Where Should Our Focus Be? Part II

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By Tom DiBello, CO, LPO, FAAOP

In my last editorial I defined a problem--diminished reimbursement--which I argued was a symptom, in the minds of insurance companies and employers, of our growing irrelevance in the rehabilitation process. I also postulated that orthotic and prosthetic care represents some of the most cost-effective modalities used in rehabilitation today, and I gave some examples. Since then, I have been asked how we can go about changing this misconception in the minds of insurers and employers. I will offer some suggestions as to how we might proceed.

Can We Validate What We Do?

Recently I had the pleasure of meeting Robert Wagenaar, PhD, chairman, SAR Rehabilitation Sciences at Boston University. Dr. Wagenaar has spent his career involved in the study of methods of rehabilitation and determining their validity. I described our situation and asked if it would be possible to effectively validate the work we do. He responded that it was possible and is done routinely, but that there is no shortcut to the development of solid outcomes. The process would involve surveys, testing, development of research protocols, and ultimately, randomized control studies. In the short-term, some surveys could be done to demonstrate the impact certain classes of devices had on the recipient's quality of life. As a profession, we do not have resources such as those Dr. Wagenaar describes. We must appreciate this and go outside our field to obtain the expertise we need to advance our position.

A Call to Action

As a profession, we must meet and agree that only through a unified approach does a field as small as ours have any chance of making an impact on this situation. This could take place in the form of a meeting or consensus conference that would engender each organization and entity to commit their respective resources to the advancement of the consensus goal, both in terms of short-term immediate action and long-term planning. We as a profession and as a field--practitioner and manufacturer, salesman and engineer--must realize that our salvation lies in our ability to validate what we do. That requires a commitment to science and research. We must go outside our field to find the expertise needed to achieve these goals, and we must fund these studies. If the hundreds of thousands of dollars spent fighting amongst ourselves over the years had been directed toward this type of research, we would be far better off today.

I challenge the leadership of our national organizations, major manufacturers, and large and small facilities to begin the process of examining this hypothesis and its validity. It is time to put our differences aside and develop and execute a plan with laser-point precision.

Tom DiBello, CO, LO, FAAOP, is owner of Dynamic Orthotics and Prosthetics, Houston, Texas, and a past president of the American Academy of Orthotists & Prosthetists; tomd@dynamicoandp.com.