O&P Outcomes Initiative Is Launched

If you are wondering about the recent concern over outcomes, you are not alone. Simmering just below the surface for the past few years, the need for outcome studies in the O&P profession is finally getting more widespread attention because of the newly formed O&P Outcomes Initiative. To understand what the Outcomes Initiative means to the profession, it's necessary to first understand how outcomes research and research in general relate to evidence-based practice. Evidence-based practice is often described as the utilization of objective data, practitioner expertise, and individual patient circumstances to determine the best treatment options. The O&P profession has long relied on practitioner expertise to maximize the quality of patient care, in part because comparatively little research has been conducted. Objective data will not only help improve the quality of care but it will also help justify the costs associated with this care. Only recently have we seen an effort to substantiate the efficacy of specific O&P interventions. Currently, scoliosis management is arguably the furthest ahead when it comes to the availability of objective data that can be utilized by O&P practitioners when making clinical decisions. We need more numbers, objective data numbers, and numbers of practitioners who understand the data and have the capacity to apply the data in their practices. Related Issues To add further perspective to the "outcomes movement," let's briefly discuss some related issues. The State of the Science Conferences (SSCs) of the American Academy of Orthotists and Prosthetists (the Academy) are working to provide a comprehensive picture of current care in a variety of specialty areas within the realm of our profession. However, the SSCs are not designed to conduct research; they interpret research that has already been conducted. But as we move forward, how will we know what areas are most in need of research? Steve Gard, PhD, at the Northwestern University Prosthetics Research Laboratory and Rehabilitation Engineering Research Program (NUPRL and RERP) recently chaired the State of the Science (SOS) conference that was designed to identify priority areas for future O&P research. Researchers can utilize the SOS results when determining the focus and scope of their projects, which should help keep the profession on track. Outcomes research is only one type of research. It is generally considered simpler and more straightforward than basic science research, which is typically conducted in a laboratory setting with randomized trials. Outcomes research can be retrospective in nature, allowing the investigator to look back on clinical events that have already transpired. Additionally, outcomes data can be collected at multiple locations. This is particularly important for O&P outcomes research since involving multiple facilities means a much larger cross-section of the population can be included and collecting results will be faster. Outcomes Initiative: How It Started How did the Outcomes Initiative begin? The American Orthotic & Prosthetic Association (AOPA) increasingly recognized the need to help guide and justify O&P interventions so that the profession can continue to make advancements in care, especially when utilizing emerging technology. The Academy had already launched its Research Council to promote evidence-based practice, but its plans were not heavily targeting outcomes as a priority. Understanding the benefits of collaboration, AOPA initiated plans to bring not only these two organizations together for this effort but also experts from other areas within the profession including researchers, manufacturers, practitioners, and educators. A steering committee was quickly established, and the Outcomes Initiative officially began. Following some groundwork to orient steering committee members to the task, a two-day meeting was convened in February with the following invitees: Walter L. Racette, CPO, chairman; Gary Berke, MS, CP, FAAOP; James Campbell, PhD, CO; Scott Cummings, PT, CPO, FAAOP; Mark DeHarde; Kathy Dodson; Stefania Fatone, PhD; Steve Gard, PhD; Caterina Lowenadler; John Rush, MD; and Kimberly Walsh. The group first agreed on the following characteristics and priorities of this outcomes research initiative: To contribute to evidence-based practice. To provide some quick results, in addition to more lengthy studies. To obtain profession-wide involvement. To survey the current state of outcomes research. To develop financial support for this work. To demonstrate clinical effectiveness. To be multidisciplinary in nature. This perspective helped guide a discussion that resulted in the Outcomes Initiative mission and an accompanying background statement: "Recognizing the intense pressures in the healthcare system, this initiative is an opportunity for prosthetists and orthotists to demonstrate the effectiveness and necessity of O&P interventions." The initiative's mission is "to advance evidence-based practice and improve patient care by facilitating outcomes research within the O&P profession." Several key points were established: Strike a balance between speed and validity so that one is not sacrificed for the other. The steering committee would facilitate outcomes research but not carry it out. Actual data gathering would be done at the O&P facility level. Others, outside the steering committee, would need to be recruited to assist with this effort. Much time and effort was dedicated to developing a list of objectives that would promote the mission of the Outcomes Initiative: Survey the status of existing outcomes research and establish a framework and research priorities. Explore appropriate outcome measures and methodologies. Identify appropriate funding sources. Educate and support the O&P profession to accomplish this mission. Define and coordinate activities related to outcomes research. Steering committee members were assigned to five work groups that correspond to the five objectives. These five work groups will be working in concert with one another toward the greater goal of facilitating outcomes research to advance evidence-based practice. The steering committee will regularly apprise the profession of its progress, so look for future articles defining this work. Outcomes research is time-consuming and will require both input and patience from the entire profession. An estimated timeline is: By the end of 2007, finish preparatory work, including white papers, and have funding in place to turn over to a primary investigator. During 2008, carry out data collection. During 2009-2010, have initial research submitted for publication. Sir William Thomson (Lord Kelvin) said, "When you can measure what you are speaking about and express it in numbers, you know something about it." This sentiment could very well be applied to the O&P Outcomes Initiative. The task before us, as a profession, is monumental but not insurmountable. It will go far in determining who we are and how we practice. Note: The Academy SSC reports can be accessed via the Academy website: www.oandp.org The report on the Research in P&O SOS can be found on the NUPRL & RERP website: www.medschool.northwestern.edu/depts/...articles_2007.html Scott D. Cummings, PT, CPO, FAAOP, is employed by Next Step O&P, Manchester, New Hampshire. He is a member of the American Academy of Orthotists and Prosthetists (the Academy) Board of Directors, where he serves as a chair of the Research Council and the Academy's liaison to the American Physical Therapy Association (APTA).

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