Abstract
The ISPO Consensus Conference on Appropriate Lower Limb Orthotics for Developing Countries was held in collaboration with Leahy War Victims Fund of the United States Agency for International Development (LWVF-USAID) and the World Health Organisation (WHO) at the Vietnamese Training College for Orthopaedic Technology (VIETCOT), Hanoi, Vietnam from 3rd – 8thApril, 2006. The report of the meeting, edited by Nerrolyn Ramstrand and Norman A Jacobs, has just been published by ISPO. The conclusions and recommendations from the conference follow below. These were the result of extensive discussion in syndicate and plenary sessions. Summaries of these discussions as well as the supporting presentations can be found in the published report.
The conference agreed upon the following conclusions and recommendations listed under their respective sub-headings.
Needs assessment
Need of orthotics has not been met and orthotics should be given greater attention. The greatest area of need is the lower limbs. Epidemiological data collection related to orthotics needs is required for policy and service development. Standardised tools and methodology need to be developed and implemented for data collection.
Outcome assessment
Reliable patient record keeping is essential for all phases of orthotic management including prescription, checkout and follow-up. Regular follow-up/evaluation of outcomes of orthotic management should be performed. This should include functional outcomes. User involvement including satisfaction surveys must be an integral part of outcome assessment. User satisfaction surveys should be performed and include measures of the impact of orthotic management to enhance the quality of life.
Education
There remains an overwhelming unmet need for trained persons to work in the orthotics sector in developing countries. The meeting endorses the ISPO standards of education and the WHO/ISPO guidelines for education and training. There is a need for upgraded knowledge and understanding of medical and rehabilitation personnel in issues relevant to orthotic management. Need for upgraded knowledge and understanding of relevant pathologies for orthotics personnel. The conference endorses the use of quality management and outcome systems in P&O educational institutions. P&O schools should promote the role of orthotics in rehabilitation, the rehabilitation team and continuing education. ISPO should establish a working group to investigate issues related to the provision of orthopaedic footwear in developing countries.
Technology
Need for research, development, production and evaluation of appropriate∗ orthotic components. ISPO should explore and implement methods to share and transfer appropriate technology. ISPO should promote and encourage the coordination of availability and accessibility to appropriate orthotic technology.
Rehabilitation team
Establish better links between orthotic service and user groups. The user/family must be an equal member of the rehabilitation team. There is a great need for exchange of information between different rehabilitation personnel. It is recognised that the full clinical team is not always available. However it is recommended that the minimal clinical team should include the user/family and the orthotist.
Community based rehabilitation
Establish a network between the orthotic service and CBR, PHC and/or other community based programmes – an example of a positive relationship between CBR and orthotic services is the implementation of the Ponseti club foot management programme in Uganda, amongst other places. A close working relationship between CBR programmes and the orthotics service providers should facilitate early detection, early intervention and follow-up to promote optimum functional capacity and prevent further impairment.
Quality management
Schools should promote the knowledge and need of quality orthotic services as a part of their education curriculum. Orthotic service providers need to develop and implement quality management procedures. The conference endorses the use of quality management and outcome systems in orthotic service delivery.
Cost calculation
The conference recommends promotion, feedback, evaluation and development of the ISPO/USAID cost calculation tool. It is recommended that the individual P&O schools use the ISPO/USAID cost calculation tool in their curriculum. Recommend the establishment of a forum through which users of the ISPO/USAID cost calculation tool can communicate.
General
Orthotic management should address the most common conditions encountered in the field. These include; cerebral palsy, clubfoot, polio, stroke/traumatic brain injury and the insensate foot. Orthotic treatment should be based upon individual assessment of the patients functional deficit. General orthotics treatment protocols may be impractical due to the variability of individual patients' presentation.