Introduction: The provision of orthoses is a specialized practice within healthcare that requires collaboration among professionals for successful treatment outcomes. Although orthotists are an integral part of the process, the role of the orthotists may not be commonly understood or appreciated. Among the rehabilitative health care team, physical therapists (PTs) and orthotists are especially aligned, with overlapping roles in each profession's scope of practice.
Materials and Methods: A cross-sectional survey was distributed to members of the health care team, including certified prosthetist orthotists and PTs. Chi-squared tests were calculated to compare PT and orthotist responses to a question regarding role responsibilities of each team member. We hypothesized that there would be disagreement among the professions as to which tasks orthotists are responsible for performing.
Results: The results of this study suggest that PTs and orthotists agree that orthotists are responsible for recommending a patient-specific orthosis. Interestingly, PTs did not identify orthotists as a team member responsible for performing patient assessment and evaluation tasks, despite these tasks being a key driver of patient-specific orthosis recommendations.
Conclusions: Interprofessional education to increase knowledge of orthotic management principles among PTs may improve collaboration and communication within the health care team.
Clinical Relevance: The present study identified a potential gap in PT awareness of the scope of practice and training of certified orthotists. Provision of optimal patient management requires clear understanding of respective roles and responsibilities of the health care team. (J Prosthet Orthot. 2023;35:12–18)
Orthoses are widely used rehabilitation tools that function to support, align, and assist compromised joints in the presence of neuromuscular conditions and symptomatic anatomical presentations. Certified orthotists undergo specialized education and training, which includes a master's degree in orthotics and prosthetics (O&P) and a minimum of an 18-month clinical residency. According to the ABC (American Board for Certification in Orthotics, Prosthetics & Pedorthics) scope of practice, orthotists are certified health care professionals responsible for “patient evaluation and the design, fabrication, fitting, modification, maintenance, and repair of orthoses to treat a neuromusculoskeletal disorder or acquired condition.” To effectively provide orthotic intervention, orthotists are trained to assess joint range of motion (ROM), muscle strength, balance, and perform observational gait analysis. Orthotists develop background knowledge of the material science and biomechanical principles that influence orthotic design decisions as well. Their knowledge and training prepares orthotists to recommend and implement patient-specific orthoses designed to meet the personalized functional needs of each patient, in addition to patient goal and outcome monitoring over time.
Orthotists add unique value to the interdisciplinary team with this specialized skill set and, in many settings, work closely with physical therapists (PTs), physicians, and other health care professionals to optimize patient outcomes. Although it is encouraging that the American Heart Association/American Stroke Association Guideline for Stroke Rehabilitation and Recovery lists orthotists as a member of the interprofessional rehabilitative team, the role of the orthotist is not well represented elsewhere. For example, in the Clinical Practice Guideline for Stroke Rehabilitation created by the US Department of Veterans Affairs, the term “interdisciplinary team” is referenced 24 times, and ankle-foot orthosis (AFO) is referenced 11 times, but orthotists are not referenced at all. The Academy of Pediatric Physical Therapy's “Fact Sheet: Ankle-Foot Orthoses and Footwear for Children With Cerebral Palsy—Selecting Optimal Designs” recommends that orthotic interventions need an interdisciplinary family-centred approach with shared goal setting, including the parents, child, and all professionals involved to share expertise. However, it lacks a reference to orthotists or their role in AFO design considerations, despite the sheet providing detailed AFO prescription recommendations. The professional evolution of the O&P field over time may provide some explanation for this phenomenon.