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Research Priorities 2020
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Introduction

The mission of the American Academy of Orthotists and Prosthetists (AAOP) Research Council (RC) is to provide research education for orthotic and prosthetic (O&P) professionals, to enhance the profession's research capacity, and to produce O&P secondary knowledge resources that advance evidence-based practice. To address this mission in part, the RC is tasked with identification and prioritization of research topic statements that describe current knowledge gaps with the greatest clinical need. Historically, topics have been recommended to the Academy Board of Directors to consider funding a systematic review (or reviews), which would eventually be discussed and disseminated as part of the Academy State of the Science Program (SSP). Recently, a process of prioritizing the most needed research topics was established, and the resulting list has been provided to funding agencies to inform research program development and requests for proposals (RFPs). In this way, the research topic identification and prioritization process of the RC serves as one of the highest quality initiatives within the Academy toward establishing research evidence and disseminating knowledge across the profession to enhance patient care.

The RC performed this activity most recently in 2015,1 with the resulting research priority list being shared amongst the O&P Alliance members (American Academy of Orthotists and Prosthetists, AAOP; American Orthotic and Prosthetic Association, AOPA; Amputee Coalition, AC; National Association for the Advancement of Orthotics and Prosthetics, NAAOP; American Board for Certification in Orthotics, Prosthetics, and Pedorthics, ABC; and Board of Certification/Accreditation, BOC) and used to advocate for research funding with national funding agencies (National Institutes of Health, NIH; United States Department of Veterans Affairs, VA; and the United States Department of Defense, DOD). Many of the research topics from that list were included in grant funding opportunities, such as funding for pilot research or systematic reviews by the Center for Orthotic & Prosthetic Learning (COPL) funded by AOPA. These funding opportunities resulted in primary and secondary research evidence and addressed the greatest research needs at that time.

The aim of this work was to identify current research topics and establish a prioritized list that includes more appropriate and contemporary clinical questions. To create a list of priorities, recent literature reviews pertinent to O&P were reviewed for statements regarding future research needs. These statements were then consolidated and presented to stakeholders representing a variety of organizations in the O&P field for assessment, prioritization of research needs. The research priority list created through this process is intended to be used by the Academy to inform the use of research resources, as well as to be shared throughout the O&P clinical and research community to help guide research funding and development for the coming years.

Method

Literature Search

A comprehensive search of relevant research topics that have been recommended in published literature were gathered from past State of the Science Conference Proceedings2-13 and published literature reviews in August, 2017 (see Appendix 1). Search terms included orthotic, orthosis, prosthetic, prosthesis, and amputation, and publication type was limited to reviews. Discussion sections of identified State of the Science Conference Proceedings and published reviews were examined to identify statements that described a need for future research or secondary knowledge development (termed “research topic statements”). These research topic statements were aggregated into general clinical topic areas, redundancies were collapsed, and topics were revised for clarity. Additional topics were solicited from Academy councils, committees, societies, and members.

A final list of all relevant research topic statements was compiled and separated by O&P intervention area, including: lower limb prostheses, upper limb prostheses, lower limb orthoses, spinal orthoses and cranial remolding orthoses, lower limb orthoses, and general O&P topics. Topics were separated by intervention area to isolate the influence of interest and enthusiasm for research in one area (e.g. lower limb prostheses) from overshadowing necessary research in other device areas (e.g. cranial and spinal orthoses). Within each O&P intervention area, statements were separated into sub-topics (e.g. partial foot prostheses).

Ranking and consensus process

The research topics were disseminated amongst the RC members in an initial ballot for a first round of prioritization. The RC membership is made up of chairs of the RC committees including: Secondary Knowledge Committee (SKC), Outcome Research Committee (ORC) and State of the Science Program Committee (SSP-C). This initial list was reviewed by RC members to reduce the number of topics to a manageable amount that was less onerous for a larger stakeholder group to rank and prioritize. In the initial ballot, RC members were asked to rate each research topic on a 1-5 scale according to priority and a 1-5 scale according to relevance to the O&P profession.

The initial ballots were collected and an average score for each research topic was taken across all RC member ballots. The priority and relevance scores were then averaged for a combined score. Within each O&P intervention type (e.g. lower limb prostheses) an average combined score of all topics was calculated. This average score was used as a cut-off for identifying the research topics within each O&P intervention type that received a score “above average” in from the initial ballot. These topics which scored “above average” were included in the next round of research topic prioritization, functionally reducing the number of topics by half.

From the initially reduced research topic list, the RC members were asked to identify whether each topic is relevant for primary research, secondary research or both. This poses an important delineation and a departure from the process used to prioritize research topics previously. Stakeholders invited to rank the topics needed to consider whether an adequate amount of primary research related to a topic existed and a systematic review of literature or other secondary knowledge source was warranted, or if the topic had limited evidence and therefore more primary research was needed to address a knowledge gap. The intended result was two lists; one list of research topics prioritized for secondary knowledge (e.g. for informing Academy’s State of the Science Program) and another list prioritized for funding of primary research (e.g. by DoD, NIH, OPERF, COPL or other agency).

The final step for this initiative included creation of an online survey (Survey Monkey) from the reduced research topic list, separated by secondary/primary research and by O&P intervention type. The survey was created to require respondents to rank their top four choices in descending order within each O&P intervention type for primary and secondary research. For topic areas that had four choices or less, respondents were required to rank their top two choices. The RC identified and invited stakeholders from other Academy councils and committees, Academy society leadership and representatives from other stakeholder groups including: AC, AOPA, DOD/VA, ABC, BOC, and NAAOP. Two conference calls were hosted by the authors, during which the participants received a description of the purpose of the survey, its format and instructions for completing the survey.

Results

The initial list compiled from published literature included 118 succinctly written research topics. This list was reduced through the initial ballot by the Academy’s RC to 50 topics considered for primary research and 38 topics considered for secondary research. In total 16 invited stakeholder and 5 members of the Academy’s RC completed the final ballot. The top ranked research topics from the ballot are depicted in Figure 1 for secondary knowledge and Figure 2 for primary research. The full research topic priority list with full title and description for secondary knowledge and primary research are included in Appendix 2 and 3, respectively.

Discussion

The initial topic list was extensive in size and exhaustive in the number of sources reviewed from State of the Science Proceedings and systematic literature reviews. The initial topic list will be maintained by the Academy as a legacy document for future research topic prioritization efforts, as these represent known knowledge gaps. As the research topics identified by the current prioritization process are addressed through primary and secondary knowledge research efforts, other topics from the initial list may become more relevant and necessary. Future efforts by the RC to produce a research priority list can review the current list of recommended topics to see if research has met these needs and reach back to the initial topic list that includes all the research topics pulled from published literature.

Based upon prior experience with the topic prioritization process and after compiling the initial list of research topics, the need to separate research topics into general device type categories became apparent. This allowed raters to focus their comparison of research topics within a narrow area of practice and avoid research topics from one device area (e.g. lower limb prostheses) from overshadowing the need for research in other device areas (e.g. cranial and spinal orthoses). The first round of prioritization performed within the RC served to reduce the topic list to a reasonable size, as the length of the initial ballot made meaningful comparison between individual topics difficult. This step reduced the list of topics to half of its original size, and allowed a survey to be created for stakeholders from the O&P field to review and rank the research topics.

Asking the raters to consider research topics as primary research and secondary knowledge separately was also informed by prior experience with the research topic prioritization process.1 The types of research topics that are suitable for systematic review of literature will likely have a substantial amount of existing primary research evidence. This would make such topics higher on the priority list for secondary knowledge, but lower on the priority list for primary research. For this reason, the ballot was separated into two sections (primary research and secondary knowledge). Arriving at two research topic lists also allows distinct and different uses for each list by the Academy. The list of secondary knowledge research topics is intended for internal use by the State of the Science Program to guide topic selection for State of the Science Conferences and Systematic Reviews commissioned by the Academy. The list of primary research topics is intended to share with partner organizations through the O&P Alliance and to publicly advocate for research funding to support new evidence to address the knowledge gaps in these areas. There is extensive overlap of topics across both lists, however the motivation behind separating the ballot into two lists was to improve the prioritization process and to create lists for different purposes.

There are several limitations to the process used in identifying and prioritizing research topics, as outlined in this manuscript. First, there were only a handful of topics which were offered by Academy councils, committees, societies and members, while the vast majority of the topics were generated from review of State of the Science Conference Proceedings and literature reviews. This limits the representativeness of the topics to the clinical care environment, because most topics were initially suggested by authors of research publications and not from practicing clinicians. Additionally, the topic ranking process only involved representatives of stakeholder groups, who were asked to contribute on behalf of the constituents they represent. Future efforts could engage the full membership of these stakeholder groups in the topic ranking and prioritization process. Finally, this process did not consider the research topics from any previous research priority topic lists generated by the Academy. Future efforts could review earlier lists and evaluate whether the prioritized research topics have been addressed by adequate primary and secondary research, or whether the topics should continue to be considered for prioritization and advocacy.

Conclusion

The process of identifying and prioritizing research topics has resulted in a list of research topics that require the greatest attention. The Secondary Knowledge Research Priority List (Appendix 1) will be used within the Academy to inform topic selection for development of secondary knowledge resources. The Primary Research Priority List (Appendix 2) will be disseminated with the O&P Alliance and other research funding agencies.

 

Acknowledgements: The authors would like to thank the American Academy of Orthotists and Prosthetists and its volunteers in the Research Council for the opportunity to lead this research topic prioritization process. Additionally, many thanks to the following stakeholders representing AC, AOPA, DOD/VA, ABC, BOC, and NAAOP for their contributions. The following list of individuals contributed to the process:

  • Leigh Davis, MSPO, CPO, FAAOP
  • Gerald Stark Jr., PhD, MSEM, CPO/L, FAAOP(D)
  • Katheryn (Kate) J. Allyn, CPO/L, FAAOP
  • Eric Ramcharran, CPO
  • Robert Lipschutz, CP
  • Jack D. Richmond, CPOA, CFo
  • George Gondo, MA
  • Megan Z. Christ, CPO
  • Chris Baschuk, MPO, CP, FAAOP
  • Kara Davis, MS, CPO, LPO
  • John Rheinstein, CPO, FAAOP
  • David Boone, PhD
  • Kyle Sherk, CPO, FAAOP, MS
  • Cara Negri, BSME, CP
  • Duffy Felmlee, CPO
  • David Knapp, BSME, MEd, CPO
  • Jessica Corso, CO, LO
  • John Brinkmann, MA, CPO/L, FAAOP(D)
  • Jason Highsmith, PT, DPT, PhD, CP, FAAOP

References

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Appendix 1 List of Literature Reviews Examined

Orthotic-related Reviews

  1. Aboutorabi A, Bahramizadeh M, Arazpour M, Fadayevatan R, Farahmand F, Curran S, et al. A systematic review of the effect of foot orthoses and shoe characteristics on balance in healthy older subjects. Prosthetics and orthotics international. 2016;40(2):170-81.
  2. Agabegi SS, Asghar FA, Herkowitz HN. Spinal orthoses. The Journal of the American Academy of Orthopaedic Surgeons. 2010;18(11):657-67.
  3. Ahn S, Lee YS, Song YD, Chang CB, Kang SB, Choi YS. Does surgical reconstruction produce better stability than conservative treatment in the isolated PCL injuries? Archives of orthopaedic and trauma surgery. 2016;136(6):811-9.
  4. Albright JC, Crepeau AE. Functional bracing and return to play after anterior cruciate ligament reconstruction in the pediatric and adolescent patient. Clinics in sports medicine. 2011;30(4):811-5.
  5. Almekinders LC, Tao MA, Zarzour R. Playing hurt: hand and wrist injuries and protected return to sport. Sports medicine and arthroscopy review. 2014;22(1):66-70.
  6. Alsiddiky AM. An insight into early onset of scoliosis: new update information - a review. European review for medical and pharmacological sciences. 2015;19(15):2750-65.
  7. Altaf F, Gibson A, Dannawi Z, Noordeen H. Adolescent idiopathic scoliosis. BMJ (Clinical research ed). 2013;346:f2508.
  8. Anderson J, Stanek J. Effect of foot orthoses as treatment for plantar fasciitis or heel pain. Journal of sport rehabilitation. 2013;22(2):130-6.
  9. Andersson D, Samuelsson K, Karlsson J. Treatment of anterior cruciate ligament injuries with special reference to surgical technique and rehabilitation: an assessment of randomized controlled trials. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 2009;25(6):653-85.
  10. Arazpour M, Samadian M, Ebrahimzadeh K, Ahmadi Bani M, Hutchins SW. The influence of orthosis options on walking parameters in spinal cord-injured patients: a literature review. Spinal cord. 2016;54(6):412-22.
  11. Azadinia F, Ebrahimi ET, Kamyab M, Parnianpour M, Cholewicki J, Maroufi N. Can lumbosacral orthoses cause trunk muscle weakness? A systematic review of literature. The spine journal : official journal of the North American Spine Society. 2017;17(4):589-602.
  12. Baert IA, Nijs J, Meeus M, Lluch E, Struyf F. The effect of lateral wedge insoles in patients with medial compartment knee osteoarthritis: balancing biomechanics with pain neuroscience. Clinical rheumatology. 2014;33(11):1529-38.
  13. Baghaei Roodsari R, Esteki A, Aminian G, Ebrahimi I, Mousavi ME, Majdoleslami B, et al. The effect of orthotic devices on knee adduction moment, pain and function in medial compartment knee osteoarthritis: a literature review. Disability and rehabilitation Assistive technology. 2017;12(5):441-9.
  14. Ballal MS, Pearce CJ, Calder JD. Management of sports injuries of the foot and ankle: an update. The bone & joint journal. 2016;98-b(7):874-83.
  15. Beaudreuil J. Orthoses for osteoarthritis: A narrative review. Annals of physical and rehabilitation medicine. 2017;60(2):102-6.
  16. Beaudreuil J, Coudreuse JM, C NG, Deat P, Chabaud A, Pereira B, et al. An algorithm to improve knee orthosis prescription for osteoarthritis patients. Annals of physical and rehabilitation medicine. 2016;59s:e156.
  17. Bell D. Evidence-based rationale for offloading treatment modalities. Surgical technology international. 2008;17:113-7.
  18. Bennell K, Hunter DJ, Vicenzino B. Long-term effects of sport: preventing and managing OA in the athlete. Nature reviews Rheumatology. 2012;8(12):747-52.
  19. Bennell KL, Hall M, Hinman RS. Osteoarthritis year in review 2015: rehabilitation and outcomes. Osteoarthritis and cartilage. 2016;24(1):58-70.
  20. Bert JM, Bert TM. Nonoperative treatment of unicompartmental arthritis: from bracing to injection. Clinics in sports medicine. 2014;33(1):1-10.
  21. Bettany-Saltikov J, Parent E, Romano M, Villagrasa M, Negrini S. Physiotherapeutic scoliosis-specific exercises for adolescents with idiopathic scoliosis. European journal of physical and rehabilitation medicine. 2014;50(1):111-21.
  22. Birch JG. Blount disease. The Journal of the American Academy of Orthopaedic Surgeons. 2013;21(7):408-18.
  23. Block JA, Shakoor N. Lower limb osteoarthritis: biomechanical alterations and implications for therapy. Current opinion in rheumatology. 2010;22(5):544-50.
  24. Bodendorfer BM, Anoushiravani AA, Feeley BT, Gallo RA. Anterior cruciate ligament bracing: evidence in providing stability and preventing injury or graft re-rupture. The Physician and sportsmedicine. 2013;41(3):92-102.
  25. Bogunovic L, Matava MJ. Operative and nonoperative treatment options for ACL tears in the adult patient: a conceptual review. The Physician and sportsmedicine. 2013;41(4):33-40.
  26. Bonanno DR, Landorf KB, Munteanu SE, Murley GS, Menz HB. Effectiveness of foot orthoses and shock-absorbing insoles for the prevention of injury: a systematic review and meta-analysis. British journal of sports medicine. 2017;51(2):86-96.
  27. Bono CM. The halo fixator. The Journal of the American Academy of Orthopaedic Surgeons. 2007;15(12):728-37.
  28. Bos RA, Haarman CJ, Stortelder T, Nizamis K, Herder JL, Stienen AH, et al. A structured overview of trends and technologies used in dynamic hand orthoses. Journal of neuroengineering and rehabilitation. 2016;13(1):62.
  29. Bouchard M, Mosca VS. Flatfoot deformity in children and adolescents: surgical indications and management. The Journal of the American Academy of Orthopaedic Surgeons. 2014;22(10):623-32.
  30. Brehm M, Bus SA, Harlaar J, Nollet F, Brehm M, Bus SA, et al. A candidate core set of outcome measures based on the International Classification of Functioning, Disability and Health for clinical studies on lower limb orthoses. Prosthetics & Orthotics International (Taylor & Francis Ltd). 2011;35(3):269-77.
  31. Briem K, Ramsey DK. The role of bracing. Sports medicine and arthroscopy review. 2013;21(1):11-7.
  32. Brooks G, Almquist J. Rehabilitation of Musculoskeletal Injuries in Young Athletes. Adolescent medicine: state of the art reviews. 2015;26(1):100-15.
  33. Brooks KS. Osteoarthritic Knee Braces on the Market: A Literature Review. Journal of Prosthetics & Orthotics (JPO). 2014;26(1):2-32.
  34. Burns TC, Owens BD. Management of shoulder instability in in-season athletes. The Physician and sportsmedicine. 2010;38(3):55-60.
  35. Bus SA. The Role of Pressure Offloading on Diabetic Foot Ulcer Healing and Prevention of Recurrence. Plastic and reconstructive surgery. 2016;138(3 Suppl):179s-87s.
  36. Camara R, Ajayi OO, Asgarzadie F. Are External Cervical Orthoses Necessary after Anterior Cervical Discectomy and Fusion: A Review of the Literature. Cureus. 2016;8(7):e688.
  37. Chang V, Holly LT. Bracing for thoracolumbar fractures. Neurosurgical focus. 2014;37(1):E3.
  38. Cherian JJ, Jauregui JJ, Leichliter AK, Elmallah RK, Bhave A, Mont MA. The effects of various physical non-operative modalities on the pain in osteoarthritis of the knee. The bone & joint journal. 2016;98-b(1 Suppl A):89-94.
  39. Chew KT, Lew HL, Date E, Fredericson M. Current evidence and clinical applications of therapeutic knee braces. American journal of physical medicine & rehabilitation. 2007;86(8):678-86.
  40. Chisholm AE, Perry SD. Ankle-foot orthotic management in neuromuscular disorders: recommendations for future research. Disability & Rehabilitation: Assistive Technology. 2012;7(6):437-49.
  41. Chu A, Lehman WB. Treatment of Idiopathic Clubfoot in the Ponseti Era and Beyond. Foot and ankle clinics. 2015;20(4):555-62.
  42. Chuter V, Spink M, Searle A, Ho A. The effectiveness of shoe insoles for the prevention and treatment of low back pain: a systematic review and meta-analysis of randomised controlled trials. BMC musculoskeletal disorders. 2014;15:140.
  43. Coetzee JC, Seybold JD, Moser BR, Stone RM. Management of Posterior Impingement in the Ankle in Athletes and Dancers. Foot & ankle international. 2015;36(8):988-94.
  44. Conceicao CS, Gomes Neto M, Mendes SM, Sa KN, Baptista AF. Systematic review and meta-analysis of effects of foot orthoses on pain and disability in rheumatoid arthritis patients. Disability and rehabilitation. 2015;37(14):1209-13.
  45. Corrado B, Ciardi G, Bargigli C. Rehabilitation Management of the Charcot-Marie-Tooth Syndrome: A Systematic Review of the Literature. Medicine. 2016;95(17):e3278.
  46. Crossley KM, Callaghan MJ, van Linschoten R. Patellofemoral pain. BMJ (Clinical research ed). 2015;351:h3939.
  47. Cutolo M, Berenbaum F, Hochberg M, Punzi L, Reginster JY. Commentary on recent therapeutic guidelines for osteoarthritis. Seminars in arthritis and rheumatism. 2015;44(6):611-7.
  48. Cutts S, Obi N, Pasapula C, Chan W. Plantar fasciitis. Annals of the Royal College of Surgeons of England. 2012;94(8):539-42.
  49. Cychosz CC, Phisitkul P, Belatti DA, Wukich DK. Preventive and Therapeutic Strategies for Diabetic Foot Ulcers. Foot & ankle international. 2016;37(3):334-43.
  50. d'Hemecourt PA, Hresko MT. Spinal deformity in young athletes. Clinics in sports medicine. 2012;31(3):441-51.
  51. Dall P, Granat M. The function of the reciprocal link in paraplegic orthotic gait. Journal of Prosthetics & Orthotics (JPO). 2001;13(1):10-3.
  52. Dare DM, Dodwell ER. Pediatric flatfoot: cause, epidemiology, assessment, and treatment. Current opinion in pediatrics. 2014;26(1):93-100.
  53. Daryabor A, Arazpour M, Samadian M, Veiskarami M, Ahmadi Bani M. Efficacy of corrective spinal orthoses on gait and energy consumption in scoliosis subjects: a literature review. Disability and rehabilitation Assistive technology. 2017;12(4):324-32.
  54. Davies N, Branthwaite H, Chockalingam N. Where should a school shoe provide flexibility and support for the asymptomatic 6- to 10-year-olds and on what information is this based? A Delphi yielded consensus. Prosthetics and orthotics international. 2015;39(3):213-8.
  55. de Almeida PH, MacDermid J, Pontes TB, Dos Santos-Couto-Paz CC, Matheus JP. Differences in orthotic design for thumb osteoarthritis and its impact on functional outcomes: A scoping review. Prosthetics and orthotics international. 2016.
  56. de Almeida PH, MacDermid JC, Pontes TB, Dos Santos-Couto-Paz CC, da Mota LM, Matheus JP. Orthotic use for CMC osteoarthritis: Variations among different health professionals in Brazil. Journal of hand therapy : official journal of the American Society of Hand Therapists. 2016;29(4):440-50.
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  59. Desmarais TJ, Keller MS. Pectus carinatum. Current opinion in pediatrics. 2013;25(3):375-81.
  60. DiPreta JA. Metatarsalgia, lesser toe deformities, and associated disorders of the forefoot. The Medical clinics of North America. 2014;98(2):233-51.
  61. Dizon JM, Reyes JJ. A systematic review on the effectiveness of external ankle supports in the prevention of inversion ankle sprains among elite and recreational players. Journal of science and medicine in sport. 2010;13(3):309-17.
  62. Doherty C, Bleakley C, Delahunt E, Holden S. Treatment and prevention of acute and recurrent ankle sprain: an overview of systematic reviews with meta-analysis. British journal of sports medicine. 2017;51(2):113-25.
  63. Dolan LA, Weinstein SL. Surgical rates after observation and bracing for adolescent idiopathic scoliosis: an evidence-based review. Spine. 2007;32(19 Suppl):S91-s100.
  64. Drakos MC, Murphy CI. Bracing versus casting in ankle fractures. The Physician and sportsmedicine. 2014;42(4):60-70.
  65. Duerinck S, Swinnen E, Beyl P, Hagman F, Jonkers I, Vaes P, et al. The added value of an actuated ankle-foot orthosis to restore normal gait function in patients with spinal cord injury: a systematic review. Journal of rehabilitation medicine. 2012;44(4):299-309.
  66. Duffy PS, Miyamoto RG. Management of medial collateral ligament injuries in the knee: an update and review. The Physician and sportsmedicine. 2010;38(2):48-54.
  67. Duhem R, Tonnelle V, Vinchon M, Assaker R, Dhellemmes P. Unstable upper pediatric cervical spine injuries: report of 28 cases and review of the literature. Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery. 2008;24(3):343-8.
  68. Duivenvoorden T, Brouwer RW, van Raaij TM, Verhagen AP, Verhaar JA, Bierma-Zeinstra SM. Braces and orthoses for treating osteoarthritis of the knee. The Cochrane database of systematic reviews. 2015(3):Cd004020.
  69. Dutton RA, Khadavi MJ, Fredericson M. Update on rehabilitation of patellofemoral pain. Current sports medicine reports. 2014;13(3):172-8.
  70. Eddison N, Chockalingam N. The effect of tuning ankle foot orthoses-footwear combination on the gait parameters of children with cerebral palsy. Prosthetics and orthotics international. 2013;37(2):95-107.
  71. Eftekhary N, Nwosu K, McCoy E, Fukunaga D, Rolfe K. Overutilization of bracing in the management of penetrating spinal cord injury from gunshot wounds. Journal of neurosurgery Spine. 2016;25(1):110-3.
  72. El-Hawary R, Chukwunyerenwa C. Update on evaluation and treatment of scoliosis. Pediatric clinics of North America. 2014;61(6):1223-41.
  73. Elliott RE, Tanweer O, Boah A, Morsi A, Ma T, Frempong-Boadu A, et al. Is external cervical orthotic bracing necessary after posterior atlantoaxial fusion with modern instrumentation: meta-analysis and review of literature. World neurosurgery. 2013;79(2):369-74.e1-12.
  74. Farwell KE, Powden CJ, Powell MR, McCarty CW, Hoch MC. The effectiveness of prophylactic ankle braces in reducing the incidence of acute ankle injuries in adolescent athletes: a critically appraised topic. Journal of sport rehabilitation. 2013;22(2):137-42.
  75. Fayssoux RS, Cho RH, Herman MJ. A history of bracing for idiopathic scoliosis in North America. Clinical orthopaedics and related research. 2010;468(3):654-64.
  76. Feeley BT, Gallo RA, Sherman S, Williams RJ. Management of osteoarthritis of the knee in the active patient. The Journal of the American Academy of Orthopaedic Surgeons. 2010;18(7):406-16.
  77. Fisahn C, Aach M, Jansen O, Moisi M, Mayadev A, Pagarigan KT, et al. The Effectiveness and Safety of Exoskeletons as Assistive and Rehabilitation Devices in the Treatment of Neurologic Gait Disorders in Patients with Spinal Cord Injury: A Systematic Review. Global spine journal. 2016;6(8):822-41.
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Prosthetic-related Reviews

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Appendix 2 Final List of Prioritized Research Topics for Secondary Knowledge Research

General O&P Topics

Healthcare cost effectiveness studies: Health care cost effectiveness of orthotic and prosthetic interventions and their effect on overall costs (health related and non-health related) over time

Translational research findings into clinical care: Translational research to ensure that results of clinical studies are implemented in clinical care.

Cranial Remolding Orthoses and Spinal Orthoses

Effectiveness of cranial remolding orthoses: Are cranial remolding helmets effective in patients with moderate to severe deformities and do such devices improve outcomes and/or reduce cost compared to existing therapies?

What patient factors predict curve progression: Which patients with idiopathic scoliosis are most likely to demonstrate significant curve progression?  Which patients are thus indicated for earlier orthotic intervention?  Which patients may be currently “overtreated”?

Lower Limb Prostheses

Effect of prosthesis use on secondary health conditions: How does prosthetic use/activity correlate to secondary conditions or pain, including but not limited to: Back pain, Degenerative joint disease, Diabetic foot complications, Residual limb pain, Phantom pain, Hip pain, Osteoporosis?

Validity of mobility classification levels on access to technology: Investigate the Medicare K-levels to determine the potential for more discreet or more collapsed levels

Correlation of performance and patient reported measures and quality of life: How do quality of life measures correlate to performance measures and patient-report measures of balance and mobility?

Measures of socket fit quality and effects on outcome: Development and evaluation (psychometric properties) of clinically useful methods of measuring socket fit quality (comfort, pistoning, stiffness and restriction to desired/undesired motion) and studies of acceptable range of fit quality of prosthetic sockets and how clinically meaningful changes in socket fit and affect outcomes (patient-report, function, activity participation, biomechanical and gait).

Lower Limb Orthoses

Evaluate effectiveness of ankle foot orthoses with environmental barriers: Evaluate extremity orthosis function complexity of environmental conditions encountered at home and within the community (i.e., uneven terrain, stairs and ramps) to increase ecological validity of outcomes

Effect of orthosis on secondary effects of the limb and proximal joints: Determine the influence of extremity orthoses on muscle atrophy, spasticity, joint pain, joint contracture and other deformities (e.g. degenerative knee changes) within the body segment being braced and effects on proximal joints (e.g. spinal deformity)

Effect of orthosis alignment on function: Determine the influence of orthosis alignment, and modifications to orthosis alignment, on functional outcomes.

Effect of physical therapy on orthosis outcome: Determine short-term and long-term effects of physical therapy interventions, including gait training, on outcome and acceptance of orthotic devices.

Upper Limb Prostheses

Cost effectiveness of upper limb prosthetic rehabilitation: Studies of cost efficacy of upper-limb prostheses and associated training between device types and compared to use of no prosthesis

Functional differences of body powered and myoelectric prostheses: Empirical evidence regarding functional differences in upper-limb prostheses, specifically body-powered compared to myoelectric designs


Appendix 3 Final List of Prioritized Research Topics for Primary Research

General O&P Topics

Longitudinal outcome studies: Prospective, longitudinal studies that assess important long-term outcomes related to orthotic and prosthetic interventions.

Healthcare cost effectiveness studies: Health care cost effectiveness of orthotic and prosthetic interventions and their effect on overall costs (health related and non-health related) over time

Randomized controlled trials and multi-center comparative effectiveness trials: High-level, powered comparative effectiveness studies for all areas of orthotic and prosthetic research, including randomized controlled trials, randomized cross-over trials, and multicenter trials.

Effect of practice guidelines on patient outcomes: Evaluation of the effect of practice guidelines and treatment pathways on outcomes for people that require prostheses, orthoses and other assistive devices Do guidelines and/or standards improve the outcomes for people who use prostheses and orthoses? In what ways?

Cranial Remolding Orthoses and Spinal Orthoses

Effects of untreated plagiocephaly: What is the natural history of untreated plagiocephaly? Are there any functional or developmental issues associated with untreated plagiocephaly?

Effectiveness of cranial remolding orthoses: Are cranial remolding helmets effective in patients with moderate to severe deformities and do such devices improve outcomes and/or reduce cost compared to existing therapies?

What patient factors predict curve progression: Which patients with idiopathic scoliosis are most likely to demonstrate significant curve progression?  Which patients are thus indicated for earlier orthotic intervention?  Which patients may be currently “overtreated”?

Measurement of corrective forces for successful outcomes: What is the location, direction, and magnitude of the corrective forces most associated with successful outcome as defined by in brace correction, patient compliance, and overall treatment success at skeletal maturity? 

Lower Limb Prostheses

Effect of prosthesis use on secondary health conditions: How does prosthetic use/activity correlate to secondary conditions or pain, including but not limited to: Back pain, Degenerative joint disease, Diabetic foot complications, Residual limb pain, Phantom pain, Hip pain, Osteoporosis?

Validity of mobility classification levels on access to technology: Investigate the Medicare K-levels to determine the potential for more discreet or more collapsed levels

Measures of socket fit quality and effects on outcome: Development and evaluation (psychometric properties) of clinically useful methods of measuring socket fit quality (comfort, pistoning, stiffness and restriction to desired/undesired motion) and studies of acceptable range of fit quality of prosthetic sockets and how clinically meaningful changes in socket fit and affect outcomes (patient-report, function, activity participation, biomechanical and gait).

Correlation of performance and patient reported measures and quality of life: How do quality of life measures correlate to performance measures and patient-report measures of balance and mobility?

Lower Limb Orthoses

Effect of orthosis alignment on function: Determine the influence of orthosis alignment, and modifications to orthosis alignment, on functional outcomes.

Longitudinal effects on ambulation: Studies that assess long-term effects of extremity orthoses interventions on gait performance (with respect to proximal body structures and the affected and non-affected sides), endurance and daily walking activity.

Effect of orthosis on secondary effects of the limb and proximal joints: Determine the influence of extremity orthoses on muscle atrophy, spasticity, joint pain, joint contracture and other deformities (e.g. degenerative knee changes) within the body segment being braced and effects on proximal joints (e.g. spinal deformity)

Evaluate effectiveness of ankle foot orthoses with environmental barriers: Evaluate extremity orthosis function complexity of environmental conditions encountered at home and within the community (i.e., uneven terrain, stairs and ramps) to increase ecological validity of outcomes

Upper Limb Prostheses

Overuse and repetitive stress injury in upper limb loss patients: Studies of the incidence, severity and contributing factors to overuse and repetitive stress injuries in persons with limb loss and congenital limb differences.

Cost Effectiveness of upper limb prosthetic rehabilitation: Studies of cost efficacy of upper-limb prostheses and associated training between device types and compared to use of no prosthesis

Contact

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