Celebrating 50 years of the International Society for Prosthetics and Orthotics: Past,present,and future

Inspiration from the past

The International Society for Prosthetics and Orthotics (ISPO) is a non-governmental organization that, since its establishment in the 1970s, has worked globally to improve the quality of life for people that use or may benefit from prosthetic and orthotic devices, as well as other assistive technology. ¹ ISPO’s modern vision is a “world where all people have equal opportunity for full participation in society.” ² The Society’s journal, Prosthetics and Orthotics International, supports this vision by providing an avenue for dissemination of peer-reviewed research peer-reviewed evidence in the form of research reports, reviews, clinical and technical notes, and case reports.

In celebration of the ISPO’s 50th anniversary, the Executive Board asked that a special edition of Prosthetics and Orthotics International be published to commemorate the role that the ISPO has played in contributing to the development of knowledge in the field over the past 50 years. We reflected on the inaugural edition of Prosthetics and Orthotics International from 1977, where one article drew our attention and offered an exciting framework for this issue. The article, which was titled Education in Prosthetics and Orthotics and authored by Dr Sidney Fishman, ³ spoke of the need for institutionalized education and training to ensure that every clinician working in prosthetics and orthotics could demonstrate the competencies necessary to provide safe and effective clinical services.

In considering what a contemporary curriculum for the education of clinicians might include, Dr Fishman identified a core set of skills, capabilities, and knowledge that he summarized under the following domains:

• Physical sciences, including mathematics;

• Biological sciences;

• Psychological sciences;

• Mechanical skills and crafts;

• Communication skills;

• Personal and cultural qualifications.

At first glance, the competencies encompassed by these six domains may not seem relevant to the education of contemporary clinicians, particularly given Dr Fishman’s focus on basic sciences. However, we posit that a thoughtful exploration of each domain will highlight how these core competencies have evolved since 1977 and reveal that they are still required of a clinician working in prosthetics and orthotics today. Hence, our use of this seminal article by Dr Fishman as the framework for this 50th anniversary issue.

We invited subject matter experts to author evidence-based commentaries on the domains proposed by Dr. Fishman. In keeping with ISPO’s multidisciplinary scope, we solicited articles from individuals with different professional backgrounds. Authors were encouraged to reflect on the ideas that Dr Fishman proposed 50 years ago and to answer several key questions related to each domain; how has prosthetics and orthotics changed, what role has research played in shaping our understanding, how has research been translated into clinical practice, and what might the next 50 years hold for the field. In this editorial, we are proud to introduce these invited contributions and provide some context for their foci.

Contributions to this issue

The response we received from invited authors was overwhelmingly positive and speaks to the engagement of individuals currently contributing to research and education in our field. It is clear from the invited commentaries contained in this special edition that many of the competencies first articulated by Dr Fishman have endured over the last 50 years, remaining critical competencies for prosthetists and orthotists today. The domains that Dr Fishman discussed in 1977 were, in many ways, ahead of their time, given their relevance outside of the immediate remit of the profession. While still relevant today, these domains sometimes seemed too narrow to our invited authors, reflecting perhaps how far understanding in each area has advanced. Using communication skills as an example, ⁴ Dr Fishman suggested a rather limited definition, focused primarily on the spoken word, whereas the communication skills that prosthetists and orthotists use today vary widely. For example, use of information technologies (ITs) for non-physical consultations, as discussed in the commentary on communication skills, ⁴ represents an advance pertinent to prosthetics and orthotics that was not widely foreseen in 1977. As our collective understanding of communication, psychological sciences, and mechanical sciences and their effects on clinical practice and prosthesis and orthosis users^4–8 has progressed and expanded over time, it is with hindsight that we can identify limitations to what was forecast approximately 50 years ago. This is a privileged perspective and the commentaries are enlightening with regard to such historical limitations.

Several of the invited authors have focused on the contribution that Prosthetics and Orthotics International has made in documenting the professional and academic development of our field. In the areas of biological ⁷ and physical sciences, ⁸ for example, Prosthetics and Orthotics International has contributed to the body of knowledge regarding developments in prosthetic interface and component design, as well as to the application of biomechanical principles to prosthetics and orthotics. Dr Fishman highlighted these areas as fundamental in 1977, and these commentaries discussing developments over the past 50 years have confirmed their lasting relevance.

What is evident from the commentaries presented in this issue is that while there has been a substantial volume of research over the past 50 years in some domains, others, such as the communication ⁴ and psychological sciences domains, ⁶ have received comparatively less attention. However, it is heartening that, in the area of psychological sciences, encouraging developments are identified, including both greater focus on, and subsequent increase in, the number of publications examining psychosocial factors related to prosthesis and orthosis users.

Considering treatment from a lifespan perspective was raised as a critical component of formulating and providing effective care given that prostheses and orthoses are often long-term interventions. The commentaries focusing on professional communication, ⁴ education, ⁹ and psychological sciences ⁶ also identified aging populations as a topic of great relevance to care in the future.

The role that advanced technological solutions may play in improving care in the future was also a common theme among the commentaries.^4–9 For example, technology is having a particular influence on how we deliver education and training to a wider student population. Given the ongoing effort to increase the number of prosthetic and orthotic graduates in order to fulfill healthcare needs around the world,^10,11 the field must consider the role of technology in this process. In addition, as more communication between users and clinicians occurs digitally, ensuring quality in this communication will require us to have a thorough understanding of the facilitative role of information technology.

The original article by Dr Fishman had a clear educational focus, not surprising given that Dr Fishman was a renowned educator who developed and directed the first accredited 4-year college-level program in prosthetics and orthotics at New York University in the United States. ¹² We recognize that our understanding and delivery of prosthetic and orthotic education has also progressed over the last half century, prompting us to include a specific commentary on this topic in this special edition. ⁹ While almost 50 years may have passed since Dr Fishman first described the skills, capabilities, and knowledge required of prosthetists and orthotists, we believe that educators today share the same timeless goals of ensuring that every prosthetist and orthotist demonstrates the competencies necessary to meet the needs of prosthesis and orthosis users through provision of safe and effective clinical care.

The future is bright and multidisciplinary

What is apparent from the commentaries in this special edition is the variety of professions, skills, technologies, and scientific advances that have both benefited from and been enriched by the field of prosthetics and orthotics. The significant changes that have occurred are perhaps a consequence of the field being, at its very core, multifaceted and multidisciplinary. Prosthetics and orthotics has historically been open-minded with regard to looking externally for inspiration, and thus the influence of parallel fields has enhanced prosthetics and orthotics by providing an outside perspective. This synergy and open-mindedness has benefited both prosthetics and orthotics and those fields with which it interacts.

Irrespective of what the future holds for the field of prosthetics and orthotics, we are confident that the ISPO will continue to play an active role by providing a multidisciplinary platform for high-quality evidence through the publication of Prosthetics and Orthotics International. By continuing to support clinicians and researchers in the dissemination of relevant and high-quality evidence, we can ensure that the ISPO and Prosthetics and Orthotics International remain active contributors during the coming 50 years, thus helping to improve the quality of life for prosthesis and orthosis users, regardless of where future developments take us.