2002 – Clinical Practice Guidelines and Outcomes in Prosthetic and Orthotic Rehabilitation
Modern healthcare is increasingly characterized by the development and implantation of evidence-based Clinical Practice Guidelines (CPGs) and the collection of reliable, validated Outcome Measures (OMs). These elements have been historically lacking in orthotic and prosthetic rehabilitation. In this session we introduce our recent efforts to establish population-specific CPGs using a model adapted from the American College of Physicians. Using a pre-defined search strategy, the highest levels of evidence including systematic review and meta-analysis are identified and utilized to address questions of comparative efficacy, potential patient benefits and potential patient harms. To date, this process has yielded CPGs germane to the treatment of deformational plagiocephaly, conservative management of scoliosis, orthotic management of paraplegia secondary to spinal cord injury, benefits of orthotic interventions following stroke, perioperative management of the transtibial amputee, prosthetic foot/knee selection, and transtibial componentry considerations. References to CPGs that have been peer-reviewed and published will be included. In addition to CPGs, the standardized, routine collection of patient outcomes using reliable, validated OMs is needed to better understand the value and impact of prosthetic rehabilitation. We will introduce national initiatives that we have undertaken to create a culture of outcomes collection, enabling an unprecedented volume of outcomes data within these patient communities. Implementation strategies and the process of outcome measures selection are described. Key findings will be presented with emphasis on patient reported mobility among individuals with lower limb amputation and its relationship to patient well-being, satisfaction and quality of life. The impact of comorbid health conditions, upper extremity assistive devices and certain prosthetic components on patient reported mobility will also be presented.
1. Enumerate the role of Clinical Practice Guidelines in the provision of Evidence-Based Medicine
2. Summarize key treatment recommendations contained in Clinical Practice Guidelines germane to Orthotic and Prosthetic rehabilitation
3. Articulate the challenges and benefits associated with national initiatives to capture outcome data