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Orthotists and Prosthetists – The A to Z of Allied Health

The orthotic and prosthetic profession is a small but critical allied health workforce.

Orthotists and prosthetists can enhance the independence of people with functional limitations or physical impairments, in many cases providing the mobility to participate in aspects of social and professional life that would otherwise be inaccessible. In this article we take a closer look at the orthotic and prosthetic profession—what they do, where they work, their educational and professional frameworks, and the role they play for healthcare, support services, and caregivers.

What do orthotists and prosthetists do?

Orthotists and prosthetists promote quality of life through client-centred orthotic and prosthetic treatment. Also referred to in health care as O&Ps, they are allied health practitioners who design, prescribe (in the Australian context), fit, and monitor orthoses and prostheses.

They work as part of a multidisciplinary team to deliver acute and rehabilitation treatments for conditions such as limb amputation, stroke, diabetes, cerebral palsy, and trauma events, providing orthoses—braces or splints—and prostheses—artificial limbs—to restore function or compensate for muscular and skeletal disabilities.

Prosthetists develop, manufacture and fit artificial replacements for patients who are missing a limb, while orthotists design, manufacture and fit a range of aids to support body parts including nerves, muscles and bones.

To ensure a client’s personal and functional treatment goals are met, orthoses and prostheses are continually evaluated for their fit, function, quality and safety.

Orthotists/prosthetists can also provide expert advice on issues such as third-party compensation and medico-legal representation.

Referral contexts – what kinds of clients do O&Ps work with?

People require orthosis or prosthesis for a range of different conditions.

Orthosis  may be required by newborn babies with hip dysplasia (needing a hip orthosis); infants with plagiocephaly (needing a cranial orthosis); children with club foot; neuromuscular conditions (e.g., cerebral palsy) needing ankle-foot orthoses; older children with scoliosis or pectus carinatum needing a spinal brace; as well as young, middle aged and older adults with a range of orthopaedic, neuromuscular, lymphatic conditions, both acute (e.g., post-surgery or post-injury, burns orthoses) and chronic (e.g., post-polio, stroke, diabetes related foot disease, muscular sclerosis, cerebral palsy, spinal cord injury, rheumatoid arthritis, osteoarthritis).

Prosthesis may be required by people of any age to accommodate for limb loss. Congenital limb loss is when part of a limb is missing from birth. Acquired limb loss can be caused by cancer, infection, injury, or peripheral vascular disease. Limb loss could involve the loss of part of a finger, to part of the pelvis or shoulder girdle and everything in between. People use prosthetic limbs for a variety of reasons, sometimes it’s for every-day use, sometimes it’s for very specific activities, and sometimes it’s about function.

Where do orthotists and prosthetists work?

Orthotists and prosthetists exist in most countries, although may have different titles and levels of training, including (but not limited to) Australia, the USA, the UK, South Africa, Canada, New Zealand, India, Cambodia, Singapore and Malaysia, although their titles and training may vary.

Orthotists/prosthetists can be employed in public and private hospitals, private practice, rehabilitation facilities, not-for-profit organisations, universities and research institutes.

In Australia, O&Ps typically work in major tertiary hospitals or private clinics. Private clinics range from sole practitioners to multi-site practices, some of which service private hospitals or offer outreach clinics to more remote locations. Within the clinical setting O&Ps are part of the allied health team. A number of practitioners also work in education, academia, research, policy and consulting.

Orthotists and prosthetists are considered allied health practitioners and have a similar scope of practice in some countries, including the USA, Canada, the UK and New Zealand. However, in other parts of the world, O&Ps have a different name—sometimes orthopaedic technologist—and may not be well recognised as part of the health workforce or as allied health practitioners.

orthotist and prosthetist

What are the professional, educational and regulatory frameworks for orthotists and prosthetists?

The minimum qualification for an orthotist/prosthetist in Australia is a Bachelor of Prosthetics and Orthotics. Two accredited training programs are available in Australia: a three-year Bachelor of Health Science with an Extended Major in Prosthetics and Orthotics at the University of the Sunshine Coast, and a four-year Bachelor of Prosthetics & Orthotics (Honours) at La Trobe University. Practitioners who have trained outside of Australia must satisfy the equivalent certification requirements as Australian-trained O&Ps.

In Canada, it takes eight years to complete all necessary requirements to become a Certified Orthotist or a Certified Prosthetist, including a relevant Bachelor Degree, completion of an accredited two-year, post-graduate Prosthetic and Orthotic Clinical Methods Program, and completion of a 3,450 hour residency in prosthetics or orthotics under the supervision of a certified practitioner. In addition, aspiring orthotists and prosthetists must successfully complete the Canadian Board for Certification of Prosthetists and Orthotists (CBCPO) written and practical certification exams, followed by an adherence to the Canons of Ethical Conduct.

In the UK, completion of an approved degree in prosthetics and orthotics is required, along with registration with the Health and Care Professions Council (HCPC). Only a small number of full-time university courses are available in the UK, however degree apprenticeship training models are also available.

Regulatory and training requirements for O&Ps differ around the world—Australia is one of only six countries with a fully-regulated O&P workforce.

The Australian Orthotic Prosthetic Association (AOPA) provides self-regulation for the profession and is a member of the National Alliance of Self Regulating Health Professions (NASRHP). Certified O&Ps are members of the peak professional body for O&Ps in Australia—the Australian Orthotic Prosthetic Association (AOPA).

Workforce considerations for orthotists and prosthetists

In Australia, orthotist/prosthetists are one of the smallest allied health professions. Its peak professional body, the Australian Orthotic Prosthetic Association (AOPA), has recognised the profession’s susceptibility to changes in workforce supply and demand, as well as developments in technology, funding models and professional pathways. To support informed workforce planning for the profession, the AOPA has published a series of orthotist/prosthetist workforce snapshots that can be accessed here.

Global demand for O&P services expected to double by 2050, but the current O&P workforce capacity is insufficient to meet this growing demand. Currently, only 5% of the world’s 197 countries have a well-regulated O&P workforce. Workforce capacity could be strengthened by supporting O&P national associations to regulate their local workforce by establishing an international professional body for orthotists and prosthetists.

Hand prosthetic

What’s it like to work as an O&P?

For a clinically focused O&P, a regular day might include reviewing the referral and clinical history of a new patient before meeting them for the first time, spending time talking and understanding their background, needs and goals, and assessing them for orthotic or prosthetic intervention.

There is often paperwork to do to assess funding options before formulating a prescription.

Prescription of an orthosis or prosthesis always requires some type of measurement, from simple circumferential measure for an off-the-shelf orthosis, through to 3D scanning of body parts for a custom-made device.

For existing patients, the day might include trouble-shooting minor (e.g., needing new supplies, minor adjustments of orthosis/prosthesis) or major issues (e.g., broken component, orthosis/prosthesis no longer fitting or functioning optimally) or refining/reviewing/changing a patient’s orthotic/prosthetic prescription to better meet their individual goals and needs.

O&Ps are often asked to consult with patients before they need an orthotic/prosthetic services. For example, they might have conversations with patients who are awaiting an amputation, or discussions about what orthotic/prosthetic services might look like if a patient chooses to go forward with treatment (e.g., cranial helmets or scoliosis).

Find out more about orthotists and prosthetists

Here are some links to websites and resources for and about orthotists and/or prosthetists:

 

Share your views and experiences

Are you an O&P and keen to share your views on the profession or your experiences? We would like to hear from you. Email us at [email protected]