How Do We Turn the Tide in O&P Research and Education?
January 2005 Issue
As a student of orthotics and prosthetics
(O&P) in the late 1980s and early 1990s, it became readily
apparent to me that there was a stark limitation in the research
base. Only a paucity of evidence supported the orthosis/prosthesis
designs and patient care strategies that were taught. After
searching the fragmented annals of O&P research journals, I
discovered that the majority of the knowledge base of the
profession was produced from the extensive research effort
initiated by the National Academy of Sciences (NAS) that partnered
with universities, the Department of Veterans Affairs (VA), private
industry, and other military units between 1945 and 1976
1,2. When the funding dried up, the close relationship
between NAS, the research in O&P, and the consistency of the
O&P curriculum in the schools generally diminished.
The new millennium continues to present notable challenges to the O&P profession. Increasing advances in technology and methods of patient care have created an enormous expansion of knowledge that has made healthcare progressively more complex. Parallel to these developments, the orthotist's and prosthetist's role has expanded from a focus on the technical aspects of device design to a more inclusive role as members of the rehabilitation profession. Negotiated rulemaking has continued to force the profession to define who is a qualified provider of O&P care.
Reduced reimbursements have expanded the need for streamlining services and other cost containment measures. The closure of O&P schools (most recently St. Ambrose University, along with several others over the years) due to lack of funding and administrative support has not helped 3. The increasing need for qualified providers is predicted to steadily rise in the face of an expanding patient population 4.
Key to Professional Identity
Looking at the development of our collaborating professions in
physical and occupational therapy, physiatry, orthopedics, and
bioengineering, there is strong evidence that expansion of new
knowledge through research is the key to professional identity
5, 6. O&P can define itself with an expanded
research agenda and dissemination of the new knowledge through
advanced training and education programs. These needs are
imperative for survival. The O&P schools need to accept the
challenge of expanding the research information base and foster it
through partnerships with industry and interdisciplinary
collaborations with related healthcare disciplines.
However, many schools still struggle to simply remain operational at the most fundamental level. The dependence upon student enrollments for tuition or supplemental clinical practice revenue to augment shrinking budgets takes significant time and energy away from curriculum development, instruction, and research. In addition to fulltime teaching, many faculty members must maintain clinical practice responsibilities or market their programs to other students, school counselors, and donors. Research investigations and the development of research mentors for the profession are not being created in this system.
I grew increasingly interested in playing a role in the academia and research aspects of O&P. In order to become an effective researcher and educator, I sought advanced education in a related program, as no advanced university-based degree program in O&P existed at the time. After I acquired the masters degree, seemingly limitless opportunities became available for me in academia. Now I am fortunate to pursue my teaching and research aspirations in the hopes of enhancing the profession that has provided me so many opportunities.
Positive Change Evident
Fortunately, there is evidence of positive change. The Georgia Institute of Technology Master of Science program in Prosthetics and Orthotics (MSPO) recently became the first CAAHEP-accredited entry-level masters program in the profession. By May of 2004, the first graduates of this landmark program entered O&P residencies across the nation. Subsequent student enrollments have increased as the program nears capacity. Solid development is seen through strong administrative support from the university and the establishment of state-of-the-art clinical and technical design and fabrication laboratories. Partnerships with the O&P industry, as well as clinical and medical community, have enhanced the applied clinical component of the program. Research activities have begun to expand through collaborations with the VA, the clinical O&P community, and scientists and engineers within the university's extensive research laboratories.
The developments at Georgia Tech are only the beginning of even bigger plans. In the fall of 2005, the school will matriculate students in the first doctoral program in O&P within North America. This event will have historic implications as it will represent the first time an American O&P program will offer a PhD with emphasis in orthotic and prosthetic biomechanics. As a profession, we will finally have a terminal degree research program dedicated to becoming a more meaningful player in the clinical research and academic arena.
What was started in Georgia Tech will most likely continue as Eastern Michigan University aims to attain CAAHEP accreditation for its existing postgraduate certificate program in O&P with plans to transform to a masters degree program 7. There are also reports that Alabama State University aims to develop a masters degree program in prosthetics 8.
Additional signs of expanded support for O&P education are developing. The Academy has successfully completed the first tier of work it set out to accomplish via Project Quantum Leap. This ambitious initiative included the creation of a nationwide O&P awareness campaign, defining a national O&P research agenda, and instituting state-of-science conferences. Recently the Academy achieved another milestone by acquiring another $1 million grant from the US Department of Education and will work with the O&P schools in creating research grant funding opportunities to address the state of science of the profession 9.
On the national scene, the Bone and Joint decade of 2000-2010 has increased priority funding for rehabilitation research in orthopedics for the next several years, and the VA has renewed interest in pairing with O&P for increased funding to study clinical outcomes 6. Is there hope for the profession of O&P? Indeed, there is a change in the tide in O&P research and education.
Christopher F. Hovorka, MS, CPO, is clinical director of the Master of Science program in Prosthetics and Orthotics at the Georgia Institute of Technology, Atlanta. He is a commissioner of the National Commission on Orthotic & Prosthetic Education (NCOPE), secretary/treasurer of the National Association of Orthotic & Prosthetic Educators (NAPOE) and is on the editorial board for the Journal of Prosthetics and Orthotics.
Committee on Artificial Limbs. National Research Council: Terminal Research Reports on Artificial Limbs (Covering the Period from April 1, 1945 through June 30, 1947).
Wilson AB. History of Amputation Surgery and Prosthetics. In JH Bowker, JW Michael (eds), Atlas of Limb Prosthetics. Surgical, Prosthetic, and Rehabilitation Principles (2nd ed.). St. Louis: Mosby, 1992:3-15.
Hovorka CF, Shurr DG, Bozik DS. The concept of an entry-level interdisciplinary graduate degree preparing orthotists for the new millennium part 1: history of orthotic and prosthetic education. JPO 2002; 14(2):51-58.
Nielsen CC. Issues affecting the future demand for orthotists and prosthetists, a study prepared for the National Commission on Orthotic and Prosthetic Education. Update 2002 [report]. Alexandria, VA: National Commission on Orthotic and Prosthetic Education; May 2002.
Ford N. Helmbring A, Hodge MC, Hovorka C, Kogler G, Lilja M, Raschke S. Prosthetic & orthotic educators meeting Developing strategies for the future of P&O university education post meeting book. Jönköping, Sweden: Jönköping University. August 2002.
DeLisa JA. Shaping the future of medical rehabilitation research: using the interdisciplinary research model. Arch Phys Med Rehabil April 2004; 85:531-537.
Otto JP. Advancing O&P education: how are we doing? O&P Edge. February 2004; 3(2); 22-26.
National Commission on Orthotic and Prosthetic Education Meeting Minutes, August 14, 2004. Alexandria, VA.
Project quantum leap 2004 progress report. Alexandria, VA: American Academy of Orthotists and Prosthetists, 2004.