Lower-limb Care Through the Research Lens
June 2018 Issue
Each year, we at The O&P EDGE select one issue to focus specifically on lower-limb O&P care. In this year's issue, the features examine the topic through the lens of systematic research studies and support for evidence-based practice. For many of you, in your day-to-day practice, it is the success of your individual patients as they regain mobility or reach goals you have set with them that provides your professional motivation. But, as reimbursement pressures continue to increase, and the O&P profession fights for recognition within the larger healthcare arena, research that validates your choice of interventions becomes essential, and I hope that you will enjoy the overviews of studies that provide support for your work in lower-limb care and learn more about the research's potential to affect the profession.
"Neuroprosthetics and the Making of a Cyborg Olympic Champion" introduces research where multichannel implanted neural stimulation is being used to enable people with mobility impairment to stand and transfer with minimal reliance on external orthotic support. While the approaches used within the examined studies have some shortcomings, they are advances in neuroprosthetics that nonetheless warrant attention as they continue to develop.
The second feature in this issue examines support for early post-operative interventions that improve outcomes for individuals following transtibial amputations. Notably, "Evidence-based Post-operative care for Transtibial Amputees" reviews published evidence about improved outcomes with the use of rigid removable dressings that are applied shortly after the amputation surgery in promoting healing and preparing the residual limb for prosthesis use. The authors also explore the research regarding the positive impact of early peer support on transtibial amputation outcomes.
Even as a layperson, I've often noticed that I can identify someone I know from a distance based on his or her gait, and as John Brinkmann, CPO, FAAOP(D), notes, most O&P practitioners intuitively identify gait dysfunction through visual observation. However, it is difficult for visual observations to be communicated precisely enough to meet high standards of inter-rater reliability. "Biometrics Identification and Gait" provides information on several technologies for using gait as a biometric identifier and the implications for clinical application that may eventually help to address the gap between the clinician's skill at identifying gait deviations and providing quantifiable support for his or her observation. While video-based gait analysis by smartphone is not yet feasible, it could become another tool that will benefit practitioners and patients in the future.