The Relevance of Including O&P Professionals in Research

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By Thomas J. Cutler, CPO, FAAOP, CPHM
Thomas J. Cutler

I have a confession: I am not a physical therapist. I also have an observation for physical therapists, physicians, biomechanists, and other medical staff: You are not orthotists. Nor are you prosthetists.

Earlier this year, The O&P EDGE published articles about peer review and research relevancy in O&P. Now I ask: How much of the O&P-related research that is published is accurate? This year I've done a lot of research, and the more I read O&P journal articles written without including orthotists and/or prosthetists as coauthors, the more I find lacking in the studies' designs and conclusions.

In one study, the biomechanist and her colleagues declared that compensatory movements are "inefficient" for people with transfemoral amputations, leading the researchers to conclude that residual limb length may not be as important for gait efficiency as it is. This conclusion could be used to lessen efforts to preserve limb length and may be why we see shorter residual limbs in the future. I e-mailed the principal investigator and asked, in short, "Who wants to walk funny for no reason? Your other data clearly shows how effectively these gait deviations preserve efficiency." (I haven't received a response.)

Our profession may try the standard route of generating some type of outcome or measure that shows a measureable improvement using these canonized conclusions. It appears these kinds of researchers believe that orthotists and prosthetists belong at the "kids' table," and not with the grownups-the "real" medical professionals. Here's my point: Based on what I know from the research and from many years of practical experience, we are making a critical error by assuming that they are right.

Ask the researchers, "Are you comfortable with your study and your conclusions? Is the role of the orthotist and/or prosthetist irrelevant? What if your study is wrong?" I believe that by joining with researchers and replicating or correcting flawed study designs, we will demonstrate the relevance of the O&P profession and the contributions that O&P practitioners can make to research. What's more, it will serve notice that assumptions about O&P can result in flawed research that negatively impacts patients.

How will these researchers continue to see us? As the youngsters relegated to the proverbial kids' table, or in our case, the "vendors" table? Or is this our chance to be seen as a different child, the one pointing out that the emperor indeed has no clothes covering the residual limb-by pointing out that, in transfemoral amputation surgery, hip abduction, not adduction, must be maximized. That a lateral longitudinal arch support is different from a lateral heel wedge. That there's no post-amputation venous return without compression. (Mr. Emperor, gradient compression ACE wrapping is an oxymoron.) That testing AFO mobility instead of stability with a solid AFO design is like testing abstinence with Viagra. If you are a physical therapist reading this, you likely won't understand the impact of these statements. Why should you? You already have your area of expertise. So do we. And with collaboration, we will appreciate each other more and make better science.

Thomas J. Cutler, CPO, FAAOP, CPHM, owns Limbitless LLC, Visalia, California, where he provides clinical services and a bit more. That "more" is a result of observing patterns and relationships in healthcare for years.