Abstract
Prosthetics and Orthotics is such an interesting area in the circle of rehabilitative care. It is unique in many ways as it involves a number of health professionals all working together for the optimal rehabilitation of patients who require a prosthetic or orthotic device of some kind. It is the coming together of technical, medical, biomechanical, engineering, therapeutic and psycho-social expertise to bring about an optimal outcome for the care of such individuals. It is an area where you can actually point to, touch and pick the exact treatment being implemented which, if you think about it, is not the norm for the other related modalities of treatment. The Prosthetic and Orthotic profession itself is unique as there are very few disciplines where there is such a wide demand of knowledge areas and skill sets. With the passage of time, the demand on prosthetic and orthotic practitioners to be widely competent and knowledgeable in many of these areas has increased.
Addressing the topic of “Moving the profession”, I feel I personally can give a good perspective on where we have come from, where we are going, and what may lie ahead in the future. I feel confident that I can speak on such a topic with a background involving almost 25 years in the profession as a practitioner, educator and one who has been involved in many levels of professional associations and credentialing bodies. From an international perspective, I have been very fortunate to witness and analyse the Prosthetic and Orthotic world in almost 30 different countries and my ‘on the ground’ experience has been a great education in itself. I will also try to give some insight on what are the key issues and challenges that must be met to move the profession forward in a positive direction.
Overall the Prosthetic and Orthotic profession has grown out of the post World War II era, and has had a profile of being a male-dominated group who have been trade oriented and ‘craft’ based. This has in many ways stereotyped the view from the other related professions and the public that Orthotists and Prosthetists are only ‘technical’ people with little academic and theoretical knowledge and, for the most part, are less educated and qualified than those they work with. In the past, the medical specialist (Orthopaedic Surgeon or Rehabilitation Specialist) was the main head of the rehabilitation team and prescribed the orthosis or prosthesis and was the main director of care over the other rest of the professionals involved. During those early years, research-based activities were not as prevalent or common practise.
This has now evolved where today the Orthotic and Prosthetic-based professional is educated at a higher level, has better recognition by his/her peers, has higher credentials, is impacted more and more by technological advances and is part of a group that has much more balance in terms of gender. The rehabilitation team members are more equal partners than in the past, are felt to have a better respect for the roles each member plays and hopefully work together in a more collaborative model. In most areas, there is generally more validity in the research published and each professional group is moving forward to contribute more in this area.
As the current President of the International Society for Prosthetics and Orthotics (ISPO), it should be noted that over this time the society itself has experienced its own development. ISPO was formed over 35 years ago and has grown over the years to be a strong supporter of those directly involved with Prosthetics and Orthotics. ISPO being a society that is multi-disciplinary in nature and exists to play a coordinating and advising role directly related to Prosthetics, Orthotics and Rehabilitation Engineering. The ISPO's role is to also encourage and promote research, development and evaluation related to prosthetics and orthotics, guide and support education and training and to encourage and facilitate a high level of uniform practice in prosthetics and orthotics. With the development of various publications, the putting on of consensus conferences, courses and world congresses, the development and recognition of educational and practise standards and the forming of significant relationships with key international organizations and NGOs, the ISPO has been a significant player in facilitating the continued growth and support of many elements related to Prosthetics and Orthotics.
Looking at the topic of how we can “Move the profession” forward, one has to look at a number of key issues. The main issues identified in this paper are education, recognition, mentoring, the building of relationships, political awareness, research and the need for a collective vision for what will impact us all in the future. At the same time, I would like to highlight the role that the ISPO has played to assist the movement of the profession to date and how it can continue to do so.
From my perspective and experience, I would identify education as the most important of these issues. This is due to the impact it has in giving the area of prosthetics and orthotics its recognition, to encourage meetings, courses and congresses that have a multi-disciplinary nature and to be give the baseline competencies to future professionals who will be working in this field. The growth of programs and curriculum directly related to prosthetics and orthotics assists in creating centres of excellence in prosthetic and orthotic education that has a ‘spill-over’ effect to all the professions involved with not only undergraduate education but also with continuing education and post graduate courses.
Today, it is encouraging to see the growth in prosthetic and orthotic schools worldwide that have enhanced curriculum, attracting very talented candidates and offering credentials at a higher level. In terms of education overall related to prosthetics and orthotics, this activity must continue to help pave the road ahead for our continued development and improvement in the front line care for those receiving prosthetic and orthotic treatment.
It follows that recognition of the educational standards set around the area of prosthetics and orthotics is key to our long-term existence and quality of care. This is necessary for the proper support of professionals in our field and allows for those working in this area to be properly recognized, certified or licensed to practice and at the same time, have a professional career that is supported by an appropriate salary. Overall it is very clear that having the appropriate job or professional title along with the appropriate national recognition is vital to the sustainability and long-term stability and existence of prosthetic and orthotic profession and related services in a country.
In terms of the ISPO, the society has played a significant role in assisting such recognition. The ISPO, in collaboration with the World Health Organization (WHO), developed a categorization for prosthetic and orthotic practitioners which today is the accepted international standard for Prosthetic and Orthotic professionals (WHO 1990). The society is responsible for the growth of the profession in developing countries as a result of this recognition and with its promotion and recognition of educational programs. The society now formally recognizes successful graduates of these programs and awards international certificates based on the ISPO/WHO categorization of professionals. It is now very exciting to announce that there are now over 20 educational and practitioner pathways formally recognized by the ISPO at either the Category II or I level. In addition, the society is actively engaged in over 15 consultations with various institutions and professional groups who are planning to formally become recognized internationally by the ISPO.
There have been significant lessons learned through the process of developing standards for Prosthetic and Orthotic education. The ISPO has always supported the need for a complete and comprehensive education for Prosthetic and Orthotic practitioners that meets the minimal requirements set forth in the ISPO/WHO Guidelines. This has for the most part been a very good approach as any ‘short cuts’ to training attempted historically have, for the most part, ended up with very dismal or disastrous outcomes. On the other hand, the ISPO has learned that there must be some flexibility allowed in training methods and pathways to compensate for the huge demand that exists for practitioners worldwide. The most recently published WHO/ISPO guidelines allow for such flexibility and give other designations for professionals going through recognized single discipline or modular training (WHO 2005).
The ability to mentor new professionals as it relates to building an infrastructure of talented people who can carry forth the roles required for the future is critical to the long-term growth and survival of the activities related to prosthetics and orthotics. To instil the values of leadership and create passion for this kind of work in our young professionals is very important. There must also be a clear strategy for ensuring the proper succession in leadership out of the next generation and to have the foresight to recognize who the future leaders will be. ISPO must take an active role in attempting to facilitate this activity and support exchanges and post graduate activities that will assist in accomplishing this goal.
The relationships that we have amongst ourselves in such a multi-disciplinary environment are very critical in helping us move forward. If we are unable to get along in a positive way, it will no doubt be destructive and diminish the advancements and progress we are looking for. The relationships we have outside our multi-disciplinary groups are also very important in ensuring progress and movement forward. This is the case when speaking of the key relationships with international and national organizations, NGOs, such as the World Health Organization, the United States Agency for International Development, the International Committee of the Red Cross, and so on. This is where the ISPO has set a very good example of having strong relationships with many organizations that have definitely assisted in advancing our way forward. It will be very important that these and other relationships continue.
Within the Orthotic and Prosthetic profession itself, the ability to communicate, share information, collaborate and share ideas is so much tied to the strength of the relationships and bonds between us. From my own experiences, I can quite honestly say, my own effectiveness as a leader of an organization and educational programs are very much tied to the strength of my professional and personal relationships with others.
Political awareness and connections go hand in hand with the issue of relationships. It would be naive to think otherwise. The importance of having our voices heard by relevant political bodies, funding agencies, government ministries is much more critical than first thought by myself. To facilitate proper recognition of professionals and to have direct support of prosthetic and orthotic services, it is absolutely critical that we have a voice with such groups. Along with this, is the continual need to market ourselves and our activities to the outside world. To have those key parts of the public more aware of who we are and what prosthetics and orthotic is all about, is very important today and in the future.
At the moment there are some key national and regional initiatives that are taking place worldwide. These initiatives are in relation to the prosthetic and orthotic profession's ability to be better recognized by the involved government structures and to have a system of better reimbursement based on professional procedures instead of the historical payment by devices and device parts. In addition, there are some key developments taking place where various groups are working hard to formulate the professional profiles for Prosthetists and Orthotists that will take us 10–20 years ahead. The evolution, initiation and outcome of these various activities are critical to the positive movement forward of the profession in the years ahead.
In terms of supporting professionals in their day-to-day activities, to assisting schools modify and advance their educational standards and to validate the kind of treatments implemented, research activities must continue to grow and advance. We must find a way to have so-called centres of excellence that are directly involved in research related to prosthetics and orthotics. This can facilitate the forming of more post graduate programs that can grant advanced degrees besides publishing the outcomes of research activities to the rest of us. The ISPO is taking an active role in helping make this happen by forming an international scientific committee whose role is to coordinate, promote and support such activities.
The very great demand to increase the numbers of prosthetic and orthotic professionals around the globe in almost all areas is overwhelming. It is hoped, with the natural momentum being gained with the aforementioned developments in the profession, that the numbers of those entering the profession will accelerate in the next decade and continue to do so for the foreseeable future. Unfortunately, there is no ‘quick fix’ to this issue, which is one that will be difficult to solve considering the gross demand for practitioners likely over the next 10–15 years.
To move forward as a professional group involved directly in the area of prosthetics and orthotics, we must have a collective vision for what will impact us all in the future. As a group of professionals it will be critical that the collective work together continues in terms of improving the quality and recognition of education and development of new practitioners. The professional associations collectively must always see ahead and prepare for inevitable changes that will occur and take on the role of leadership where needed. With such a small profession in terms of numbers, there is a clear need for all to contribute.
The world around also has experienced such rapid changes in the past decade in terms of technological and communication advances. This of course, has had a great impact on the prosthetic and orthotic profession and as a result the profession must have the foresight to react to the ever-changing forces ahead. The need to encompass, understand and implement new technologies being introduced by the industry and build a research infrastructure within the profession to understand the outcomes of such technology is very much needed. Along with this is the need to encompass the rapidly advancing communication tools available to everyone on the planet today. This ability to communicate amongst each other effectively and economically will allow the easier and freer exchange of knowledge and allow for the extension of relationships beyond the normal geographical boundaries.
It will also be vital to have someone with their political ears to the ground, to be aware and understand the changing tides politically. The case in point is the issue of disability, where such issues are on the agenda of major organizations as the United Nations and World Health Organization. Currently, disability is taking a back seat to many other key issues and in some cases the issue of the disabled is being completely left out. This ability to monitor such shifts in focus by the bigger organizations is critical to our ability to having our interests heard and met. We can also see similar shifts in the preferred models of patient care. There seems to be an ever-shifting emphasis away from the traditional medical model to a more social one.
So, I think it is very clear that we must always look ‘outside the box’ in the way we approach things and always set the bar higher so we can advance prosthetic and orthotic services to those in need. It must also be stated, that we cannot lose sight of the most significant part of this journey which is the care and well-being of our patients and clients. They should always be at the centre when thinking ahead and moving forward.
In conclusion, it seems the journey ahead will be an exciting one and it is hoped we are collectively up to the challenge to move ourselves forward as a group involved in prosthetics and orthotics. I personally hope that many of you are inspired to take up this challenge and contribute to our advancement as a profession as much as possible.