of brace. So, out of the ten patients, nine were included in this study as they had follow up of at least 12 weeks. Seven cases were male and two female. The average age of the patients was 5 years (range 3 to 9 years). The follow up period ranged from 12 weeks to 3 years with average period of 9.3 months. Radiological union was seen to occur at 12th week in 7 patients and 9th week in 2 patients and the brace was discarded at that time. Fracture united in all patients without any obvious angular, rotational deformities and limb length discrepancy. Conclusion: Preliminary findings of this study showed the use of this Orthosis in the treatment of fracture shaft of femur in children has proved to be as good as the traditional method with distinct advantages of treating at home and early mobilization with the brace on. DOI: http://dx.doi.org/10.2126/joim.v35i1.8892 Journal of Institute of Medicine, April, 2013; 35:18-22
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Darling, A. L., and W. Sun. "Orthotic Design through 3D Reconstruction: A Passive-Assistance Ankle–Foot Orthotic." Applied Bionics and Biomechanics 3, no. 2 (2006): 93–99. http://dx.doi.org/10.1155/2006/497687.
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Current methods of designing and manufacturing custom orthotics include manual techniques such as casting a limb in plaster, making a plaster duplicate of the limb to be treated and forming a polymer orthotic directly onto the plaster model. Such techniques are usually accompanied with numerous postmanufacture alterations to adapt the orthotic for patient comfort. External modeling techniques rely heavily on the skill of the clinician, as the axes of rotation of any joint are partially specified by the skeletal structure and are not completely inferable from the skin, especially in cases where edema is present. Clinicians could benefit from a simultaneous view of external and skeletal patient-specific geometry. In addition to providing more information to clinicians, quantification of patient-specific data would allow rapid production of advanced orthotics, requiring machining rather than casting. This paper presents a supplemental method of orthotic design and fitting, through 3D reconstruction of medical imaging data to parameterise an orthotic design based on a major axis of rotation, shape of rigid components and placement of skin contact surfaces. An example of this design approach is shown in the design of an ankle–foot orthotic designed around the computed tomography data from the Visible Human Project.
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Desmond, D., and M. MacLachlan. "Psychological issues in prosthetic and orthotic practice: A 25 year review of psychology in Prosthetics and Orthotics International." Prosthetics and Orthotics International 26, no. 3 (December 2002): 182–88. http://dx.doi.org/10.1080/03093640208726646.
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In the inaugural edition of Prosthetics and Orthotics International, Fishman identified the psychological sciences as one of six indispensable areas of skill and knowledge in professional prosthetic-orthotic practice. Given the journal's significant role in reporting and developing pertinent research and practice, this review assesses the profile of psychology in prosthetic and orthotic research, as evidenced by the content of Prosthetics and Orthotics International since its inception. A MEDLINE search of the journal's abstracts over a twenty-five year period was conducted using the search terms: ‘psychology’, ‘psychosocial’, ‘quality of life’, ‘developmental’ and ‘coping’. Results of this search are summarised under the following headings: (a) body image; (b) coping and adjustment; (c) developmental issues; (d) psychosocial well-being; (e) quality of life; and (f) psychological factors leading to amputation. On the basis of this review, the authors conclude by highlighting a number of key areas where the psychological aspects of prosthetics and orthotics warrant further investigation and dissemination.
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Uygur, F., N. Bek, B. Kürklü, and Ö. Yilmaz. "Orthotic management of the lower limb in children with hereditary motor sensory neuropathy (HMSN)." Prosthetics and Orthotics International 25, no. 2 (August 2001): 139–43. http://dx.doi.org/10.1080/03093640108726587.
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The lower limbs of 55 paediatric patients, with the diagnosis of hereditary motor sensory neuropathy (HMSN) referred to the Orthotics and Biomechanics Department of Hacettepe University, were assessed for appropriate orthotic intervention. Since in the natural history of HMSN symptoms and complaints are variable there is a wide range of interventions possible. The biomechanics of deforming forces and the consequential incidence of deformities in these 55 children, its orthotic implications and the efficacy of orthotic applications are discussed in detail.
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Robinson, Christopher, Matthew J. Major, Charles Kuffel, Kevin Hines, and Pamela Cole. "Orthotic management of the neuropathic foot: An interdisciplinary care perspective." Prosthetics and Orthotics International 39, no. 1 (January 22, 2015): 73–81. http://dx.doi.org/10.1177/0309364614545422.
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Background: Clinical management of the patient with neuropathic foot is becoming commonplace in orthotic clinics worldwide. The presentations that can result from neuropathic foot are diverse, requiring clinicians to understand the pathomechanics of ulceration, infection, and Charcot joint arthropathy to provide effective interventions. Objectives: The purpose of this clinical perspective is to provide a review of the literature regarding clinical conceptsassociated with orthotic management of neuropathic foot. Study design: Literature review and clinical case study. Methods: Relevant literature were reviewed and summarized, and a clinical case study synthesizing reviewed concepts was presented. Results: Given the multifactorial nature of the neuropathic foot, treatments must be multifaceted and patient-specific to effectively address the underlying disease processes. While systemic issues such as peripheral arterial disease are treated by physicians, local issues such as foot deformity are managed by orthotists. Orthotic interventions commonly include custom footwear to reduce the risk of ulceration through creation of a protective environment or targeted plantar offloading. Patient and caregiver education to encourage management compliance is equally as important to ensure successful treatment. Conclusion: Patients with neuropathic foot benefit from an interdisciplinary care approach which engages physicians, wound care practitioners, and orthotists to treat and manage systemic and local problems. Addressing this pathology through interdisciplinary care may positively affect the patient’s health status while lowering associated healthcare costs through improved treatment efficacy. Clinical relevance The commonality of neuropathic foot and associated complications including ulceration, infection, and Charcot joint arthropathy requires that the patient care team have a fundamental understanding of these pathologies and common treatment modalities. We review orthotic treatment modalities to assist clinicians with the management of patients with neuropathic foot.
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Sanz-Pena, Inigo, Shanika Arachchi, Dhammika Halwala-Vithanage, Sanjaya Mallikarachchi, Jeewantha Kirumbara-Liyanage, Alison McGregor, Pujitha Silva, and Nicolas Newell. "Characterising the Mould Rectification Process for Designing Scoliosis Braces: Towards Automated Digital Design of 3D-Printed Braces." Applied Sciences 11, no. 10 (May 19, 2021): 4665. http://dx.doi.org/10.3390/app11104665.
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The plaster-casting method to create a scoliosis brace consists of mould generation and rectification to obtain the desired orthosis geometry. Alternative methods entail the use of 3D scanning and CAD/CAM. However, both manual and digital design entirely rely on the orthotist expertise. Characterisation of the rectification process is needed to ensure that digital designs are as efficient as plaster-cast designs. Three-dimensional scans of five patients, pre-, and post-rectification plaster moulds were obtained using a Structure Mark II scanner. Anatomical landmark positions, transverse section centroids, and 3D surface deviation analyses were performed to characterise the rectification process. The rectification process was characterised using two parameters. First, trends in the external contours of the rectified moulds were found, resulting in lateral tilt angles of 81 ± 3.8° and 83.3 ± 2.6° on the convex and concave side, respectively. Second, a rectification ratio at the iliac crest (0.23 ± 0.04 and 0.11 ± 0.02 on the convex and concave side, respectively) was devised, based on the pelvis width to estimate the volume to be removed. This study demonstrates that steps of the manual rectification process can be characterised. Results from this study can be fed into software to perform automatic digital rectification.
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Hamlyn, Chris, Carrie L. Docherty, and Joanne Klossner. "Orthotic Intervention and Postural Stability in Participants With Functional Ankle Instability After an Accommodation Period." Journal of Athletic Training 47, no. 2 (March 1, 2012): 130–35. http://dx.doi.org/10.4085/1062-6050-47.2.130.
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Context: Most protocols established to treat patients with functional ankle instability (FAI) have focused on taping the ankle. Orthotic intervention is a different treatment protocol that may have a positive effect on these patients, especially after an accommodation period. Objective: To determine whether the use of a prefabricated orthotic affects postural stability in patients with FAI and a control group. Design: Randomized controlled clinical trial. Setting: Research laboratory. Patients or Other Participants: Forty patients with unilateral FAI. Intervention(s): Postural stability was measured on both limbs using a force plate on 3 occasions. Participants were instructed to balance on 1 limb with their eyes closed for 20 seconds. In session 1, postural stability was measured with the patient wearing his or her own athletic shoes. The control group repeated this procedure in sessions 2 and 3. When those in the orthotic group returned for session 2, they received prefabricated, full-length Quick Comfort Insoles for both feet, immediately placed the orthotics in their shoes, and were tested for postural stability. Patients in the orthotic group were instructed to wear the inserts daily and return 2 weeks later for session 3 and repeat postural stability testing. Main Outcome Measure(s): Center of pressure. Results: In the orthotic group, postural stability improved between sessions 1 and 2 and sessions 1 and 3. In session 3, postural stability was different for the orthotic and control groups. We also identified a difference between the limbs such that the FAI ankle displayed worse postural stability than did the healthy ankle. Conclusions: Prefabricated orthotics improved postural stability in participants with FAI. Similar to the findings of previous researchers, we found that postural stability was worse in FAI ankles than in healthy ankles.
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Hertel, Jay, Craig R. Denegar, W. E. Buckley, Neil A. Sharkey, and Wayne L. Stokes. "Effect of Rear-Foot Orthotics on Postural Control in Healthy Subjects." Journal of Sport Rehabilitation 10, no. 1 (February 2001): 36–47. http://dx.doi.org/10.1123/jsr.10.1.36.
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Objective:To identify changes in sagittal- and frontal-plane center of pressure (COP) excursion length and velocity during single-leg stance under 6 orthotic conditions.Design:1 × 6 repeated-measures.Setting:University biomechanics laboratory.Participants:Fifteen healthy young adults without excessive forefoot, arch, or rear-foot malalignments.Measurements:Selected variables of COP length and velocity were calculated in both the frontal and sagittal planes during three 5-second trials of quiet unilateral stance.Methods:Postural control was assessed under 6 conditions: shoe only and 5 orthotics.Results:The medially posted orthotic caused the least frontal COP length and velocity, and the Cramer Sprained Ankle Orthotic® caused the greatest frontal-plane sway. No significant differences were found between the different orthotic conditions in sagittal-plane measures.Conclusions:Differently posted rear-foot orthotics had various effects on frontal-plane postural control in healthy participants. Further research is needed on pathological populations.
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Hoffman, Jeffrey W., Rogerio C. Bitar, Daniel R. Sturnick, Glenn Garrison, Constantine A. Demetracopoulos, Mark C. Drakos, and Martin J. O’Malley. "Influence of Foot Orthotics and Intrinsic Factors on Strain Measurements in the Fifth Metatarsal." Foot & Ankle Orthopaedics 5, no. 4 (October 1, 2020): 2473011420S0025. http://dx.doi.org/10.1177/2473011420s00250.
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Category: Midfoot/Forefoot; Sports Introduction/Purpose: Fractures of the fifth metatarsal occur in young, athletic populations and often result in sub-optimal clinical outcomes, even after surgical fixation. With such a high demand for decreased return to play in athletic populations, the development of intervention strategies which mitigate intrinsic and extrinsic risk factors of initial injury is important. Foot orthotics have been shown to decrease strain in the 2nd metatarsal. However, limited research has investigated the influence of intrinsic risk factors and the use of foot orthotics on fifth metatarsal strain. Therefore, the purpose of our study was to investigate the effect of foot orthotics and intrinsic risk factors on fifth metatarsal strain during cadaveric simulation. Methods: Ten specimens were loaded to simulate the stance phase of normal gait using a validated 6-degree of freedom robot with tendon actuators. Strain gauges were placed at the metaphyseal - diaphyseal junction (Zone II), and the proximal diaphysis (Zone III) to measure principal strain. Specimens were tested in a sneaker-only control condition and ten orthotic conditions, which include combinations of a commercial orthotic insole, three plates, and two foam wedges (Figure 1A). The average peak strain from three simulations were recorded for each orthotic condition. Relevant intrinsic factors were recorded from reconstructions of axially loaded computed tomography scans. A two-way repeated measures ANOVA was conducted to determine the effect of orthotic conditions on fifth metatarsal strains, with significantly correlated intrinsic factors included as covariates. Tukey-Kramer post-hoc analysis with a Bonferroni correction was used to analyze differences between individual orthotic conditions and main effects of components. Results: Metatarsus adductus angle, 4-5 intermetatarsal angle, and Meary’s angle (R2= 0.944; p<0.001) were included as covariates in analysis of Zone III strain. Significant (p<0.05) differences in Zone III strain were found for the both the main effect of a plate and individual orthotic cond itions with statistical adjustment for previously stated intrinsic measurements. However, post- hoc testing revealed no significant differences between non-plate conditions and full plate conditions(p=0.23), lateral plate conditions (p=0.025), or lateral cut plate conditions (p=0.026). Additionally, the Full Plate with Lateral Wedge condition reduced strains by 285 µΕ relative to the sneaker condition, no significant differences (p = 0.07) were found in post-hoc analysis. No significant differences were found in Zone II with the models considered. Conclusion: Zone III strains were shown to be significantly correlated with intrinsic factors in the current analysis. Plate conditions demonstrated a trend towards significant reduction of Zone III strain relative to the sneaker condition, despite failing to achieve statistical significance in conservative post-hoc analysis. However, these results may be clinically significant as the reduction of strain in plate conditions exceeded previously reported significant decreases in the 2nd metatarsal. Correlations found between intrinsic risk factors and strain in this study corroborate with previous studies. This indicates that the effectiveness of foot orthotics to reduce strain is strongly influenced by individual foot structure.
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Gabriner, Michael L., Brittany A. Braun, Megan N. Houston, and Matthew C. Hoch. "The Effectiveness of Foot Orthotics in Improving Postural Control in Individuals With Chronic Ankle Instability: A Critically Appraised Topic." Journal of Sport Rehabilitation 24, no. 1 (February 2015): 68–71. http://dx.doi.org/10.1123/jsr.2013-0036.
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Clinical Scenario:Chronic ankle instability (CAI) is a condition commonly experienced by physically active individuals. It has been suggested that foot orthotics may increase a CAI patient’s postural control.Clinical Question:For patients with CAI, is there evidence to suggest that an orthotic intervention will help improve postural control?Summary of Key Findings:The literature was searched for studies of level 2 evidence or higher that investigated the effects of foot orthotics on postural control in patients with CAI. The search of the literature produced 5 possible studies for inclusion; 2 studies met the inclusion criteria and were included. One randomized controlled trial and 1 outcomes study were included. Foot orthotics appear to be effective at improving postural control in patients with CAI.Clinical Bottom Line:There is moderate evidence to support the use of foot orthotics in the treatment of CAI to help improve postural control.Strength of Recommendation:There is grade B evidence that foot orthotics help improve postural control in people with CAI. The Centre of Evidence Based Medicine recommends a grade of B for level 2 evidence with consistent findings.
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Geelen-Baass, Briana NL. "Learning to manage in health." Australian Health Review 31, no. 3 (2007): 327. http://dx.doi.org/10.1071/ah070327.
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'I'M A MRP' is the grammatically incorrect response I offer anyone who asks the ever popular 'What do you do?' question. The error in the statement may be understood when you realise that the acronym stands for an inanimate entity: Management Residency Program. Despite the struggle I have with the inherent clumsiness of the phrase, I am actually quite happy to use the term. I feel comforted by the idea of having an identity. I think this comes from my former life as a Prosthetist/Orthotist (P&O). As a P&O, you have an identity. Regardless of where you are working, you are a P&O and this is interesting in itself. It's a great conversation piece. Now that I attempt to make the move into management, I find myself placing greater importance on where I am rather than what I am. It now matters more to me which organisation I belong to. I?d like to attribute this to an academic theory such as Henry Mintzberg's, which would suggest that my focus is changing from a professional orientation to an organisational one.1 However, I realise there is a slight possibility that the title 'health manager' is actually just boring. I know lawyers who find themselves in the same predicament. As soon as they say, 'I'm a lawyer', conversation comes to a screeching halt.
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Laughton, Carrie A., Irene McClay Davis, and Joseph Hamill. "Effect of Strike Pattern and Orthotic Intervention on Tibial Shock during Running." Journal of Applied Biomechanics 19, no. 2 (May 2003): 153–68. http://dx.doi.org/10.1123/jab.19.2.153.
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The main purpose of this study was to investigate the effects of both strike pattern (forefoot vs. rearfoot strike pattern) and orthotic intervention on shock to the lower extremity. Semi-rigid orthotic devices were manufactured for 15 injury-free recreational runners. Tibial accelerometry, ground reaction force, and 3D kinematic data were collected on their right leg in four conditions: forefoot strike (FFS) and rearfoot strike (RFS) with and without orthotics. Two-way repeated-measures analysis of variance tests were used to assess the effects of strike pattern and orthotic intervention on tibial acceleration; angular excursions of the ankle and knee; ground reaction force (GRF) vertical and anteroposterior peaks and load rates; and ankle, knee, and leg stiffness. There was a significant increase in tibial acceleration for the FFS pattern compared to the RFS pattern. This may be explained in part by the significantly greater peak vertical GRF, peak anteroposterior GRF, anteroposterior GRF load rates, knee stiffness, and leg stiffness found in the FFS pattern compared to the RFS pattern. Tibial acceleration and rearfoot eversion excursions were similar between the orthotic and no-orthotic conditions. Knee flexion excursion and average GRF vertical load rates were significantly decreased while dorsiflexion excursion and knee stiffness were significantly increased in the orthotic condition. No significant interactions were found between strike pattern and orthotic condition for any variables assessed.
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McDonald, Cody L., Deborah Kartin, and Sara J. Morgan. "A systematic review in prosthetics and orthotics education research." Prosthetics and Orthotics International 44, no. 3 (April 17, 2020): 116–32. http://dx.doi.org/10.1177/0309364620912642.
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Background: Formal prosthetic/orthotic education has evolved greatly since its inception in the 1950s. The International Society for Prosthetics and Orthotics has established guidelines and recognition for prosthetic/orthotic programs worldwide. However, the current state-of-the-science in prosthetic/orthotic education is largely unknown. Objectives: To evaluate and synthesize available prosthetic/orthotic education research. Study design: Systematic review. Methods: Three bibliographic databases were searched and quality of included articles assessed using criteria from the National Institutes for Health Quality Assessment Tool for Observational Cohort, Cross-Sectional Studies, and the Critical Appraisal Skills Programme Qualitative Research Checklist, and Delphi quality criteria. Results: This review included 25 articles from 23 studies. Included studies explored description, development, implementation, and/or assessment of the teaching/learning methods, curriculum, program, or country/region level. Studies were conducted in 18 countries and published in 14 journals. Methodological quality was rated high in 6 articles, moderate in 6, and low in 13. Content synthesis was not attempted due to the heterogeneous literature. Conclusion: This systematic review suggests that prosthetic/orthotic education research is only being conducted at a limited level. There is a strong need for high quality, collaborative education research to be conducted and published in peer-reviewed journals to improve prosthetic/orthotic education and build a global conversation. Clinical relevance Research in prosthetic/orthotic education is limited. The current body of literature is not sufficient to inform and guide future education of prosthetic/orthotic students. Opportunities to improve prosthetic/orthotic education research include academic collaborations, a dedicated education special issue or journal, and disciplinary support for prosthetic/orthotic education research.
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Kamath, Jagannath B., Deepak M. Naik, and Ankush Bansal. "Current concepts in managing fractures of metacarpal and phalangess." Indian Journal of Plastic Surgery 44, no. 02 (May 2011): 203–11. http://dx.doi.org/10.1055/s-0039-1699505.
Full textAbstract:
ABSTRACTFractures of the metacarpal and phalanges constitute 10% of all fractures. No where in the body, the form and function are so closely related to each other than in hand. Too often these fractures are treated as minor injuries resulting in major disabilities. Diagnosis of skeletal injuries of the hand usually does not pose major problems if proper clinical examination is supplemented with appropriate radiological investigations. Proper preoperative planning, surgical intervention wherever needed at a centre with backing of equipment and implants, selection of appropriate anaesthesia and application of the principle of biological fixation, rigid enough to allow early mobilisation are all very important for a good functional outcome. This article reviews the current concepts in management of metacarpal and phalangeal fractures incorporating tips and indications for fixation of these fractures. The advantages and disadvantages of various approaches, anaesthesia, technique and mode of fixation have been discussed. The take-home message is that hand fractures are equally or more worthy of expertise as major extremity trauma are, and the final outcome depends upon the fracture personality, appropriate and timely intervention followed by proper rehabilitation. Hand being the third eye of the body, when injured it needs a multidisciplinary approach from the beginning. Though the surgeon's work appears to be of paramount importance in the early phase, the contribution from anaesthetist, physiotherapist, occupational therapist, orthotist and above all a highly motivated patient cannot be overemphasised.
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Ramstrand, N., and T. H. Brodtkorb. "Considerations for developing an evidenced-based practice in orthotics and prosthetics." Prosthetics and Orthotics International 32, no. 1 (January 1, 2008): 93–102. http://dx.doi.org/10.1080/03093640701838190.
Full textAbstract:
Evidence-based practice has become somewhat of a catchphrase over the past ten years. In this paper evidence-based practice is defined and its importance for the development of the prosthetics and orthotics profession is highlighted. The authors suggest that evidence-based practice needs to be prioritized within the profession and that a cultural change needs to be initiated which supports clinicians in incorporating research findings into their daily practice. In addition, the authors highlight the need for prosthetists/orthotists to become more active in generating research rather than relying on other professional groups to contribute to their professional body of knowledge.