Northwestern Survey Identifies Research Priorities

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Is research important in prosthetics and orthotics?
Is enough research being conducted?
What aspects of O&P are the most important target areas?

Charts and graphs reprinted with permission. S. Fatone, "Results of the Northwestern University Online Survey and Forum on Prosthetics and Orthotics Research", Capabilities (Vol 14 No 1) pp.4-6, 2006
Charts and graphs reprinted with permission. S. Fatone, "Results of the Northwestern University Online Survey and Forum on Prosthetics and Orthotics Research", Capabilities (Vol 14 No 1) pp.4-6, 2006

A survey conducted late last year by the Northwestern University Rehabilitation Engineering Research Center in Prosthetics and Orthotics sought answers to these and other questions. The online Survey and Forum was conducted to elicit opinions from the O&P community about directions that O&P research should take during the next five to ten years. Results were presented at Northwestern's State of the Science in Prosthetics and Orthotics Meeting February 28 in Chicago, Illinois, and at the Annual Meeting of the American Academy of Orthotists and Prosthetists (the Academy) March 1-4 in Chicago.

An article by Assistant Research Professor Stefania Fatone, PhD, in the summer 2006 issue of Capabilities, published quarterly by the Northwestern University Prosthetics Research Laboratory and Rehabilitation Engineering Research Program, detailed the results.

The survey drew 224 responses. Sixty percent identified themselves as certified prosthetists, orthotists, and prosthetists/orthotists.

Almost unanimously (98.2 percent), the respondents agreed that research is important, but a majority-79.9 percent-answered that they believe the current quantity of research is insufficient.

Eighty percent indicated insufficiency in these areas:

  • Outcomes/evidence/efficacy;
  • Orthotics research;
  • Funding;
  • Statistically significant studies with strong design;
  • Objectivity/independence and research;
  • Time to do research;
  • Quantity of research being conducted;
  • Quality of research being conducted;
  • Involvement of prosthetists and orthotists in research.

Fifty-four percent of respondents indicated that they do not conduct research in O&P; 44 percent said they do conduct research. However, the majority of prosthetists and/or orthotists who conduct research spend less than 20 percent of their time in research. Those who spend more than 80 percent of their time tended to be engineers.

The need for research is on the minds of those in the field, as represented by the survey respondents. More than 78 percent, though, indicated they had identified areas that need further study but lacked the ability and resources to conduct research. Of the total, 74.6 percent said that insufficient funding prevents more research.

To help stay current with O&P-related research, the majority said they read various journals. When asked which publications they read regularly, 66-68 percent named The O&P EDGE, Journal of Prosthetics and Orthotics, and O&P Business News. An additional 33 sources were cited as "other." Sources cited more than once included: O&P Almanac, InMotion, Challenge [Disabled Sports USA], Alignment, ADVANCE for Directors of Rehabilitation, Journal of Bone and Joint Surgery, Journal of Pediatric Orthopedics, Developmental Medicine and Child Neurology, Clinical Biomechanics, and the Internet.

What did the survey respondents rank as the most important research area? Number one-in both orthotics and prosthetics-was "outcome measures." For prosthetics, "socket/interface" joined as number one with "outcomes measures."

The survey also asked an open-ended question: "What do you consider to be the three most important questions to be addressed by prosthetics and orthotics research in the next five to ten years?"

The most frequent topics mentioned were:

  • Outcomes measures with emphasis on efficacy of P&O service, evidence-based practice;
  • Cost-benefit analysis of P&O services/technologies;
  • Develop low-cost alternatives;
  • Development of materials for P&O applications;
  • Develop light-weight components;
  • Develop fabrication processes for ease and quality;
  • Develop prescription principles for better decision making, e.g., components and device choice;
  • Long-term and real-world functional analyses with applicability to O&P;
  • Interface/socket design and comfort;
  • Development of control options for prostheses; and
  • Education and qualifications: standards, continuity, quality.

From the Forum

From the forum, Northwestern identified more than 70 potential research questions. Most were kindled by two topics: 17 issues derived from "Research Desires" and 14 related to "Sockets and Liners."

Suggestions in "Research Desires" sought to determine function and efficacy of different technologies, to improve current technologies, and to develop new ones.

Most suggestions regarding upper-limb prostheses focused on the improvement of function through reductions in weight and weight distribution, improvement of control processes, and sensory feedback.

Most suggestions regarding lower-limb prostheses focused on improving function, particularly in real-world conditions; developing better prescription principles; improving and better understanding alignment; establishing the cost-benefit of new technologies; and improving understanding of the socket-limb interface and its effects on tissue health. Additional suggestions focused on the efficacy and function of orthoses; the role of CAD/CAM in O&P; and improvements in the selection criteria and determination of the life span of materials and components used in P&O.

"Overall the State of the Science Meeting, online Survey, and Forum generated many important recommendations for future research directions in P&O," Fatone wrote. "By involving P&O clinicians, we believe we have identified clinically relevant topics that should be the focus of short-and long-term research endeavors."-Miki Fairley

Capabilities is published quarterly by Northwestern University's Rehabilitation Engineering Research Center. Subscriptions are free to all individuals interested in prosthetics and orthotics. Send subscription requests to: Capabilities, Northwestern University RERC, 345 E. Superier St., Room 1441, Chicago, IL 60611 or call 312.238.6500.