<img style="float: right;" src="https://opedge.com/Content/OldArticles/images/2003-11_02/judy_otto.jpg" hspace="4" vspace="4" /> <h2>What will be the state of orthotic and prosthetic research five years from now? What will help take the profession to the next level? Some leading educators offer their insights.</h2> <b>Mark Geil, PhD</b> , assistant professor, School of Applied Physiology, Georgia Institute of Technology, Atlanta, comments, "It's hard to predict the future. We're doing what we can to teach research and encourage our students to answer questions and solve problems through sound research mechanisms. If they're taught research adequately, they will have a big impact. <table class="clsTableCaption" style="float: right;"> <tbody> <tr> <td><img src="https://opedge.com/Content/OldArticles/images/2003-11_02/mark_geil.jpg" alt="Mark Geil, PhD" /></td> </tr> <tr> <td>Mark Geil, PhD</td> </tr> </tbody> </table> "Anecdotally, what I've seen in some of the offerings, for example, from the Academy [American Academy of Orthotists & Prosthetists] in some of its courses in material science and gait analysis, enthusiasm is really strong among existing practitioners," Geil observes. The more training that can take place, the better equipped practitioners will be to add to the knowledge base, he points out. Geil encourages defining who is involved in O&P from a research perspective, noting that research comes best from a multidisciplinary team, "just like we do clinical care in a multidisciplinary team." <b>Sidney Fishman, PhD</b> , served as chairman of the New York University (NYU) Department of Prosthetics & Orthotics and has spent over 40 years in prosthetic/orthotic research, development, and education. Fishman is troubled by the inability of people to agree on the various meanings and implications of "research." <table class="clsTableCaption" style="float: right; width: 33.223%; height: 243px;"> <tbody> <tr> <td style="width: 100%;"><img src="https://opedge.com/Content/OldArticles/images/2003-11_02/sidney_fishman.jpg" alt="Sidney Fishman, Phd" /></td> </tr> <tr> <td style="width: 100%;">Sidney Fishman, Phd</td> </tr> </tbody> </table> As Fishman defines it, " <b>Basic research</b> is a scholarly activity usually conducted by individuals who are specifically educated to scientifically investigate matters for the purpose of developing new knowledge. Such organized basic research is usually planned and supervised by research scientists in university settings. "At present, there is no structure within the P&O fields to support this formal expensive type of activity," he says, adding that most individuals involved in research have academic training in other fields or overseas. The minimal funding currently available to P&O comes from outside foundations or the government, which require persons to have academic degrees, Fishman notes. "The present educational structure within P&O in no way prepares it to achieve any real research progress as a recognized investigatory pursuit," he concludes. Basic research may be confused with the efforts of manufacturers and drug companies to pursue promising ideas to produce new products, Fishman points out. "This is normally identified as <b>research and development</b> . In this sense of the word, there is absolutely nothing wrong with the state of research in P&O. New products are evolving, a number of which have merit and which are then integrated into clinical practice." Research and development sometimes involves investigation which requires a specialized background not related to O&P clinical care, such as the development of CAD/CAM, Fishman explains. "It makes no sense for an orthotist or prosthetist to want to be involved in that kind of research, except when the equipment is ready for clinical application." Researchers conducting studies for O&P clinical applications, known as clinical research or outcome studies, should not evaluate their own work, Fishman advises, since results would likely be dismissed as non-objective. "That's good and bad," he adds. "We don't know as much as we wish we did, but [this type of research] opens the door for a lot of research questions that have yet to be answered--and, therefore, a lot of opportunities." <table class="clsTableCaption" style="float: right; width: 34.2829%; height: 283px;"> <tbody> <tr> <td style="width: 100%;"><img src="https://opedge.com/Content/OldArticles/images/2003-11_02/dudley_childress.jpg" alt="Dudley Childress, PhD" /></td> </tr> <tr> <td style="width: 100%;">Dudley Childress, PhD</td> </tr> </tbody> </table> <b>Dudley Childress, PhD</b> , professor of Physical Medicine & Rehabilitation and Biomedical Engineering, Northwestern University, Chicago, Illinois, also believes that the multidisciplinary team approach to research is advantageous. "Research in P&O in the United States mainly began after World War II and was mostly interdisciplinary, with prosthetists, orthotists, engineers, scientists, therapists, orthopedic surgeons, and other professionals cooperating in the national program." Since not many clinicians have time for research, they are not usually principal investigators (P.I.s), Childress points out. However, this situation is changing, he adds. In Childress' laboratory, three prosthetists/orthotists with PhD degrees are beginning to write grants and pursue research. Childress sees a trend for more orthotists and prosthetists to obtain advanced degrees for research and also for more persons with PhDs to take P&O training. "There are probably five or six practitioners--maybe as many as ten--in the United States who have their PhDs and who are certified prosthetists and orthotists. And that number will likely increase." <table class="clsTableCaption" style="float: right; width: 33.9783%; height: 227px;"> <tbody> <tr> <td style="width: 100%;"><img src="https://opedge.com/Content/OldArticles/images/2003-11_02/scott_hornbeak.jpg" alt="Scott Hornbeak, CPO, FAAOP" /></td> </tr> <tr> <td style="width: 100%;">Scott Hornbeak, CPO, FAAOP</td> </tr> </tbody> </table> <b>Scott Hornbeak, CPO, FAAOP</b> , director, O&P Program, California State University-Dominguez Hills, agrees that those who get NIDRR (National Institute on Disability Research & Rehabilitation) funds from the Department of Education are mostly PhDs, and therein lies the future hope for O&P clinicians. "If more O&P clinicians can obtain PhDs, we will have much greater access to government research funds," Hornbeak says. "Presently some of the best clinical O&P research is done by O&P practitioners working for PhDs who are able to obtain grant funding. Of course, O&P practitioners are seldom recognized as the primary authors of the paper that is eventually published, and often their significant contribution is underrated. We've got a long way to go." O&P is a latecomer to higher education in general, Hornbeak notes, with 1984 being the first time the American Board for Certification in Orthotics & Prosthetics (ABC) required a bachelors degree. "Because of that, many of the orthotists and prosthetists who were new to higher education were latecomers to this exposure to formal research methods. My perspective is that we are just now coming up to speed with undergraduate and certificate programs which require formal instruction in research methods." Hornbeak perceives this stage as part of O&P's transition from a vocation or trade to an allied health profession. Because of that transition, certified orthotists and prosthetists have not contributed much to the body of knowledge, he explains, noting that much of the literature in prosthetics and orthotics has come from professionals in other disciplines, such as therapists, physicians, or other PhDs. "However, universities [offering O&P education] are doing a much better job now of recognizing the need for formal research education," he points out. "First of all, it's important for the practitioners of orthotics and prosthetics simply to be able to read and interpret the literature," Hornbeak continues. To do this, practitioners need to understand the basic concepts of research design, he says, adding that a goal at CSUDH is to teach research methods, so students can understand what is being written in the <i>Journal of Prosthetics and Orthotics (JPO)</i> , published by the Academy, along with other articles from clinical publications in related disciplines such as physical medicine and orthopedics. The Cal State curriculum includes a basic research methods course similar to what is required for a bachelors degree in nursing. Students are assigned to develop a research question and write a proposal. During their residency, they are assigned to carry out a formal research project, as defined by their proposal. "We look at this project as very practical," Hornbeak explains. "We have a lot more buy-in from our students when it's not just some abstract course they think they're never going to use." Most applicants are unprepared for a formal research class, Hornbeak says. "Only some of our students come in with a formal statistics class. If they don't have this, a number of our students don't understand the validity of data." Although statistics and probability courses are not currently prerequisites in most O&P programs in order to take a research class, such a requirement should be considered, according to Hornbeak. "It is required in some bachelors degree programs, including CSUDH's undergraduate degree, but it's not required for O&P education in general. So, if you ask how research can be improved, some of it can be done through prerequisite work." Hornbeak continues, "Overall, teaching about research in allied health is a way that practitioners can validate their clinical practice, and that is something that is lacking in O&P--a lot of the practices in O&P are [the results of] hearsay, rumors, and unproved opinions." <table class="clsTableCaption" style="float: right; width: 37.1841%; height: 207px;"> <tbody> <tr style="height: 190px;"> <td style="width: 100%; height: 190px;"><img src="https://opedge.com/Content/OldArticles/images/2003-11_02/susan_kapp.jpg" alt="Susan Kapp, CPO" /></td> </tr> <tr style="height: 17px;"> <td style="width: 100%; height: 17px;">Susan Kapp, CPO</td> </tr> </tbody> </table> <b>Susan Kapp, CPO</b> , associate professor and director, Prosthetics & Orthotics, University of Texas Southwestern Medical Center, Dallas, points out the importance of imbuing students with an understanding and appreciation of what goes into research. "Teaching students to recognize valid research and its effect on patient care is crucial." Kapp describes a course entitled "Health Care Research," which discusses the process and theory of research and takes students through developing a research proposal such as would be submitted to a funding agency. "They obviously have to understand the components of research and valid statistics and how to select subjects, etc.," Kapp explains. "They also learn about the importance of the Institutional Review Board (IRB) and having the IRB monitor human subject research." The topics students select may be carried on to their senior year and even beyond graduation into their residency. "It's about half and half," says Kapp. "Students complete their project while at the school, but also may choose to take it on into residency." Noting that these are pilot projects, Kapp continues, "We want students to get the experience of going through the process--this is the most important aspect. Outcome is important, of course but there's the question of validity. Student researchers don't have the resources or funding available to carry out complex and lengthy projects. "This experience is meant to be an exercise in understanding and appreciation," she adds. "It's important for clinicians to recognize valid research, so that when we read journals and hear manufacturers' claims, we look at those things more critically." <table class="clsTableCaption" style="float: right; width: 28.2667%; height: 266px;"> <tbody> <tr> <td style="width: 100%;"><img src="https://opedge.com/Content/OldArticles/images/2003-11_02/mark_edwards.jpg" alt="Mark Edwards, CP" /></td> </tr> <tr> <td style="width: 100%;">Mark Edwards, CP</td> </tr> </tbody> </table> <b>Mark Edwards, CP</b> , director, Prosthetics Education, Northwestern University Prosthetics-Orthotics Center (NUPOC), notes that Northwestern has been participating in O&P research and research education since shortly after its beginning in 1958. Its philosophy is that basic science research related to prosthetics and orthotics could lead to developments in technology. However, researchers would have to start with a foundation, Edwards points out. Most education programs, including Northwestern's, are at the baccalaureate or post-baccalaureate level, and there is little time in the curriculum for students to do research, Edwards comments. Since residencies require a research project, Edwards adds, "Hopefully, as the residencies evolve and students become knowledgeable of research and research methods in their primary education, then research can develop and improve the profession. Through multiple students doing similar projects or adding on to previous research from other students, we can get more research coverage in specific areas." Graduate students in the biomedical engineering program and rehabilitation engineering program at Northwestern are looking at gait, componentry for both prosthetic knees and feet, and at upper-limb prosthetic use, as well as outcome measurements, according to Edwards. "Our students who are involved in the practitioner program are writing a research proposal guided by the faculty. Hopefully, they can bring the project into their residency--follow up, collect the data, and do the actual experiment. We guide our students to look for projects which will begin to measure the efficacy or quality of care they are giving." Research projects are currently in their infancy, since students were not required to do research before the mid-90's, when the schools had to provide research in their curriculum, Edwards explains. "I believe that the level of research and the quality of the projects will improve over time. We are in an evolutionary period. We're getting better students, getting them to understand research, and getting them to focus in on a particular type of research project. "I hope that we're producing students who want to expand the body of knowledge of the profession, so that if they find something interesting in their residency research project, they will continue in research and do some publishing and presentation," Edwards concludes. <h1>What's the Prognosis for O&P Research?</h1> The prognosis is hard to predict, says Geil. "The things we can predict are not always the best indicators of what will happen with research." Although there's a lack of advanced degrees in the field now, that situation is changing, Geil points out: "We are the first entry-level masters program in P&O; you'll see more coming. More thorough instruction on how to do research and actually conducting it would typically be involved with obtaining an advanced degree." Practitioners with advanced degrees doing a research project in their residency program will contribute a significant impact, he believes. "It's going to take time for these programs to develop--for these students to graduate--for these advanced training courses to have an impact," Geil continues. "These efforts are all relatively new, so we're going to need to give them at least five years to see what sort of impact they'll have. But beyond that, I think we've got some real momentum going." "So many practitioners are too busy making a living," reflects Hornbeak. "Any solution probably needs to happen as joint projects between the academic world and the manufacturers' research teams." "Although lack of graduate programs and a lack of academic centers that specialize in O&P research has been a handicap in the past, Northwestern and the University of Washington have been focused on P&O research for a long period of time," Edwards says. The closing of the P&O programs at New York University (NYU) and the University of California-Los Angeles (UCLA), where much of the research was done early on, was a setback, he says. "I believe that future practitioners and academic facilities will bring forward research to where it once flourished." <h1>What Can We Do to Precipitate Progress?</h1> "Practitioners or residency directors who are sponsoring residents need to allow them to do a quality research project," suggests Edwards, "and to allow time for them to do research during their residency so we can get quality projects to NCOPE [National Commission on Orthotic & Prosthetic Education]. Ultimately these projects will bring about increased awareness of research and improve the quality of care." <i>Judith Philipps Otto is a freelance writer who has also assisted with marketing and public relations for various clients within the O&P industry. A graduate of the University of Missouri School of Journalism, Columbia, she has been a newspaper writer and editor and has won national and international awards as a broadcast writer-producer. Her home is in Holly Springs, Mississippi.</i>
<img style="float: right;" src="https://opedge.com/Content/OldArticles/images/2003-11_02/judy_otto.jpg" hspace="4" vspace="4" /> <h2>What will be the state of orthotic and prosthetic research five years from now? What will help take the profession to the next level? Some leading educators offer their insights.</h2> <b>Mark Geil, PhD</b> , assistant professor, School of Applied Physiology, Georgia Institute of Technology, Atlanta, comments, "It's hard to predict the future. We're doing what we can to teach research and encourage our students to answer questions and solve problems through sound research mechanisms. If they're taught research adequately, they will have a big impact. <table class="clsTableCaption" style="float: right;"> <tbody> <tr> <td><img src="https://opedge.com/Content/OldArticles/images/2003-11_02/mark_geil.jpg" alt="Mark Geil, PhD" /></td> </tr> <tr> <td>Mark Geil, PhD</td> </tr> </tbody> </table> "Anecdotally, what I've seen in some of the offerings, for example, from the Academy [American Academy of Orthotists & Prosthetists] in some of its courses in material science and gait analysis, enthusiasm is really strong among existing practitioners," Geil observes. The more training that can take place, the better equipped practitioners will be to add to the knowledge base, he points out. Geil encourages defining who is involved in O&P from a research perspective, noting that research comes best from a multidisciplinary team, "just like we do clinical care in a multidisciplinary team." <b>Sidney Fishman, PhD</b> , served as chairman of the New York University (NYU) Department of Prosthetics & Orthotics and has spent over 40 years in prosthetic/orthotic research, development, and education. Fishman is troubled by the inability of people to agree on the various meanings and implications of "research." <table class="clsTableCaption" style="float: right; width: 33.223%; height: 243px;"> <tbody> <tr> <td style="width: 100%;"><img src="https://opedge.com/Content/OldArticles/images/2003-11_02/sidney_fishman.jpg" alt="Sidney Fishman, Phd" /></td> </tr> <tr> <td style="width: 100%;">Sidney Fishman, Phd</td> </tr> </tbody> </table> As Fishman defines it, " <b>Basic research</b> is a scholarly activity usually conducted by individuals who are specifically educated to scientifically investigate matters for the purpose of developing new knowledge. Such organized basic research is usually planned and supervised by research scientists in university settings. "At present, there is no structure within the P&O fields to support this formal expensive type of activity," he says, adding that most individuals involved in research have academic training in other fields or overseas. The minimal funding currently available to P&O comes from outside foundations or the government, which require persons to have academic degrees, Fishman notes. "The present educational structure within P&O in no way prepares it to achieve any real research progress as a recognized investigatory pursuit," he concludes. Basic research may be confused with the efforts of manufacturers and drug companies to pursue promising ideas to produce new products, Fishman points out. "This is normally identified as <b>research and development</b> . In this sense of the word, there is absolutely nothing wrong with the state of research in P&O. New products are evolving, a number of which have merit and which are then integrated into clinical practice." Research and development sometimes involves investigation which requires a specialized background not related to O&P clinical care, such as the development of CAD/CAM, Fishman explains. "It makes no sense for an orthotist or prosthetist to want to be involved in that kind of research, except when the equipment is ready for clinical application." Researchers conducting studies for O&P clinical applications, known as clinical research or outcome studies, should not evaluate their own work, Fishman advises, since results would likely be dismissed as non-objective. "That's good and bad," he adds. "We don't know as much as we wish we did, but [this type of research] opens the door for a lot of research questions that have yet to be answered--and, therefore, a lot of opportunities." <table class="clsTableCaption" style="float: right; width: 34.2829%; height: 283px;"> <tbody> <tr> <td style="width: 100%;"><img src="https://opedge.com/Content/OldArticles/images/2003-11_02/dudley_childress.jpg" alt="Dudley Childress, PhD" /></td> </tr> <tr> <td style="width: 100%;">Dudley Childress, PhD</td> </tr> </tbody> </table> <b>Dudley Childress, PhD</b> , professor of Physical Medicine & Rehabilitation and Biomedical Engineering, Northwestern University, Chicago, Illinois, also believes that the multidisciplinary team approach to research is advantageous. "Research in P&O in the United States mainly began after World War II and was mostly interdisciplinary, with prosthetists, orthotists, engineers, scientists, therapists, orthopedic surgeons, and other professionals cooperating in the national program." Since not many clinicians have time for research, they are not usually principal investigators (P.I.s), Childress points out. However, this situation is changing, he adds. In Childress' laboratory, three prosthetists/orthotists with PhD degrees are beginning to write grants and pursue research. Childress sees a trend for more orthotists and prosthetists to obtain advanced degrees for research and also for more persons with PhDs to take P&O training. "There are probably five or six practitioners--maybe as many as ten--in the United States who have their PhDs and who are certified prosthetists and orthotists. And that number will likely increase." <table class="clsTableCaption" style="float: right; width: 33.9783%; height: 227px;"> <tbody> <tr> <td style="width: 100%;"><img src="https://opedge.com/Content/OldArticles/images/2003-11_02/scott_hornbeak.jpg" alt="Scott Hornbeak, CPO, FAAOP" /></td> </tr> <tr> <td style="width: 100%;">Scott Hornbeak, CPO, FAAOP</td> </tr> </tbody> </table> <b>Scott Hornbeak, CPO, FAAOP</b> , director, O&P Program, California State University-Dominguez Hills, agrees that those who get NIDRR (National Institute on Disability Research & Rehabilitation) funds from the Department of Education are mostly PhDs, and therein lies the future hope for O&P clinicians. "If more O&P clinicians can obtain PhDs, we will have much greater access to government research funds," Hornbeak says. "Presently some of the best clinical O&P research is done by O&P practitioners working for PhDs who are able to obtain grant funding. Of course, O&P practitioners are seldom recognized as the primary authors of the paper that is eventually published, and often their significant contribution is underrated. We've got a long way to go." O&P is a latecomer to higher education in general, Hornbeak notes, with 1984 being the first time the American Board for Certification in Orthotics & Prosthetics (ABC) required a bachelors degree. "Because of that, many of the orthotists and prosthetists who were new to higher education were latecomers to this exposure to formal research methods. My perspective is that we are just now coming up to speed with undergraduate and certificate programs which require formal instruction in research methods." Hornbeak perceives this stage as part of O&P's transition from a vocation or trade to an allied health profession. Because of that transition, certified orthotists and prosthetists have not contributed much to the body of knowledge, he explains, noting that much of the literature in prosthetics and orthotics has come from professionals in other disciplines, such as therapists, physicians, or other PhDs. "However, universities [offering O&P education] are doing a much better job now of recognizing the need for formal research education," he points out. "First of all, it's important for the practitioners of orthotics and prosthetics simply to be able to read and interpret the literature," Hornbeak continues. To do this, practitioners need to understand the basic concepts of research design, he says, adding that a goal at CSUDH is to teach research methods, so students can understand what is being written in the <i>Journal of Prosthetics and Orthotics (JPO)</i> , published by the Academy, along with other articles from clinical publications in related disciplines such as physical medicine and orthopedics. The Cal State curriculum includes a basic research methods course similar to what is required for a bachelors degree in nursing. Students are assigned to develop a research question and write a proposal. During their residency, they are assigned to carry out a formal research project, as defined by their proposal. "We look at this project as very practical," Hornbeak explains. "We have a lot more buy-in from our students when it's not just some abstract course they think they're never going to use." Most applicants are unprepared for a formal research class, Hornbeak says. "Only some of our students come in with a formal statistics class. If they don't have this, a number of our students don't understand the validity of data." Although statistics and probability courses are not currently prerequisites in most O&P programs in order to take a research class, such a requirement should be considered, according to Hornbeak. "It is required in some bachelors degree programs, including CSUDH's undergraduate degree, but it's not required for O&P education in general. So, if you ask how research can be improved, some of it can be done through prerequisite work." Hornbeak continues, "Overall, teaching about research in allied health is a way that practitioners can validate their clinical practice, and that is something that is lacking in O&P--a lot of the practices in O&P are [the results of] hearsay, rumors, and unproved opinions." <table class="clsTableCaption" style="float: right; width: 37.1841%; height: 207px;"> <tbody> <tr style="height: 190px;"> <td style="width: 100%; height: 190px;"><img src="https://opedge.com/Content/OldArticles/images/2003-11_02/susan_kapp.jpg" alt="Susan Kapp, CPO" /></td> </tr> <tr style="height: 17px;"> <td style="width: 100%; height: 17px;">Susan Kapp, CPO</td> </tr> </tbody> </table> <b>Susan Kapp, CPO</b> , associate professor and director, Prosthetics & Orthotics, University of Texas Southwestern Medical Center, Dallas, points out the importance of imbuing students with an understanding and appreciation of what goes into research. "Teaching students to recognize valid research and its effect on patient care is crucial." Kapp describes a course entitled "Health Care Research," which discusses the process and theory of research and takes students through developing a research proposal such as would be submitted to a funding agency. "They obviously have to understand the components of research and valid statistics and how to select subjects, etc.," Kapp explains. "They also learn about the importance of the Institutional Review Board (IRB) and having the IRB monitor human subject research." The topics students select may be carried on to their senior year and even beyond graduation into their residency. "It's about half and half," says Kapp. "Students complete their project while at the school, but also may choose to take it on into residency." Noting that these are pilot projects, Kapp continues, "We want students to get the experience of going through the process--this is the most important aspect. Outcome is important, of course but there's the question of validity. Student researchers don't have the resources or funding available to carry out complex and lengthy projects. "This experience is meant to be an exercise in understanding and appreciation," she adds. "It's important for clinicians to recognize valid research, so that when we read journals and hear manufacturers' claims, we look at those things more critically." <table class="clsTableCaption" style="float: right; width: 28.2667%; height: 266px;"> <tbody> <tr> <td style="width: 100%;"><img src="https://opedge.com/Content/OldArticles/images/2003-11_02/mark_edwards.jpg" alt="Mark Edwards, CP" /></td> </tr> <tr> <td style="width: 100%;">Mark Edwards, CP</td> </tr> </tbody> </table> <b>Mark Edwards, CP</b> , director, Prosthetics Education, Northwestern University Prosthetics-Orthotics Center (NUPOC), notes that Northwestern has been participating in O&P research and research education since shortly after its beginning in 1958. Its philosophy is that basic science research related to prosthetics and orthotics could lead to developments in technology. However, researchers would have to start with a foundation, Edwards points out. Most education programs, including Northwestern's, are at the baccalaureate or post-baccalaureate level, and there is little time in the curriculum for students to do research, Edwards comments. Since residencies require a research project, Edwards adds, "Hopefully, as the residencies evolve and students become knowledgeable of research and research methods in their primary education, then research can develop and improve the profession. Through multiple students doing similar projects or adding on to previous research from other students, we can get more research coverage in specific areas." Graduate students in the biomedical engineering program and rehabilitation engineering program at Northwestern are looking at gait, componentry for both prosthetic knees and feet, and at upper-limb prosthetic use, as well as outcome measurements, according to Edwards. "Our students who are involved in the practitioner program are writing a research proposal guided by the faculty. Hopefully, they can bring the project into their residency--follow up, collect the data, and do the actual experiment. We guide our students to look for projects which will begin to measure the efficacy or quality of care they are giving." Research projects are currently in their infancy, since students were not required to do research before the mid-90's, when the schools had to provide research in their curriculum, Edwards explains. "I believe that the level of research and the quality of the projects will improve over time. We are in an evolutionary period. We're getting better students, getting them to understand research, and getting them to focus in on a particular type of research project. "I hope that we're producing students who want to expand the body of knowledge of the profession, so that if they find something interesting in their residency research project, they will continue in research and do some publishing and presentation," Edwards concludes. <h1>What's the Prognosis for O&P Research?</h1> The prognosis is hard to predict, says Geil. "The things we can predict are not always the best indicators of what will happen with research." Although there's a lack of advanced degrees in the field now, that situation is changing, Geil points out: "We are the first entry-level masters program in P&O; you'll see more coming. More thorough instruction on how to do research and actually conducting it would typically be involved with obtaining an advanced degree." Practitioners with advanced degrees doing a research project in their residency program will contribute a significant impact, he believes. "It's going to take time for these programs to develop--for these students to graduate--for these advanced training courses to have an impact," Geil continues. "These efforts are all relatively new, so we're going to need to give them at least five years to see what sort of impact they'll have. But beyond that, I think we've got some real momentum going." "So many practitioners are too busy making a living," reflects Hornbeak. "Any solution probably needs to happen as joint projects between the academic world and the manufacturers' research teams." "Although lack of graduate programs and a lack of academic centers that specialize in O&P research has been a handicap in the past, Northwestern and the University of Washington have been focused on P&O research for a long period of time," Edwards says. The closing of the P&O programs at New York University (NYU) and the University of California-Los Angeles (UCLA), where much of the research was done early on, was a setback, he says. "I believe that future practitioners and academic facilities will bring forward research to where it once flourished." <h1>What Can We Do to Precipitate Progress?</h1> "Practitioners or residency directors who are sponsoring residents need to allow them to do a quality research project," suggests Edwards, "and to allow time for them to do research during their residency so we can get quality projects to NCOPE [National Commission on Orthotic & Prosthetic Education]. Ultimately these projects will bring about increased awareness of research and improve the quality of care." <i>Judith Philipps Otto is a freelance writer who has also assisted with marketing and public relations for various clients within the O&P industry. A graduate of the University of Missouri School of Journalism, Columbia, she has been a newspaper writer and editor and has won national and international awards as a broadcast writer-producer. Her home is in Holly Springs, Mississippi.</i>