Roles & Responsibilities

The Board of Directors of the American Board for Certification in Orthotics, Prosthetics & Pedorthics (ABC) commissioned a task force to develop an Orthotics and Prosthetics Scope of Practice document for use by orthotic and prosthetic professionals, consumers, members of the rehabilitation team, and health care decision makers. To write this consensus document, the task force used a variety of resources including the Report of the Task Force on the Scope of Practice in Orthotics and Prosthetics and the Practice Analysis of the Disciplines of Orthotics and Prosthetics. In addition, the task force conducted both a survey of the profession as well as interviews with credentialed individuals. The following is an excerpt from the report.

Patient Assessment

Perform a comprehensive assessment of the patient to obtain an understanding of the patient's orthotic/prosthetic needs:

• Review patient’s prescription/referral.
• Take a comprehensive patient history, including demographic characteristics, family dynamics, previous use of an orthosis/prosthesis, diagnosis, work history, avocational activities, signs and symptoms, medical history (including allergies to materials, current medications), reimbursement status, patient expectations, patient compliance with ancillary care, results of diagnostic evaluations.
• Perform a diagnosis-specific functional clinical and cognitive ability examination that includes manual muscle testing, gait analysis, and evaluation of sensory function, range of motion, joint stability, and skin integrity.
• Consult with other health care providers and caregivers, when appropriate, about patient’s condition in order to formulate a treatment plan.
• Verify patient care by documenting history, ongoing care, and follow-up, using established record-keeping techniques.
• Refer patient, if appropriate, to other health care providers for intervention beyond orthotic/prosthetic scope of practice.

Formulation of the Treatment Plan

Create a comprehensive orthotic/prosthetic treatment plan to meet the needs and goals of the patient:

• Evaluate the findings to determine an orthotic/prosthetic treatment plan.
• Formulate treatment goals and expected orthotic/prosthetic outcomes to reduce pain, increase comfort, provide stability, prevent deformity, address aesthetic factors, and/or promote healing to enhance function and independence.
Consult with physician/referral source/appropriately licensed health care provider to modify, if necessary, the original prescription and/or treatment plan.
• Identify design, materials, and components to support treatment plan.
• Develop a treatment plan based on patient needs, including patient education and follow-up.
• Communicate to patient and/or caregiver about the recommended treatment plan and any optional plans, including disclosure of potential risks/benefits in orthotic/ prosthetic care.
• Document treatment plan using established record-keeping techniques.
• Ensure patient or responsible parties are informed of their financial responsibilities (for example, insurance verification/authorization, deductibles, co-pays) as they pertain to proposed treatment plan.

Implementation of the Treatment Plan

Perform the necessary procedures to deliver the appropriate orthotic/prosthetic services, which may include fabrication of the orthosis/prosthesis:

• Inform patient, family, and/or caregiver of the orthotic/prosthetic procedure, possible risks, and time involved in the procedure.
• Provide patient with preparatory care for orthotic/prosthetic treatment (e.g., diagnostic splint, compression garment)
• Select appropriate materials/techniques in order to obtain a patient model/image
• Prepare patient for procedure required to initiate treatment plan (e.g., measure, take impression, delineate, scan, digitize)
• Perform procedure (e.g., measure, take impression, delineate, scan, digitize)
• Refer to manufacturer’s specifications and other technical resources regarding components/materials
• Select appropriate materials and components for orthosis/prosthesis based on patient criteria to ensure optimum strength, durability, and function (e.g., ankle or knee joints, feet, knee units, lamination layups)
• Prepare delineation/impression/template for modification/fabrication (e.g., prepare impression/reverse delineation, digitize)
• Rectify and prepare patient model/image for fabrication
• Fabricate/assemble orthosis/prosthesis in order to prepare for initial or diagnostic fitting and/or delivery
• Assess device for structural safety and ensure manufacturers’ guidelines have been followed prior to patient fitting/delivery (e.g., torque values, patient weight limits)
• Assess/align orthosis/prosthesis for accuracy in sagittal, transverse, and coronal planes in order to provide maximum function/comfort
• Ensure materials, design, and components are provided as specified in the treatment plan
• Complete fabrication process after achieving optimal fit and function of orthosis/ prosthesis (e.g., convert test socket to definitive orthosis/prosthesis)
• Educate patient and/or caregiver about the use and maintenance of the orthosis/prosthesis (e.g., wearing schedules, other instructions)
• Re-assess orthosis/prosthesis for structural safety prior to patient delivery
• Document treatment using established record-keeping techniques to verify implementation of treatment plan
• Refer patient to appropriate health care providers (e.g., nurse practitioners, therapists) for necessary ancillary care

Follow-up Treatment Plan

Provide continuing patient care and periodic evaluation to assure/maintain/ document optimal fit and function of the orthosis/prosthesis:

• Obtain feedback from patient and/or caregiver to evaluate outcome (e.g., wear schedule/ tolerance, comfort, perceived benefits, perceived detriments, ability to don and doff, proper usage and function, overall patient satisfaction)
• Assess patient’s function and note any changes
• Assess patient’s skin condition (e.g., integrity, color, temperature, volume) and note any changes
• Assess patient’s general health, height, and weight, and note any changes
• Assess patient’s psychosocial status (e.g., family status, job, or caregiver), and note any changes
• Assess fit of orthosis/prosthesis with regard to strategic contact (e.g., multiple force systems, total contact) to determine need for changes relative to initial treatment goals
• Assess fit of orthosis/prosthesis with regard to anatomical relationships to orthosis/ prosthesis (e.g., trimlines, static/dynamic alignment) to determine need for changes relative to initial treatment goals
• Assess patient’s achievement of planned treatment outcomes
• Formulate plan to modify orthosis/prosthesis based on assessment of outcomes and inform patient and/or caregiver of plan to modify orthosis/prosthesis as necessary
• Make or supervise modifications to orthosis/prosthesis (e.g., relieve pressure, change range of motion, change alignment, change components, add pressure-sensitive pad)
• Assess modified device for structural safety
• Evaluate results of modifications to orthosis/prosthesis, including static and dynamic assessment
• Reassess patient knowledge of goals and objectives to ensure proper use of orthosis/ prosthesis relative to modifications
• Document all findings and actions and communicate with physicians, referral sources, and appropriately licensed health care providers to ensure patient status is updated
• Develop long-term follow-up plan

Practice Management

Develop, implement and/or monitor policies and procedures regarding human resource management, physical environment management, business/financial management and organizational management:

• Plan, implement, evaluate, and document policies and procedures in compliance with all applicable federal and state laws and regulations and professional and ethical guidelines (e.g., CMS, HIPPA, FDA, ADA, OSHA, ABC Code of Professional Responsibility)
• Develop and implement personnel policies and procedures (e.g., benefits, training, incentives, staff recognition, and regular performance evaluations)
• Establish procedures for patient care that comply with current medical/legal requirements
• Demonstrate proper documentation of patient history and financial records using established record-taking techniques
• Create a professional, cooperative working environment to improve patient care

Promotion of Competency and Enhancement of Professional Practice

Participate in personal and professional development through continuing education, training, research and organizational affiliations:

• Participate in continuing education and/or provide such education for other health care providers, orthotic and prosthetic practitioners, pedorthists, assistants, fitters, technicians, and office staff (e.g., publications, seminars, case studies)
• Participate in education of residents, students and trainees
• Conduct or participate in product development research, clinical trials, and outcome studies
• Participate in the development, implementation, and monitoring of public policy regarding orthotics/prosthetics (e.g., provide testimony/information to legislative/ regulatory bodies, serve on professional committees and regulatory agencies)
• Participate in/with consumer organizations and nongovernmental organizations in order to promote competency and enhancement of orthotic/prosthetic profession