Where Science and Art Converge

The O&P industry is not known for being a leader in the research arena. However, several developments are pushing the profession toward taking on a more scientific recognition. One pressing issue revolves around funding and reimbursement concerns that are driving practitioners to find ways to quantify their work. Others are the inquiries into the fundamental clinical issues that have historically remained staples of the profession.

Instead of holding a traditional state-of-the-science meeting – considering the science of O&P is still fairly youthful – this meeting, held by the National Institute on Disability and Rehabilitation Research (NIDRR) Rehabilitation Engineering Research Center (RERC) in P&O at Northwestern University in February 2006, was organized with the intentions of identifying the research areas in O&P that deserve further attention.

“We decided it would be far more beneficial if we were to solicit practitioners [feedback] on the areas they feel attention and research really needs to be focused,” Steven Gard, PhD, director of the Northwestern University Prosthetics Research Laboratory & Rehabilitation Engineering Research Program (NUPRL & RERP) told O&P Business News.

An artful science

“The application of orthotics and prosthetics integrates various disciplines, including biomechanics and anatomy, to provide the highest quality of care.” – Stefania Fatone, PhD, BPO (Hons)“The application of orthotics and prosthetics integrates various disciplines, including biomechanics and anatomy, to provide the highest quality of care,” explained Stefania Fatone, PhD, BPO (Hons), research assistant professor at NUPRL & RERP.

But does that distinction default O&P to a science? Should it?

In the foreword of the meeting’s final report Gard said, “Currently, the practice of O&P is very much an art form, typically requiring years of practice by prosthetists and orthotists to develop the necessary skills and expertise to become a proficient, well-respected and knowledgeable practitioner.”

Such a distinction is both honorable and limiting.

“Referring to O&P as an art form is a compliment,” Fatone said. “Artists are accomplished craftspeople who produce creative, quality works.”

Practitioners, always striving for the highest quality care, must be creative in the services they provide, she continued.

Gard, who has tremendous respect for the intuition of the experienced practitioner, recognizes why the lack of research may be limiting the growth of the field.

“There is currently little to no quantification in routine practice, but to produce this evidence and to justify reimbursement, we have to be able to quantify and objectively evaluate what is currently done in the field.”

Research is one way to reach this end.

Hot topics

Knowing what topics are research-worthy was the main focus of the meeting and the results, as reported by Fatone and Gard, were not surprising. As expected, evidence-based practice and efficacy and outcomes research were the most noteworthy items of interest.

With an increasing need to justify health care decisions, there is an equally increasing need for research to be available for validation.

“There is not a lot of good, solid evidence in the field at the moment to justify much of what is done clinically,” Gard said.

Fatone indicated that these areas repeated throughout the meeting demonstrating just how much attention needs to be paid to them.

Additionally, a number of concerns arose around what Gard considers to be fundamental issues. From an engineering perspective, he expected more involved and difficult problems to be targeted as areas for research.

“We need to be focusing our attention instead, on basic issues I think the field has been struggling with for decades now,” Gard said. “No one has conducted sufficient research to address them so that we can build on that knowledge and move on to more complex problems.”

One example he explains dealt with socket design – a fundamental of the profession. Instead of focusing efforts toward more technologically advanced components that have become available in recent years, Gard suggests that perhaps research needs to start at the beginning to get a handle on the basics first in order to provide more foundational knowledge.

“With this limitation of the prosthetic socket interface being unresolved, I am not sure that prosthesis users are able to take full advantage of capabilities afforded by the advanced technology that is coming onto the market,” he added. “I think a lot of the funding agencies are under the impression that we need more research to develop sophisticated robotic limbs, but I believe that this is somewhat of a misnomer. These types of studies are appealing to funding agencies but … we need more research that will begin to answer some of these basic questions and produce results that can be implemented right away in day-to-day practice.”

Raising the level of research

“This is a time when prosthetists and orthotists can personally make an impact on research thatis ultimately going to affect their practice.” – Steven Gard, PhDGard cited insufficient subject pools and problems with testing protocols as some of the limitations in previously published studies.

In addition, he suggested using subjective evaluations for validation of laboratory-controlled studies to demonstrate how “users perceive their function with prostheses and orthoses.”

No matter the chosen method, there still lies the task of practitioners finding the time to conduct their own research or reaching out to external investigators with their ideas.

Researchers have attended industry functions and conferences for years, which have been the primary grounds for making these connections. But Gard said that practitioners should be encouraged to make contact with interested researchers outside of these annual functions.

“Prosthetists and orthotists can identify researchers in the field by reading journals and they should be encouraged to contact investigators with their ideas or to seek out collaborators,” he said. “Researchers are constantly on the lookout for new ideas, especially those that can be directly applied to improve clinical practice.”

Right direction

The increased interest in research that has been expressed is a push in the right direction. Now, the industry needs to advocate for these clinically-relevant research areas and educate funding agencies on the specific issues that need to be addressed.

“I think there has been a shift in O&P in recent years and a developing appreciation for the value of research,” Fatone said, explaining that she thinks even as few as 5 or 10 years ago there would have been less of an appreciation for that need.

Opportunities for personal involvement

Gard thinks that while he thinks the majority of practitioners believe that research is important, they may not see opportunities for personal involvement at that level.

“I would say that practitioners today have probably never felt more of a personal conviction to get involved in research and have never perceived a greater opportunity to collaborate with investigators. Collaboration may involve active participation with a research study, or simply assisting investigators with the recruitment effort. This is a time when prosthetists and orthotists can personally make an impact on research that is ultimately going to affect their practice,” Gard said.— by Jennifer Hoydicz

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