Academy Society Spotlight - Survey: Current Clinical Utilization of CAD/CAM

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As our profession faces increasing challenges from third-party payer reimbursements, documentation justification, Medicare audits, and increasing fabrication costs, clinicians and technicians are under pressure. As O&P providers seek to improve accuracy and efficiency in all areas of practice, the aim of the Fabrication Sciences Society and the CAD/CAM Society of the American Academy of Orthotists and Prosthetists (the Academy) is to provide interested parties with resources and information to advance best practices in our respective areas of focus.

There has been a steadily increasing representation of 3D printing companies, CAD designers, digital imaging developers, and fabricators presenting their products and services at national and regional O&P conferences. Open-invitation panel sessions held at these conferences attract high attendance and include comprehensive discussions that address the issues and concerns O&P providers have about the implementation of such technologies. These indicators imply that the utilization of these novel methods in the clinic is increasing.

However, the following questions are some of the considerations clinicians, manufacturers, software developers, and technicians have in expectation of delivering the highest quality of care in the most efficient manner using the available resources: Who is using this technology? What type of training is being received? Which orthotic and prosthetic interventions are being fabricated using this technology?

The Fabrication Sciences and CAD/CAM Societies created a survey to help answer some of these questions and to establish a baseline for future areas of investigation that may develop. Qualtrics (Qualtrics, Provo, Utah) software was used for response collection and data analysis. Survey dissemination was provided by the Academy; the entire Academy membership was notified via email requesting anonymous participation in a CAD/CAM survey. The following data was compiled from the 137 responses.

Discussion

This preliminary investigation into the state of clinical use of CAD/CAM in O&P yields interesting information. The first series of graphics conveys that some of the earliest adopters of this technology are certified prosthetist/orthotists with more than 15 years of experience, followed by other O&P professionals with various certification levels and one to three years of experience. The second series of graphics interprets the training obtained by personnel and indicates formally trained users are the majority. (Author's note: Though this report does not contain numerical representation, the study found that manufacturers and developers are actively involved in educating their customers in best practices.) Furthermore, CAD/CAM is addressed in some manner during the pedagogic phase of professional education. The final series of charts shows the utilization of CAD/CAM for O&P interventions; the top four uses are for transtibial prostheses, transfemoral prostheses, TLSOs, and cranial remolding orthoses.





One of the greatest complications of this survey is the small sample size compared to the expected actual utilization of the technology nationwide. This survey was constrained to the Academy membership; polling a larger dissemination system may be coordinated in the future. Participation in polling activities and similar feedback requests is highly sought after by many communities and organizations within our profession. Information obtained from such instruments has short-term and long-term effects in the strategic development of resolutions to problematic issues facing personnel at all levels of the O&P profession.

Thank you to all who participated in this survey.

Duffy Felmlee, MSPO, CPO, is chair of the Fabrication Sciences Society of the American Academy of Orthotists and Prosthetists (the Academy) and clinical assistant professor of rehabilitation sciences at the University of Hartford. He can be contacted at felmlee@hartford.edu.

The Publications Review Committee at the Academy and the institutional review board at the University of Hartford approved this study. Academy Society Spotlight is a presentation of clinical content by the Societies of the Academy in partnership with The O&P EDGE.