ABSTRACT Introduction Prosthetic and orthotic (P&O) education summits and strategic planning meetings have been held periodically since 1970 to review the current state of practice and education and to advance the profession. These meetings typically included a panel of acknowledged experts from the ranks of educators, researchers, consumers, industry representatives, and practitioners. Materials and Methods A narrative review of education summit and strategic planning meeting reports was performed. The authors defined concrete aims and specific questions before conducting the review. The authors independently reviewed the reports to identify the purpose of each meeting and the perceived challenges of the time. Lastly, the authors performed a qualitative thematic analysis to clarify the findings. Results The recurring themes identified from the five education summit reports, joint task force report, and three National Commission on Orthotic and Prosthetic Education (NCOPE) strategic planning meeting reports include 1) workforce shortages, 2) continuous development and oversight of uniform, recognized, national academic standards, 3) sustainability of P&O academic programs, 4) development and oversight of uniform, recognized, national residency standards, 5) communication with stakeholders, including related health professionals, and 6) data collection and usage. Conclusions Recurring themes and challenges that existed previously in P&O education still exist today. Communication between academic programs and community partners (e.g., clinical practitioners, paraprofessionals, patients, payers, and interdisciplinary professionals) is a continuing priority to clarify the expectations of P&O professionals and to advance the profession. Use of a systematic approach could help map the patterns and needs of the profession to demonstrate progress over time and to facilitate future strategic planning. Clinical Relevance P&O education is designed to meet the needs of practitioners and paraprofessionals who implement P&O services (i.e., fitting, fabrication, and patient management). Maintaining communication between academia and its community partners is critical to advancing the profession.

Background: Variables that influence orthotic and prosthetic patient outcomes beyond direct care are poorly conceptualized for orthotic and prosthetic students. Restructuring educational curricula around important clinical reasoning variables (i.e. factors that may influence outcomes) could improve teaching, learning, and clinical practice. Objectives: To propose an orthotic and prosthetic education framework to enhance the development of orthotic and prosthetic students' clinical reasoning skills. Study Design: Scoping review. Methods: We conducted a scoping review, identified variables of orthotic and prosthetic usability, and performed a qualitative thematic analysis through the lens of orthotic and prosthetic clinical educators to develop a conceptual framework for orthotic and prosthetic education. Results: Sorting of variables identified from the literature resulted in three thematic areas: (1) the state of functioning, disability, and health (International Classification of Functioning, Disability and Health); (2) orthotic and prosthetic technical properties, procedures, and appropriateness; and (3) professional service as part of orthotic and prosthetic interventions. The proposed orthotic and prosthetic education framework includes these three areas situated within the context of patient-centered care. Conclusions: A conceptual framework was developed from variables identified in peer-reviewed literature. This orthotic and prosthetic education framework provides a structure to explore orthotic and prosthetic clinical reasoning and advance our teaching and assessment of students' clinical reasoning skills. Clinical Relevance The proposed orthotic and prosthetic (O&P) education framework is intended to promote conversation about variables (e.g. health condition, procedures, services, and O&P principles) that influence O&P clinical practice outcomes and further advance our teaching and assessment of students' clinical reasoning skills.

Background: Continuing education is intended to facilitate clinicians' skills and knowledge in areas of practice, such as administration and interpretation of outcome measures.Objective: To evaluate the long-term effect of continuing education on prosthetists' confidence in administering outcome measures and their perceptions of outcomes measurement in clinical practice.Design: Pretest-posttest survey methods.Methods: A total of 66 prosthetists were surveyed before, immediately after, and 2 years after outcomes measurement education and training. Prosthetists were grouped as routine or non-routine outcome measures users, based on experience reported prior to training.Results: On average, prosthetists were just as confident administering measures 1-2 years after continuing education as they were immediately after continuing education. In all, 20% of prosthetists, initially classified as non-routine users, were subsequently classified as routine users at follow-up. Routine and non-routine users' opinions differed on whether outcome measures contributed to efficient patient evaluations (79.3% and 32.4%, respectively). Both routine and non-routine users reported challenges integrating outcome measures into normal clinical routines (20.7% and 45.9%, respectively).Conclusion: Continuing education had a long-term impact on prosthetists' confidence in administering outcome measures and may influence their clinical practices. However, remaining barriers to using standardized measures need to be addressed to keep practitioners current with evolving practice expectations.Clinical relevance Continuing education (CE) had a significant long-term impact on prosthetists' confidence in administering outcome measures and influenced their clinical practices. In all, approximately 20% of prosthetists, who previously were non-routine outcome measure users, became routine users after CE. There remains a need to develop strategies to integrate outcome measurement into routine clinical practice.

Background: Outcome measures can be used in prosthetic practices to evaluate interventions, inform decision making, monitor progress, document outcomes, and justify services. Strategies to enhance prosthetists' ability to use outcome measures are needed to facilitate their adoption in routine practice.Objective: To assess prosthetists' use of outcome measures and evaluate the effects of training on their confidence in administering performance-based measures. Study design: Cross-sectional and single-group pretest-posttest survey.Methods: Seventy-nine certified prosthetists (mean of 16.0 years of clinical experience) were surveyed about their experiences with 20 standardized outcome measures. Prosthetists were formally trained by the investigators to administer the Timed Up and Go and Amputee Mobility Predictor. Prosthetists' confidence in administering the Timed Up and Go and Amputee Mobility Predictor was measured before and after training.Results: The majority of prosthetists (62%) were classified as non-routine outcome measure users. Confidence administering the Timed Up and Go and Amputee Mobility Predictor prior to training was low-to-moderate across the study sample. Training significantly (p < 0.0001) improved prosthetists' confidence in administering both instruments.Conclusion: Prosthetists in this study reported limited use of and confidence with standardized outcome measures. Interactive training resulted in a statistically significant increase of prosthetists' confidence in administering the Timed Up and Go and Amputee Mobility Predictor and may facilitate use of outcome measures in clinical practice.

A recent letter to the editor has given us the opportunity to further elaborate about the results of our study.1 The authors greatly appreciate Michael Dillon and Stefania Fatone for taking an interest in our article. They speculated that the toe plates of the ankle–foot orthoses (AFOs) in our study were too compliant to normalize center of pressure (CoP) excursion or restore the effective foot length, which is an apparent contradiction to previously reported findings using forceplates.2,3 In our study, we examined the peak plantar pressures and pressure distributions under the diabetic foot. Pressure distributions, directly under the partial foot, were measured using bipedal in-shoe F-Scan sensor system (Tekscan, South Boston, MA). The sensors were taped on top of flat 1/8′′ insoles that were placed inside the shoe and on top of the footplate of the AFO. Flat insoles were used to reduce variability between the shoe-only condition and the shoewith-Blue-Rocker condition, and because the F-Scan sensors didn’t conform to the contours of the custom-molded partial foot insole. When measuring the CoP with the F-Scan sensors on top of the 1/8′′ insole, the CoP did not traverse beyond the distal end of the foot, during either condition.1 In fact, this pilot study found that during late stance, the CoP remained further behind the distal end of the residuum while wearing the Blue Rocker AFO as compared to the shoe-only condition.1 During late stance when the AFO resists ankle dorsiflexion, load transfers from the anterior shell to the forefoot section of the AFO. The force plate under the shoe would directly measure this load. However, the F-scan sensor only registered pressure under the foot on top of the AFO footplate inside of the shoe. There was no toe filler, and there was nothing to exert force beyond the distal end of the foot. It could be expected that the CoP trajectory derived using ground reaction force plates could be different than that derived from in-shoe pressure sensors. These methodological differences could readily explain differences in findings of these studies. These questions of how to restore the effective foot length, improve gait kinetics/kinematics and better distribute the peak plantar pressures are equally important in clinical practice. Findings from both methodologies support the beneficial role of above-ankle orthoses toward improving function by reducing distal residuum pressures and extending effective foot length. However, more research is warranted to clarify the in-shoe pressure distribution to aid clinical decision-making. Many clinical questions remain about fitting an above-ankle or a below-ankle orthosis on individuals with transmetatarsal amputations due to neuropathy.