June 2006 • Vol. 2, No. 2
	Advancing Orthotic and Prosthetic Care Through Knowledge

Grant Fuels Advances in O&P Awareness, Education, and Research

In 2003 the Academy began working on the first year of what is now three years of a federal grant from the US Department of Education. The original grant was secured as the first step in the Academy’s Project Quantum Leap (PQL) initiative to define the future course of the O&P profession and to ensure that there are enough trained professionals to serve the future needs of the American public. Within three short years, the Academy has succeeded in leveraging the grant funds into a plethora of projects already paying positive dividends for practitioners and patients.

"The grant money enabled the Academy to get great people together to work on great ideas. It gave the financial support to make feasible many projects that were already started but struggling. Although the projects may have happened on their own, the grant meant that they happened sooner and more productively,” says Douglas G. Smith, MD, principal investigator of the grant.

As an example, Smith pointed to the Academy’s highly visible national recruitment and awareness campaign promoting O&P as a meaningful and rewarding career choice. “All the concepts were out there,” he notes. “The grant enabled us to establish a more formal structure, develop training tools, and reach more targets.

”Building awareness was one of the reasons the Academy began the PQL project and has become a key focus of the grant, along with advancing the profession through education and research. With the mushrooming demand for O&P care, growing numbers of qualified providers will be required in the next decade and beyond. That requires escalating recruiting efforts at the high school and college levels now to make sure adequate numbers of O&P students enter the pipeline.

Grassroots Awareness Campaign Grows

The grant money has helped fund an information-packed website (www.opcareers.org) and comprehensive career kits designed to make it as easy as possible for Academy members to make presentations at local schools and career nights. The complimentary kits are also available in print and electronic format to share with students, teachers, and guidance counselors. Julie Hayes, the Academy’s director of Grants and Special Projects, oversees the awareness campaign and hopes to include all Academy members and even O&P patients in the burgeoning grassroots network of ambassadors promoting the profession. “We’re not truly going to be successful unless everyone gets involved,” Hayes says. “I can tell ten people, but if ten people tell ten more people, it has a multiplier effect on our efforts.”

In addition, Hayes is encouraging Academy chapters to step up their outreach efforts, including replicating the popular outreach program at the Academy’s Annual Meeting, which attracts several dozen local high school students to get a more in-depth view of the O&P profession. As a result, nearly 50 students from the Seattle area Health Occupations Student Association (HOSA) attended the Academy’s Northwest Chapter meeting in April. Strengthening collaborative ties with allied health organizations such as HOSA also provides valuable opportunities to spread the word about O&P to interested audiences. For example, in late June the Academy will conduct workshops at HOSA’s national meeting for more than 5,000 secondary, post-secondary, and collegiate students interested in health-related careers.

Although it is still early in the measurement process, preliminary results of the outreach campaign have been promising. “It has certainly changed our public image quite a bit, and improved our inter- and intra-professional relationships,” notes Academy President-Elect Gary Berke, MS, CP, FAAOP. Twice the number of career kits—10,000—were distributed in the second year of the grant as in the first, website hits more than doubled, the number of students seeking mentors has increased, and pre- and post-presentation surveys indicate student interest doubles following a career presentation. The number of students applying to O&P programs and their grade point averages are both higher than in previous years. “That means we have a larger pool of students and we’re bringing in better students, which will lead to better practitioners,” says Sharon Hubbard, operations manager for the Prosthetics Research Study and a member of the grant team.

Academy Executive Director Peter Rosenstein believes that sustaining this outreach momentum and leveraging the work of the grant team after the grant ends depends on involving the membership and chapters as much as possible. There are no guarantees, but ideally, the Academy hopes to continue the grant for its anticipated five-year cycle that would run through September 2008. “We’ve been very successful,” Rosenstein says. “We’re reaching a wide audience, but we need to take everything we’ve learned and continue to expand our efforts.” He envisions heightening awareness by having chapters work with public officials at the state and local levels to declare an O&P Day or Week, and also hopes that through grant funding this year, we can develop a series of public service announcements to spread the message about O&P to an even wider audience.

Catalyst for Professional Growth

In addition to using the grant to expand and strengthen outreach, Rosenstein sees it as a critical catalyst for moving the profession toward evidence-based practice and for heightening the level of education for future generations of O&P professionals. The grant already has helped jumpstart a number of core projects in these areas and accelerated the pace at which they produced desired results.

“The grant provided the fuel to accomplish ten years of effort in three. It tripled the pace at which we’ve been able to advance the academic infrastructure of the O&P profession,” notes John Michael, MEd, CPO, FISPO, FAAOP, a former president of the Academy. “I’m really pleased the Academy could make the leap forward now because it comes at a critical time. It’s important to have prosthetists and orthotists be leaders in developing evidence-based practice rather than following others’ lead. If we have a cadre of clinically savvy people with advanced degrees, it will help ensure the field develops in ways directly related to improved patient care.

”Moving the academic agenda forward means creating pathways for earning advanced O&P degrees, including doctorates, that will produce O&P scientific researchers and academic leaders. The grant-funded strategic planning meetings on this critical topic already have borne fruit. This year, two doctoral level programs will be open to O&P candidates: one in rehabilitative sciences at the University of Washington, and the other in applied physiology at the Georgia Institute of Technology.

Michael adds, “This is the first time we’ve had PhD programs with an O&P emphasis available on US soil, so it’s no longer necessary to move to Scotland, England, Melbourne, or Hong Kong for this education. It’s a phenomenal step forward for the field academically and a big step toward developing our own scientific researchers. If you estimate 35 years of scientific productivity per person, that’s an excellent long-term dividend for a comparatively small investment.”

Although there always have been a few intrepid researchers who earned the necessary academic credentials in another field such as engineering and combined them with O&P training, historically O&P researchers have had to forge their own path. “It wasn’t easy,” Smith observes. “The next generation will have a process. They won’t have to make it happen on their own. I believe, because of the grant, ten years from now there will be far more O&P people sitting around the academic table on an equal footing with researchers from other allied health professions. It will pay dividends for decades.”

And more researchers mean more potential for much-needed O&P research. “As we build a pool of acaademic and scientific leaders,” Smith says, “there will be more people in the pipeline writing grants to answer questions pertinent to O&P. That’s a win. The grant money is out there. There just are very few people writing proposals for it.”

Educational Infrastructure Changes

Additional changes in the educational infrastructure also have been set in motion as the result of a grant-funded Educational Summit to assess entry-level O&P education. Recognizing that a rapidly expanding knowledge base and heightened use of technology will require additional education, the National Commission on Orthotic and Prosthetic Education (NCOPE) recently announced that within the next decade a masters degree will become the entry-level requirement for O&P practitioners. “An educational program that produces quality practitioners, researchers, and educators is the baseline for our evolution to evidence-based practice,”Berke explains.

Advancing Evidence-Based Practice

As chair of the Academy’s new Research Council, another outgrowth of grant-funded activity, Berke is working energetically to advance evidence-based practice in every way possible. “We’re beginning to address the limitations of our scientific knowledge,” he says. That means both increasing the amount of research being conducted and assisting clinicians in incorporating research into daily practice.

The Academy’s seven State-of-the-Science Conferences (SSCs) held to date—an eighth is now being plannned—have been playing a vital role in translating these goals into reality. Funded by the grant, the SSCs convene a multi-disciplinary panel of experts to examine a topic in-depth. “In the short-term, we’re identifying and promulgating the best of current practice, and seeing what we need to advance our practice to the next level,” Michael says. “The faster we identify key research questions and priorities, the faster the research can be undertaken, and the faster we can move to evidence-based practice.”

Identifying best practices as well as ineffective ones improves the quality of patient care and at the same time promotes timely reimbursement by third-party payers. Michael cites the treatment of adolescent idiopathic scoliosis as a model for the evolution of O&P practice in general. Fifty years ago, some practitioners advocated bracing and used it for a wide range of patients, while other clinicians treated the condition with surgery or exercise. Eventually, it became clear that bracing was an ineffective treatment for very large curves, that no treatment was required for mild curves, and that exercise alone did not change the progression of the disorder. “Scientific and clinical research has defined the lower and upper boundaries of curve magnitudes, so we can now zero in on those patients most likely to benefit from orthotic management,” Michael explains. “We’re becoming more and more sophisticated in our understanding of this disorder, and better able to target our interventions for maximum effectiveness at the lowest overall cost to the healthcare system.”

SSC Findings Highly Accessible

But in today’s fast-paced, information-filled age, it’s increasingly difficult for front-line clinicians to make the time to read dozens of journals to tease out those articles with critical new information about orthotic and prosthetic treatment, underscoring the value of the SSC findings. With the grant helping to underwrite the costs, the findings have been disseminated to practitioners nationwide in several highly accessible formats. They have been posted online, published as supplements to the Journal of Prosthetics and Orthotics, and developed into online professional continuing education courses available 24/7 through the Paul E. Leimkuehler Online Learning Center. The Academy also partnered with Netter, a leading medical illustrator, to produce a series of detailed charts based on SSC-reviewed materials and distributed these free to all members. “This makes every practitioner part of the conference,” Smith says. “It’s a process for turning the findings of the meeting into an educational forum, not just ending with a report.”

In addition, SSC research recommmendations have been sent to interested funding agencies to help guide their future research proposals. “Many funding agencies are unaware of O&P. If we give them researchable questions, they’ll issue requests for proposals and attract researchers from around the world,” observes Michael, explaining he expects the findings to spark research activity within about two years after they’re made available to the wider community. “It takes a while for requests to wind through the system. But eventually requests for proposals will appear, which will drive scientists to our website to see the findings and find potential research partners.”

With an eye toward continuing the SSCs with Academy, corporate, or university sponsorship once the grant ends, the Academy’s Master Agenda project convened a team of Subject Matter Experts to develop well-articulated guidelines for conducting future conferences, standards for performing a literature review and ranking the evidence, and protocols for identifying topics for future conferences. With these pieces firmly in place, Michael feels confident that the conferences will continue, though perhaps less frequently at first. “It’s appropriate to take a couple of years, assimilate what’s happened, and move at a more deliberate pace. It’s important to get the results into daily practice,” he says.

Better Patient Care

Helping practitioners integrate research findings into patient care also involves educating them to become better consumers of research, one of the objectives of the Research Council efforts. “It’s only when clinicians interpret research and deliver care to patients that it has value,” Michael says. “The better able they are to filter, evaluate, and apply scientific research, the higher the quality of patient care.”

Providing quality patient care also depends on identifying areas with a shortage of qualified practitioners. Through the grant’s Geographic Map project, the Academy has been documenting the distribution of certified practitioners in the United States vs. the distribution of Medicare patients who may be candidates for O&P services. In addition, the Academy has been taking advantage of grant funding to devise tools and a formal process for measuring current need that can be used as a basis for future planning and comparison.

Grant Enables Strong Foundation for Future

From the geo-map to the awareness campaign to the SSCs to the educational advances, the grant has enabled the Academy to create a new, stronger foundation on which to build for the future. This long-range planning will assure that the profession will not only survive, but thrive in a way that provides the best possible care to those who need it. “We want to find ways to continue these programs and activities as part of our regular operations,” Berke points out. “They are the key to our long-term salvation and the evolution of our profession over the next ten years. Without them we might have been left off the healthcare map.”

Smith agrees, noting, “Everyone involved has been of the mindset that we need to use the money to do good things that will continue to benefit the profession even when funding for the projects ends. With the work that’s been done to date and that we hope to continue over the next two years, we will have the procedures and programs in place to do that.”