The national profile of the prosthetic and orthotic workforce in the UK: Sociodemographics and employment characteristics.

BACKGROUND: Prosthetists and orthotists (POs) are essential members of the health care workforce and one of the United Kingdom's (UK's) allied health professions. There is a paucity of information on their demographics, which is essential for the development of the profession. To fill this void, this study has attempted to comprehensively explore the sociodemographics and work-related characteristics of the entire workforce. METHODS: Data were collected in 2022 through multiple sources, including surveys of POs, private companies employing POs, and freedom of information requests to National Health Service Trusts/Health Boards and higher education institutes offering programs leading to registration as a prosthetist/orthotist. RESULTS: The workforce survey had 641 respondents (74% response rate). The estimated national ratio of POs per million population was 13, with all bar of the 12 regions below the World Health Organization minimum recommendation of 15 POs per million population. Most of the survey respondents were female (47.6%) and younger than male respondents, were British (75.8%), and in the White ethnic group (74.3%). Most of them were employed by private companies (59.9% vs. 31.4% employed by the National Health Service) and had clinical duties (94%), permanent contracts (90%), worked full-time (75%), and treated a wide range of clinical conditions. CONCLUSIONS: The national UK prosthetist and orthotist ratio falls below the recommended international standards. The versatility and broad skill set of POs highlight their crucial role in multidisciplinary teams. Establishing a centralized prosthetist and orthotist workforce database system is recommended for data-driven strategic planning.

An exploratory qualitative study of health professional perspectives on clinical outcomes in UK orthotic practice.

BACKGROUND: Despite potential savings to the National Health Service, the collection of data on outcomes of NHS orthotic services is patchy. Indeed, several reports into orthotic services in the UK have reported a lack of data relating to outcomes of care and highlighted the need to routinely measure outcomes to demonstrate efficacy of services. Whilst a previous study provided an overview of the use of outcome measures in orthotic practice and identified some barriers to their use, further questions emerged. Hence, this qualitative study aimed to explore orthotists' opinions and personal experiences on the influences on outcomes, how appropriate and relevant outcomes can be measured and also how barriers to the use of outcome measures can be overcome. METHODS: Following a review of the literature, an initial advisory group informed semi-structured questions. These were used to create dialogue in a focus group of 12 orthotists. Data from the focus group was transcribed verbatim and analysed using thematic analysis, creating themes and subthemes for discussion. RESULTS: The setting of realistic and agreed goals through managing expectations, compromise and patient education/information were seen as factors that could inform and improve outcomes. Barriers to the collection of outcome measures were associated with inadequate technology to manage the data, lack of time to complete them, lack of training in them and difficulties selecting appropriate outcome measures for patients with complex problems managed by different health professionals. The participants discussed ways of addressing these barriers, such as the use of 'snapshots' and delegation of data collection. CONCLUSIONS: This study has revealed that measuring outcomes is considered to be an important activity. In order to achieve good outcomes, it is important to address patient expectations, discuss and establish joint goals for care at the outset and inform and include patients in the decision-making process. The identified barriers to measuring outcomes can be overcome with the solutions revealed by these participants. Hence, this study has contributed to current knowledge which has relevance for clinical practice and may provide the theoretical basis for future research.

Microstomia: Aplicação da fotogrametria para mensurar a eficiência da órtese oral associada à terapia fonoaudiológica / Microstomy: Application of photogrammetry to measure the efficiency of oral orthosis associated with speech therapy

OBJETIVO: Esse estudo teve como propósito verificar, por meio da fotogrametria computadorizada, a eficácia do uso da órtese oral como auxiliar na terapia fonoaudiológica. MÉTODO: Após a documentação fotográfica, cada paciente foi submetido a terapia fonoaudiológica, por meio da terapia miofuncional orofacial, associada ao uso da órtese oral, confeccionada segundo Borges et al. (2011). Ao término do tratamento, foi realizado novo registro fotográfico, em seguida, a mensuração da dimensão vertical (distância entre lábio superior/inferior) e horizontal (distância entre comissuras direita/esquerda), com o uso do programa Corel Draw X3. RESULTADOS: As médias da abertura bucal aumentaram da avaliação inicial para a avaliação final, tendo aumentado 5,1 mm no sentido horizontal (67,3 mm para 72,4 mm) e 13,9 mm no sentido vertical (de 32,7 mm para 46,6 mm). Essas diferenças se revelam significativas para as avaliações (p <0,05). CONCLUSÃO: O uso da órtese oral associado a terapia fonoaudiológica demonstrou ser eficaz como mais um instrumento na prevenção da microstomia.

OBJECTIVES: The aim of this study was to through computerized photogrammetry, the efficacy of oral orthosis as an aid in speech therapy. METHODS: After the photographic documentation, each patient underwent speech therapy, through orofacial myofunctional therapy, associated with the use of an oral orthosis, made according to Borges et al. (2011). At the end of the treatment, a new photographic record was taken, then the vertical dimension measurement (distance between upper lip) and horizontal (distance between corners right/left), using the program Corel Draw X3. RESULTS: The mean mouth opening increased from the initial evaluation to the final evaluation, increasing 5.1 mm in the horizontal direction (67.3 mm to 72.4 mm) and 13.9 mm in the vertical direction (from 32.7 mm to 46.6 mm). These differences are significant for the evaluations (p<0.05). CONCLUSION: The use of oral orthosis associated with speech therapy proved to be effective as another tool in the prevention of microstomia.

Cross-sectional survey of orthotic service provision in the UK: does where you live affect the service you receive?

OBJECTIVE: To investigate the quantity and quality of orthotic service provision within the UK. DESIGN: Cross-sectional survey obtained through freedom of information request in 2017. SETTING: National Health Service (NHS) Trusts/Health Boards (HBs) across the UK. MAIN OUTCOME MEASURES: Descriptive statistics of survey results, including information related to finance, volume of appointments, patients and orthotic products, waiting times, staffing, complaints, outcome measures and key performance indicators. RESULTS: Responses were received from 61% (119/196) of contacted Trusts/HBs; 86% response rate from Scotland (12/14) and Wales (6/7), 60% (3/5) from Northern Ireland and 58% (98/170) from England. An inhouse service was provided by 32% (35/110) of responses and 68% (74/110) were funded by a block contract. Long waiting times for appointments and lead times for footwear/orthoses, and large variations in patient entitlements for orthotic products across Trusts/HBs were evident. Variations in the length of appointment times were also evident between regions of the UK and between contracted and inhouse services, with all appointment times relatively short. There was evidence of improvements in service provision; ability for direct general practitioner referral and orthotic services included within multidisciplinary clinics. However, this was not found in all Trusts/HBs. CONCLUSIONS: The aim to provide a complete UK picture of orthotic service provision was hindered by the low response rate and limited information provided in some responses, with greater ability of Trusts/HBs to answer questions related to quantity of service than those that reflect quality. However, results highlight the large discrepancies in service provision between Trusts/HBs, the gaps in data capture and the need for the UK NHS to establish appropriate processes to record the quantity and quality of orthotic service provision. In addition to standardising appointment times across the NHS, guidelines on product entitlements for patients and their lead times should be prescribed to promote equity.

The influence of standards and clinical guidelines on prosthetic and orthotic service quality: a scoping review.

OBJECTIVES: Standards and guidelines are an integral part of prosthetic and orthotic service delivery in the developed world underpinned by an assumption that they lead to improved services. Implementing them has a cost, however, and that cost needs to be justified, particularly in resource-limited environments. This scoping review thus asks the question, "What is the evidence of the impact of standards and guidelines on service delivery outcomes in prosthetics and orthotics?" MATERIALS AND METHODS: A structured search of three electronic databases (Medline, Scopus and Web of Science) followed by manual searching of title, abstract and full text, yielded 29 articles. RESULTS: Four categories of papers were identified: Descriptions and Commentaries (17 papers), Guideline Development (7), Guideline Testing (2) and Standards implementation (3). No articles were explicitly designed to assess the impact of standards and guidelines on service delivery outcomes in prosthetics and orthotics. DISCUSSION AND CONCLUSION: Studies tended to be commentaries on or descriptions of guideline development, testing or implementation of standards. The literature is not sufficiently well developed to warrant the cost and effort of a systematic review. Future primary research should seek to demonstrate whether and how guidelines and standards improve the outcomes for people that require prostheses, orthoses and other assistive devices. Implications for Rehabilitation International Standards and Clinical Guidelines are now an integral part of clinical service provision in prosthetics and orthotics in the developed world. Complying with standards and guidelines has a cost and, particularly in resource-limited environments, it should be possible to justify this in terms of the resulting benefits. This scoping review concludes that there have been no previous studies designed to directly quantify the effects of implementing standards and guidelines on service delivery.

Summary of the 2nd International Symposium on Arthrogryposis, St. Petersburg, Russia, September 17-19, 2014.

Enormous progress has been made in understanding the etiology and therapies for arthrogryposis (multiple congenital contractures). A 2nd International Symposium on Arthrogryposis was sponsored by the Turner Institute in St. Petersburg, Russia. Olga Agranovich, Head of the Arthrogryposis Department of the Turner Institute, organized this special meeting. Care providers from multiple disciplines from all over the world representing 18 nations attended. Participants included: Pediatric orthopedic specialists, rehabilitation physicians, occupational therapists, physical therapists, medical geneticists, neurologists, craniofacial physicians, psychologists, developmental biologists, as well as representatives from parent support groups. The 1st symposium established the need for a collaborative and interdisciplinary approach to the treatment of arthrogryposis, engagement of parent support organizations, and the aim for more research. The Second Symposium highlighted the continuing need for more research on various therapies, identification of different types of arthrogryposis, standardized descriptions of severity, development of new orthotics, improved prenatal diagnosis, and studying adult outcome. Major progress has been made on both upper and lower limb treatments.

A scoping literature review of the provision of orthoses and prostheses in resource-limited environments 2000-2010. Part two: research and outcomes.

BACKGROUND: Despite the activities of many orthotic and prosthetic provision organizations in resource-limited environments, there is still a great need and there are several areas for improvement, as identified in Part One of this series. OBJECTIVES: Our goal was to examine outcomes and conclusions of research studies to produce an evidence base for determining factors that may lead to successful provision of orthoses and prostheses in resource-limited environments. STUDY DESIGN: Literature review. METHODS: We conducted a scoping literature review of all information related to orthotic and prosthetic provision in resource-limited environments published from 2000 to 2010. We extracted measured outcomes reported in all types of articles and analyzed conclusions from research studies. RESULTS: Reported outcomes included durability, cost, satisfaction, use/nonuse of device, amount of utilization, walking speed, discomfort, pain, fit, misalignment, capacity for service provision, number of devices produced or delivered, and number of graduates from training programs. CONCLUSIONS: There are many gaps in the evidence base, notably in measuring inclusion, participation, and quality of life for orthosis and prosthesis users in resource-limited environments. There is a paucity of reported outcomes for orthotics. Valid, reliable, and standard methods of data collection and reporting are needed to advance the field and enhance the evidence base.

Análisis de las ayudas técnicas y del material de Fisioterapia solicitadas en la consejería de educación de la comunidad autónoma de Murcia / Analysis of technical devices and physiotherapy equipment requested in the ministry of education of the region of Murcia

Objetivo La atención del alumnado con discapacidad motora en la escuela en la comunidad autónoma de Murcia requiere de la intervención de diferentes profesionales, entre los que destaca el fisioterapeuta pediátrico para valorar la dificultad que presenta el niño y las ayudas técnicas que necesita en el entorno escolar. El objetivo del estudio ha sido realizar un análisis de las ayudas técnicas solicitadas por los centros escolares en la Consejería de Educación de la Región de Murcia. Material y método Los datos fueron recogidos a través del modelo establecido al efecto, durante los meses de enero a julio de 2010. Realizamos un análisis descriptivo de los datos y se valoró la relación entre distintas variables. Resultados El número total de solicitudes revisadas es de 143, con una edad media de 6,92 años. Los equipos de Murcia presentan el mayor porcentaje (27,3%). En relación con el sexo, un 38,5% de solicitudes corresponden a niñas. En relación con el diagnóstico médico y el diagnóstico funcional, las enfermedades no degenerativas y las tetraplejías presentan el mayor porcentaje. Existe un mayor número de solicitudes referidas a ayudas técnicas individuales, mobiliario, fisioterapia y movilidad. Conclusiones Se han encontrado relaciones significativas entre el diagnóstico médico, el sexo y las etapas educativas. Es necesario profundizar en los factores sociales y en la mejora de la calidad de vida para valorar el grado de aceptación de las ayudas técnicas en el entorno del niño (AU)

Background Care of students with physical disabilities in the school requires the intervention of several professionals. Of importance among them is the pediatric physiotherapist who evaluates the child's difficulties and the technical devices needed in the school environment. This study has aimed to analyze the technical devices requested in the Ministry of Education in the Region of Murcia. Material and method The data were collected using the model established for this purpose during the months of January to July 2010. A descriptive analysis was made of the data and the relationships between variables were assessed. Results A total of 143 requests were reviewed with a mean age of the children of 6.92 years. Murcia Teams had the highest percentage (27.3%). In relation to sex, 38.5% of the requests were for girls. Non-degenerative diseases and tetraplegia had the highest percentage regarding medical and functional diagnosis. There is a higher number of requests for individual technical devices, furniture, physiotherapy and mobility. Conclusions Differences were found between medical diagnosis, sex and educational levels. It is necessary go into greater depth regarding the social factors and the environment to improve the quality of life of children with motor disabilities (AU)

Experiences of providing prosthetic and orthotic services in Sierra Leone--the local staff's perspective.

UNLABELLED: In Sierra Leone, West Africa, there are many people with disabilities in need of rehabilitation services after a long civil war. PURPOSE: The aim of this qualitative study was to explore the experiences of prosthetic and orthotic service delivery in Sierra Leone from the local staff's perspective. METHOD: Fifteen prosthetic and orthotic technicians working at all the rehabilitation centres providing prosthetic and orthotic services in Sierra Leone were interviewed. The interviews were transcribed and subjected to latent content analysis. RESULTS: One main theme emerged: sense of inability to deliver high-quality prosthetic and orthotic services. This main theme was generated from eight sub-themes: Desire for professional development; appraisals of work satisfaction and norms; patients neglected by family; limited access to the prosthetic and orthotic services available; problems with materials and machines; low public awareness concerning disabilities; marginalisation in society and low priority on the part of government. CONCLUSIONS: The findings illustrated traditional beliefs about the causes of disability and that the public's attitude needs to change to include and value people with disabilities. Support from international organisations was considered necessary as well as educating more prosthetic and orthotic staff to a higher level.

Tratamento de microstomia grave: relato de caso / Treatment of severe microstomia: case report

O tratamento da microstomia é frequentemente um desafio no dia-a-dia do tratamento das sequelas de queimaduras. De maneira geral, as técnicas utilizadas são complexas, com resultados muitas vezes insatisfatórios e com alta taxa de recidiva. O presente trabalho teve como objetivo apresentar um caso grave de microstomia em uma criança de 2 anos, que teve sua resolução alcançada de forma simples, prática e econômica em contrapartida aos métodos tradicionais que muitas vezes são caros, complexos e pouco práticos.

The microstomia treatment is still a challenge in the day by day of the burn sequelae treatment. Usually, the techniques are complex, with poor results and high incidence of recurrence. This study presents a severe case of microstomia in a 2 years old child. The solution was simple, and cheap, in comparison to the traditional surgical methods, usually expensive, complex and low acessibility in a small Center.

Proper sling selection and application while using patient lifts.

In response to staff shortages, an aging clinical workforce, and research on safe patient handling, manufacturers have provided an extensive array of patient-lifting technology, including ceiling, floor-based, and sit-to-stand lifts as well as slings that are required for their use. Expanded choice, however, may pose challenges to both healthcare facilities and individual clinicians. These challenges, if not successfully resolved, can preclude the consistent, safe, and efficient use of patient-handling devices. This article provides nurses and other direct patient care providers with a heightened awareness of the challenges to appropriate sling and lift use in rehabilitation and other clinical settings. A new way to categorize slings is introduced, and guidelines for safely evaluating and using slings for different patient-handling tasks are offered.

Footwear and offloading for patients with diabetes.

Selecting footwear that fits appropriately in order to prevent foot pathologies, such as corns and callouses, is important in the general population but even more so in people with diabetes who have associated complications of neuropathy and ischaemia (Chantelau et al, 1994). Sue Coles explains why it is necessary to adapt footwear and how this is achieved.

Reforming the Belgian market for orthotic braces: what can we learn from the international experience?

OBJECTIVES: This article aims to review regulation governing outpatient orthotic braces (neck, wrist and knee braces) in France, the Netherlands and Sweden with a view to reforming the Belgian market. METHODS: Information about the regulatory framework was derived from an analysis of legal texts and a survey completed by national experts. RESULTS: Strategies to keep down prices include public procurement in Sweden, maximum prices in France, and exclusion of expensive braces from reimbursement in the Netherlands. Reimbursement is linked to a medical indication or a chronic condition in France, the Netherlands and Sweden. To gain reimbursement, the cost-effectiveness of orthotic braces needs to be demonstrated in France and the Netherlands. Orthotic braces tend to be initially prescribed by a specialist physician and distributed by orthotists, medical equipment shops and/or community pharmacies. CONCLUSIONS: Extensive government intervention exists in the outpatient orthotic brace market in the countries studied. Our recommendations to reform the Belgian market for prefabricated orthotic braces are to separate reimbursement for service provision from reimbursement for braces; to set prices by means of a tendering process or an international price comparison; and to make reimbursement conditional on effectiveness and cost-effectiveness of braces.

Do tariffs and prices correspond with costs? A case study of orthotic braces.

OBJECTIVES: The Belgian third-party payer wishes to set reimbursement tariffs at a level that reflects the costs of orthotic braces. This article aims to calculate production and distribution costs of a prefabricated hard neck and knee brace and to explore whether Belgian tariffs and actual retail prices correspond with estimated costs of these two braces. METHODS: The cost model considered manufacturing costs, general overheads, research and development costs, warehousing costs, profit and distribution margins. Data were gathered from manufacturers, a production site visit, desk research, a decomposition of finished products and stakeholder interviews. The price year was 2007. RESULTS: The cost model estimated a retail price of euro55-euro150 for the neck brace, depending on assumptions. The estimated retail price for the neck brace was lower than the reimbursement tariff of euro194 and the actual retail price of euro241. The estimated retail price of euro331-euro694 for the knee brace was lower than the actual retail price of euro948. CONCLUSIONS: Actual retail prices and reimbursement tariffs for a neck brace and a knee brace exceeded prices based on estimated costs. Therefore, there appears to be scope for reducing tariffs.

The physician-owned orthotic and durable medical equipment service.

In recent years, orthopedic practices have been forced to create internal ancillary profit centers to help compensate for escalating operating expenses. Increased professional liability premiums and health care costs, coupled with decreased reimbursements, have made the development of these ancillary centers a necessity. Practices that assess and incorporate sound business policies in developing the entity, monitor its progression, and strive to enhance the overall offerings within the division will derive the most profitability. By following a structured plan, practices can maximize revenue potential and improve patient satisfaction and outcomes. This article describes how to construct and follow such a plan.

Ambulation in children and youth with spinal cord injuries.

OBJECTIVE: To delineate the natural history of ambulation of children and youth with spinal cord injuries (SCls). DESIGN: Retrospective single-center. PARTICIPANTS/METHODS: One hundred sixty-nine subjects who sustained SCI at 18 years of age or younger and who were followed up for at least 4 years. RESULTS: Ambulation was significantly associated with age at injury and neurological impairment but not gender. Younger age at injury was associated with greater likelihood of ambulation, higher level of ambulation, and greater duration of ambulation. Lesser severity of neurological impairment was associated with greater likelihood of ambulation. Excluding ASIA D lesions, household ambulation was noted in 5% of subjects with tetraplegic, 26% with high thoracic, 30% with low thoracic, 44% with upper lumbar, and 33% with lower lumbar lesions. Of the 7 community-level ambulators with non-ASIA D lesions, none had cervical or high thoracic injuries, 3 had low thoracic, 1 had upper lumbar, and 3 had lower lumbar lesions. Using multiple regression analysis, predictive factors for ambulation were younger age at injury, total ASIA motor score, and ASIA impairment scale score. Less cumbersome orthotics were associated with higher levels of ambulation. CONCLUSION: Ambulation status is a function of neurological impairment, age at injury, and type of orthotic.

Durable medical equipment.

Recent changes in the interpretation of the Stark laws have made it legal and advantageous for physicians to dispense and bill directly for durable medical equipment (DME). Previously, physicians either gave small braces and splints to their patients as part of the services or wrote prescriptions for the larger and more expensive items. This resulted in inconvenience to the patient as they were required to travel to another location for the fitting of the brace or splint and there was often a significant expense to the patient or insurance company. More recently the "stock and bill" business arrangement became common. These arrangements were more convenient for the patient but did nothing to control costs. Since physicians may now dispense DME directly to the patient, DME becomes a part of the "complete services" that is becoming the model for patient-centered care. In addition, physicians have more control over the fitting of the devices and have an opportunity to control the pricing. This article provides instructions for the implementation of an office DME program that can be beneficial to both patient and physician.

Pressure redistribution strategies for the diabetic or at-risk foot: Part II.

PURPOSE: To familiarize the practitioner with a variety of offloading devices by comparing their indications and application, and to present a literature review of device effectiveness. TARGET AUDIENCE: This continuing education activity is intended for physicians and nurses with an interest in better understanding and improving pressure offloading therapies. OBJECTIVES: After reading this article and taking the test, the reader should be able to: 1. Describe indications for a cast walker and various inner soles. 2. Describe the indication and application of a total contact cast. 3. Choose an appropriate device based on wounds and deformities.