Canada lacks a national data source on individuals with limb loss and limb difference (LLD), which limits understanding of incidence, prevalence, risk factors, etiology, and healthcare outcomes. In the absence of standardized data collection, the provision of LLD healthcare services in Canada remains inconsistent. The objective of this study was to gather key interest groups' perspectives on the development of a Canadian LLD registry. Invitees were identified through professional networks and snowball recruitment techniques. A two-round modified Delphi approach was utilized to identify key LLD registry domains via a pre-meeting survey followed by a virtual workshop on February 14, 2024. Of 96 invitees, 53 completed the survey, and 64 attended the workshop (63 from Canada and 1 from the United States). Five key LLD registry domains were identified: representation, standardization, practice-based evidence, research and innovation, and policy and funding. Inclusivity of diverse populations, national outcome measures adoption, and integration of psychosocial and clinical data was emphasized. Foreseen challenges included privacy concerns, necessary infrastructure, and resources to ensure long-term sustainability. Despite these challenges, a Canadian LLD registry could support advocacy, strengthen practice-based evidence, enhance research collaboration, improve clinical care, and inform population-level policies. Efforts to develop the registry are ongoing.
Health economic evaluations are essential to support health care policy and investment decisions. To date, health economic evaluations in orthotics and prosthetics have focused on discrete components of an orthosis/prosthesis (e.g. a microprocessor controlled prosthetic knee joint) rather than the broader service provided by orthotist/prosthetists. As such, the contribution to orthotic/prosthetic policy and investment decisions is unclear. Whilst there are opportunities to conduct more informative health economic evaluations that describe the costs and benefits of the orthotic/prosthetic service, it is important that prospective research is informed by a critical review of the method design challenges and an understanding of how this research can be improved. The aim of this systematic review is to critically appraise the existing orthotic/prosthetic health economic evaluation literature and therefore determine evidence gaps, critical method design issues and the extent to which the literature informs orthotic/prosthetic policy and investment decisions. A comprehensive range of databases-AMED, EMBASE, MEDLINE and PsychINFO, Cumulative Index of Nursing and Allied Health Literature (CINAHL), ProQuest Nursing and Allied Health, Web of Science, Cochrane Database of Systematic Reviews (CDSR) and specialty health economic databases-will be searched using National Library of Medicine Medical Subject Headings (MeSH) terms as well as the title, abstract, and keyword terms. Search terms related to the intervention (e.g. orthosis), including variants used by varying professional disciplines (e.g. brace), will be used in preference to defining the populations that use orthotic and prosthetic services (e.g. people living with rheumatoid arthritis). Search terms related to health economic evaluations will be guided by previously developed and tested search strings and align with recommendations by the Canadian Agency for Drugs and Technologies in Health. Articles meeting the inclusion criteria will be hand-searched for relevant citations, and a forward citation search using Google Scholar will also be conducted to identify early online articles not yet indexed in traditional databases. Original research published in the English language and after 1 January 2000 will be included. The Checklist for Health Economic Evaluation Reporting Standards (CHEERS) and the Consensus on Health Economic Criteria (CHEC)-Extended list will be used to appraise the methodological quality and identify sources of bias. Data extraction and appraisal will be conducted by one reviewer independently using appraisal instrument guidelines and a content specific decision aid with exemplars. A subsequent review by a second researcher will be undertaken to confirm the accuracy of the extraction and appraisal, and a final review by a third where consensus cannot be reached. The data will be extracted to a purpose-built data extraction template with decision-making guidelines to support consistency. Where possible, the findings of the review will be reported as a meta-analysis, although the heterogeneity of the literature will likely mean a narrative review that illuminates method design issues that contribute to imprecision and variation will be more appropriate. This protocol has been purposefully designed to summarise the existing evidence and appraise the methodological approaches used and the quality of the health economic evaluations in orthotics and prosthetics. What we learn from this review will be used to guide further work in this area and design more rigorous health economic evaluations into the future. PROSPERO CRD42018116910.
The purpose of this letter is to continue the dialogue regarding the paper "Evolving business models in Orthotics" in the Canadian Prosthetics & Orthotics Journal Volume 4, Issue2, No.3, 2021. In it we present the perspective of the current Alberta Association of Orthotists and Prosthetists (AAOP) and provide additional context and information on historical events. Finally, we provide additional clarity on how costing is approached in the Province of Alberta (Canada) and the purported inequity in compensation between the two disciplines.
Outcome measures (OMs) are useful tools; however, clinicians may find implementing them into clinical practice challenging. To characterize Canadian prosthetists' use of OMs for people with lower-limb amputation, including motivations for use, comfort selecting OMs, resources available for administration, and barriers to implementation. A cross-sectional study was conducted between March and July 2021. Orthotics Prosthetics Canada sent Canadian prosthetists an invitation to take the online survey. Forty-nine Certified Prosthetists completed the survey. Only 16% of participants reported that they were expected to use OMs. Participants reported being more comfortable administering performance-based OMs than self-report surveys. More than two-thirds of participants agreed that OMs "can be administered with knowledge they have" and are "within their scope of practice." However, less than 25% agreed that OMs are "administered in a standardized way in the profession," and less than 40% indicated they are "easy to make part of my routine." Participants reported they generally have time and space to do OMs, but there was no agreed-on reason to use them. Use of OMs among Canadian prosthetists seems to be low relative to prosthetists in the United States. Education, financial incentives, or changes to professional expectations are likely needed to increase routine OM use. Efforts to improve the standardization of OM administration and ease the incorporation of OMs into routine practice may also increase use. Canadian prosthetists may elevate their standards of clinical practice and better understand the impact of prosthetic treatments on their patients by more routinely using OMs.
This submission provides an important historical context for understanding the current challenge facing the Orthotic and Prosthetic community in Alberta including Alberta Aids to Daily Living (AADL), Suppliers, and Providers: maintaining sustainable access to Orthotic care for people with mobility disorders in the face of declining real rates of reimbursement combined with increasing costs and a shortage of skilled Clinicians. Under the Canada Health Act, the federal government delegates responsibility for providing health care to the provinces. This delegation of responsibility to the provinces results in a degree of variability of funding of Orthotics and Prosthetics between provinces across the country. Funding of Orthotics and Prosthetics in Alberta is characterized by structural inequities that favour Prosthetics at the expense of Orthotics. To the extent that the structural inequities that exist in Alberta are related to governance by volunteer-run, non-profit organizations, they may be generalized to the Canadian experience. Finally, in a Call to Action a number of recommendations are made to address the challenge of sustainable access to Orthotic care in Alberta serving as a model for other provinces across Canada.
Mild cognitive impairment impairs activities of daily living, independence and social participation in older adults. This study investigated the association between perceived occupational performance and balance, gait and fear of falling in older adults with mild cognitive impairment. The study included 36 older adults over the age of 65 with mild cognitive impairment . Balance and gait of the older adults were assessed with the Tinetti balance and gait test, fear of falling with the Tampa Scale for Kinesiophobia and occupational performance with the Canadian Occupational Performance Measure. The relationship between Canadian Occupational Performance Measure and other parameters was analysed by Spearmen's test. The mean age of the participants was 75.13 ± 6.92 years. There was a moderate positive correlation between the satisfaction parameter of the Canadian Occupational Performance Measure and the Tinetti gait test (r = 0.54, p < 0.01) and the Tinetti total score (r = 0.41, p < 0.05). There was no relationship between the other parameters. Current findings suggest that older adults with mild cognitive impairment have different perceptions of activities of daily living and that gait problems of individuals with mild cognitive impairment affect perceived occupational satisfaction more than balance and fear of falling.Clinical Trial Number: NCT06513325.
We aimed to translate, culturally adapt and test the Prosthetic Upper Extremity Functional Index-2 for a Swedish context. Ten children with congenital upper limb deficiency with an upper limb prosthesis and their parents. The translation and cultural adaptation of the Prosthetic Upper Extremity Functional Index-2 was conducted according to the International Society for Pharmacoeconomics and Outcomes Research Principles of Good Practice for cross-cultural adaptation of patient-reported outcome measures; this comprises 10 steps, including Preparation, Forward Translation, Reconciliation, Back Translation, Back Translation Review, Harmonization, Cognitive Debriefing, Review of Cognitive Debriefing Results and Finalization, Proofreading and Final Report. The new translated version, tested on 10 children, 4 boys and 6 girls, 3-14 years showed good relevance for the Swedish context, the questions were easy to understand, and response options were easy to interpret. It was also easily accessible on computers and mobile devices. The Swedish version of the Prosthetic Upper Extremity Functional Index-2 is user-friendly and provide information of the child's self-reported prosthesis use in a Swedish context. Children's right to express their opinions, is crucial, and using the questionnaire prior to their clinic visits gives children the opportunity to participate in goal setting and treatment planning. The Prosthetic Upper Extremity Functional Index (PUFI) is a Canadian self-report questionnaire for children (3–18 years) with an upper limb prosthesis. The questionnaire asks about performance of various 2-handed activities. Children under 10 years answer with a parent. The answers provide a comprehensive picture of the child’s real-world prosthesis use. Children’s daily activities change with time, and therefore an updated Canadian version, PUFI-2, has been developed. We aimed to translate and culturally adapt PUFI-2 for use in a Swedish context. The Swedish version was tested on Swedish children and parents who stated that the questions were relevant, and easy to understand and respond. The PUFI-2 gives children the opportunity to participate in goal setting and treatment planning.
Education programmes of the International Society for Prosthetics and Orthotics (ISPO) are directed primarily at prosthetists and orthotists. In a multidisciplinary setting, greater attention should be given to other professionals working in the field of amputation, prosthetics and orthotics. This includes, among others, physiotherapists, occupational therapists and residents and physicians from orthopaedics, vascular surgery and physical medicine and rehabilitation (PM&R). The aim of this paper is to describe the education programme in amputation and prosthetics for residents in PM&R in the Netherlands. The programme is based on concepts of the International Classification on Functioning, Disability and Health (ICF). This narrative paper presents the amputation and prosthetics education programme for residents in PM&R in the Netherlands. The programme is based on two models: the ICF and the Canadian Medical Education Directives for Specialists (CanMEDS). ICF core sets for amputation and prosthetics need further development. Subsequently, the application of these core sets can help stimulate the education of residents in PM&R, and other multidisciplinary team members who work in amputation rehabilitation. Through this education programme, residents work closely with other team members using the common language of the ICF, enhancing treatment and technical advice in amputee care.
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The Canadian Occupational Performance Measure (COPM) is an occupational therapy instrument designed to help participants identify, prioritize, and evaluate performance of important occupations. To investigate the validity, responsiveness, interpretability, and feasibility of the COPM when used by various health professions in home-dwelling older adults receiving reablement. Reablement is a new form of multidisciplinary home-based rehabilitation for older adults experiencing functional decline. The sample of 225 participants, mean age 80.8 years, who were in need of rehabilitation for various health conditions were included in the study. Data collection was conducted at baseline and at 10 weeks follow-up. The COSMIN guidelines and recommendations for evaluating methodological quality were followed. Content validity, construct validity, and feasibility were found to be adequate. Responsiveness, however, was moderate. Functional mobility was the most frequently prioritized occupational category of all. Regarding interpretability, the minimal important change was 3.0 points and 3.2 points for performance and satisfaction, respectively. The older adults reported that COPM was a useful and manageable instrument. The majority of the occupational therapists, physiotherapists, and nurses reported that they had the required expertise to conduct the COPM assessments. The results support the multidisciplinary use of the COPM in clinical practice and research in a home-dwelling, heterogeneous population of older adults. Based on the findings, 3 points are recommended as a cutoff point to distinguish between older adults who have a minimal important change in COPM performance and COPM satisfaction and those who have not.
Internet analytics are increasingly being integrated into public health regulation. One specific application is to monitor compliance of website and social media activity with respect to jurisdictional regulations. These data may then identify breaches of compliance and inform disciplinary actions. Our study aimed to evaluate the novel use of internet analytics by a Canadian chiropractic regulator to determine their registrants compliance with three regulations related to specific health conditions, pregnancy conditions and most recently, claims of improved immunity during the COVID-19 crisis. A customized internet search tool (Market Review Tool, MRT) was used by the College of Chiropractors of British Columbia (CCBC), Canada to audit registrants websites and social media activity. The audits extracted words whose use within specific contexts is not permitted under CCBC guidelines. The MRT was first used in October of 2018 to identify words related to specific health conditions. The MRT was again used in December 2019 for words related to pregnancy and most recently in March 2020 for words related to COVID-19. In these three MRT applications, potential cases of word misuse were evaluated by the regulator who then notified the practitioner to comply with existing regulations by a specific date. The MRT was then used on that date to determine compliance. Those found to be non-compliant were referred to the regulator's inquiry committee. We mapped this process and reported the outcomes with permission of the regulator. In September 2018, 250 inappropriate mentions of specific health conditions were detected from approximately 1250 registrants with 2 failing to comply. The second scan for pregnancy related terms of approximately1350 practitioners revealed 83 inappropriate mentions. Following notification, all 83 cases were compliant within the specified timeframe. Regarding COVID-19 related words, 97 inappropriate mentions of the word "immune" were detected from 1350 registrants with 7 cases of non-compliance. Internet analytics are an effective way for regulators to monitor internet activity to protect the public from misleading statements. The processes described were effective at bringing about rapid practitioner compliance. Given the increasing volume of internet activity by healthcare professionals, internet analytics are an important addition for health care regulators to protect the public they serve.
During the past 24 months, 177 cerebral palsied Saudi patients were provided with specialized seating systems. The majority (73%) were children, ranging from 1 to 9 years of age, and 22% were aged from 10 to 18 years. Only six were adults more than 18 years of age; 67% of the patients were male and 33% female. The majority had spastic quadriplegia (57%), and diplegia (20%). Various seating systems were prescribed including the Bead Seat, the Snug Seat, the Pin-Dot modular system, and the Canadian Posture Seating Centre (CPSC) modular and Foam-in-Place seating systems. For 34% of the cases the Bead Seat was prescribed, because it was found to have several advantages over its competitors, particularly with respect to in-house fitting and manufacturing. The Snug Seat (31%) was found to be unsatisfactory for children who had poor head control. The Pin-Dot modular system was found to be suitable mostly for domestic and institutional use. Certain problems were also identified with other systems. It has been found that adaptive seating services are in great demand in Saudi Arabia, and are essential as a complement to other rehabilitative efforts undertaken within the local cultural framework and environment.
Shortened hospital stays have shifted the burden of care for older adults to community, informal (ie, family, caregiver) and formal post-acute care and services, highlighting the need for effective post-hospital stay services and programs. As there is a dearth of information related to community-based, slow-stream rehabilitation program models for older adults transitioning from hospital to home in the Canadian context, the paper describes a mixed methods evaluation of such a program. A mixed methods program evaluation, with process- and outcome-related elements, included 1) review and analysis of program documents; 2) observations to examine fidelity. Observation data were coded and summarized using descriptive statistics. Coded information and data were compared to document review data; 3) quantitative assessment of pre-post changes in physical, social, and psychological outcome measure and instrument scores using descriptive statistics, paired t-tests and confidence intervals (p = 0.05); and 4) exploration of acceptability through interviews and focus groups with 41 of the older adult participants and 17 family caregivers. Thematic analysis was used to examine focus group and interview transcripts. Observational data indicated alignment with the program document information overall. Statistically and clinically significant positive trends in improvement for physical outcome measure scores were observed (6-minute Walk Test, Life Space Assessment, Short Physical Performance Battery, Rapid Assessment of Physical Activity). Participants and family caregivers identified several positives and benefits of the program, ie, improvement in physical, social and mental well-being, decreased caregiver burden; and areas for improvement ie, need for more information about the program prior to enrollment and individualization, several of which aligned with the observation and quantitative data. This mixed methods program evaluation provided a detailed description of a community-based, slow-stream rehabilitation program for older adults who are transitioning to home post-hospital stay and its participants. Evidence of program fidelity, acceptability, and positive trends in improvement in physical outcome measure scores were found. Information about program strengths and areas for improvement can be used by stakeholders to inform program refinement and enhancement.
The data in this paper are related to the research article entitled "Development of a government continuous quality improvement procedure for assessing the provision of bone anchored limb prosthesis: A process re-design descriptive study" (Frossard et al., Canadian Prosthetics & Orthotics Journal, 2018. 1(2). p. 1-14). This article contains quality of life data experienced by individuals before and after implantation of a press-fit or screw-type osseointegrated fixation when fitted with conventional socket-suspended and bone-anchored limb prosthesis, respectively. This specifically-designed survey was developed and administered by Queensland Artificial Limb Services (QALS), an Australian State government organization. It was an integrated part of QALS' continuous quality improvement procedure for assessing the provision of bone-anchored prosthesis. A total of 12 out of the 65 consumers completed to the survey, giving a return rate of 18%. This benchmark information can contribute to inform the design of (A) other patients' experience surveys including those built-in governmental continuous quality improvement procedure as well as (B) clinical trials looking at the overall effects of surgical implantation of ossoeintegrated fixation on patients' quality of life. Online repository contains the files: https://data.mendeley.com/datasets/bkbxxmrhfh/1.
Victoria Hand Project (VHP) is a Canadian charity with a mission to provide 3D printed prosthetic arms to people in-need across the world, by partnering with prosthetic care providers. This article explores the journey of VHP, sharing insights, lessons learned, ongoing directions, and the impact of 3D printing on prosthetic care for people with upper-limb amputation. Benefits such as affordability and customization are explored, as well as the challenges encountered, including quality control and the steep learning curve associated with working in the digital 3D space. Through this article, the potential of 3D printing to continue to transform the field of assistive technology and prosthetic and orthotic applications is underscored, especially when used for collaborative, humanitarian initiatives.
Spinal manipulative therapy (SMT) is offered by many health professions, most often by chiropractors. While SMT can be effective for some musculoskeletal disorders, there is no evidence that SMT improves human immunity in a clinically meaningful way. Despite this, we showed previously that Twitter misinformation about chiropractic/SMT  improving immunity increased sharply at the start of the COVID-19 pandemic. Here, we perform a two-year follow-up. We previously employed specialized software (i.e. Talkwalker) to search the entirety of Twitter activity in the  months before and after the COVID-19 pandemic was declared (March 11, 2020). In this paper, we conducted follow-up searches over two successive 12 month periods using terms related to SMT, immunity and chiropractic. The resulting tweets were then coded into those promoting/refuting a relation between SMT and immunity (tone) and messaging about chiropractic/interventions (content). Further analyses were performed to subcategorize tweet content, tally likes, retweets and followers, and evaluate refuting tweets and the country of origin. Finally, we created a chronology of Twitter activity superimposed with dates of promoting or refuting activities undertaken by chiropractic organizations. Over the 27 month study period, Twitter activity peaked on March 31, 2020 then declined continuously. As in our first paper, our follow-up data showed that (1) the ratio of refuting/promoting tweets remained constant and (2) tweets that refuted a relationship between SMT and immunity were substantially more liked, retweeted and followed than those promoting. We also observed that promoting tweets suggesting that SMT improves immunity decreased more rapidly. Overwhelmingly, promoting tweets originated in the USA while refuting tweets originated in Canada, Europe and Australia. The timing of the decline in peak Twitter activity, together with a parallel decline in tweets claiming that SMT improves immunity, was coincident with initiatives by chiropractic organizations and regulators targeting misinformation. Overwhelmingly, Twitter activity during the COVID-19 pandemic focussed on refuting a relation between chiropractic/SMT and immunity. A decline in Twitter activity promoting a relation between SMT and immunity was observed to coincide with initiatives from chiropractic organizations and regulators to refute these claims. The majority of misinformation about this topic is generated in the United States.
Although older people often have challenges with fractures and dizziness/balance problems, knowledge concerning the impact of reablement of people with these conditions is limited. To explore functional changes in reablement for older home-dwelling people with fractures and dizziness/balance problems regarding 1) occupational performance and satisfaction with performance, 2) physical function and 3) health-related quality of life, and 4) which occupations they prioritize as rehabilitation goals. The sample is derived from a nationwide clinically controlled trial in Norway consisting of 149 participants with fractures and 113 with dizziness/balance problems who participated in a four to 10-week reablement program. Data were collected at baseline and at 10-week, 6-month, and 12-month follow-up and were analyzed with paired t-tests and analysis of covariance. Occupational priorities were categorized into sub-areas of occupation. Both groups had significant short-, mid-, and long-term improvements in occupational performance and satisfaction with performance. Except for balance from baseline to 12-month follow-up, the fracture group showed significant improvements in physical function and health-related quality of life at all follow-ups. The results varied more in the group with dizziness/balance problems in physical function and health-related quality of life. Functional mobility was the highest prioritized occupational sub-area in both groups. The findings of this study provide extended knowledge about goals and functional changes in people with fractures and dizziness/balance problems following a reablement program. Tailoring and individual adjustments according to diagnosis may be important in person-centered care in reablement.
To describe research evidence supporting clinical recommendations for ankle-foot orthotic (AFO) prescription and examine common limitations in current research among individuals with stroke and cerebral palsy. Three databases and one journal website were searched for articles reporting AFO interventions on gait and functional mobility outcome measures in participants with stroke or cerebral palsy. The International Society for Prosthetics and Orthotics (ISPO) best practice recommendations from consensus conferences were reviewed. Data extracted from the articles include participant characteristics, AFO intervention details, evaluation methods, and outcome measures. Sixty articles were included; twenty-seven on stroke and thirty-three on cerebral palsy participants. Many articles reported insufficient detail on severity of lower limb impairment. Type of interventions included nineteen nonarticulating AFO studies, twelve articulating AFO studies and twenty-three studies testing both. Confounding factors, such as compliance, activity level and footwear, need to be considered in longitudinal studies. Most studies demonstrated improvement in walking speed and ankle dorsiflexion, whereas the indirect effect on knee stability remains unclear. Future research needs to provide detailed information on type and severity of lower limb impairment of participants and design features of the AFO intervention.
An important way of improving healthcare services is through the implementation of evidence-based practice; but this requires an understanding of the extent to which it is occurring and the factors that are driving its implementation. To examine the associations among the demographics of clinicians, the factors involved in the implementation of evidence-based practice, and the access of clinicians to various sources of information. Cross-sectional survey. An online survey that was distributed to 300 Canadian prosthetic and orthotic clinicians. Associations of selected survey items were determined. Four primary associations were found and a further 18 were considered to be indicative of potential trends. Two of the primary associations were related to authorship and the utilization of scientific literature. Specifically, those clinicians who had previously authored or co-authored a peer-reviewed journal article were more likely to utilize scientific literature to guide their clinical practice. This study has highlighted important demographics which can be targeted for greater implementation of evidence-based practice. Above all, facilitating engagement of clinicians in research and its dissemination may promote a higher consumption of research evidence leading to improved evidence-based practice.
Optimizing functioning at all ages is a major global public health goal. Rehabilitation is unique in its contribution to this public health agenda because of its focus on optimizing function. In this editorial, the editors of leading rehabilitation journals make the case for fully integrating rehabilitation into a nation's health system and strengthening it specifically at the primary care level to increase access and achieve its full potential. Authors submitting papers to rehabilitation journals are encouraged to consider the global health policy implications of their research when they prepare their research reports for publication and to make these implications explicit.