Contents
- Acknowledgements
- Executive Summary
- Introduction
- Practice Analysis Methodology
- Summary and Conclusion
- Appendix A - Practice Analysis Task Force Committee
- Appendix B - New Test Specifications
- Appendix C - Linkage Between Tasks and Knowledge
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Practice Analysis of ABC Certified Therapeutic Shoe Fitters
October 2021
Appendix B - New Test Specifications
Domains and Task Statements
| Domain 1 -- Patient Assessment 30% |
|---|
| 1. Review patient’s prescription/referral |
| 2. Take patient history (e.g., previous orthotic treatment, medical history, physical limitations, activity levels) |
| 3. Perform a diagnosis-specific clinical examination (e.g., anatomy, disease process, signs and symptoms, deformities, skin integrity, protective sensation) |
| 4. Refer patient, if appropriate, to other healthcare professionals (e.g., physician, certified orthotist, certified pedorthist) for intervention beyond the Certified Fitter of Therapeutic Shoes scope of practice |
| 5. Document assessment using established record-keeping techniques |
Domain 2 -- Formulation of the Treatment Plan 19% |
| 1. Evaluate assessment findings to determine a treatment plan |
| 2. Communicate to patient and/or caregiver about the recommended treatment, goals, and anticipated outcome(s) |
| 3. Identify appropriate shoe based on patient evaluation and prescription (e.g., last, closure, toe box, style) |
| 4. Identify appropriate insert based on patient evaluation and prescription (e.g., materials, coverings) |
Domain 3 -- Implementation of the Treatment Plan 23% |
| 1. Communicate with patient and/or caregiver regarding potential risks/benefits, financial obligations, and time involved in providing therapeutic shoes/inserts |
| 2. Select appropriate shoe based on patient assessment and prescription (e.g., last, closure, toe box, style) |
| 3. Select appropriate insert based on patient assessment and prescription (e.g., materials, coverings, adjustability) |
| 4. Take required measurements for therapeutic shoes and inserts |
| 5. Fit therapeutic shoes/heat mold inserts and assess fit and function (e.g., adjust fit of shoes as needed, modify insert as needed) |
| 6. Determine patient’s ability to properly don, doff, and fasten shoes |
| 7. Educate patient and/or caregiver about the use of and maintenance of the therapeutic shoes and inserts (e.g., wearing schedules, hygiene, foot inspection, risk precautions, manufacturer’s warranty) |
| 8. Verify that therapeutic shoes and inserts are delivered as prescribed |
| 9. Document treatment using established record-keeping techniques |
Domain 4 -- Follow-up Treatment Plan 13% |
|---|
| 1. Obtain feedback from patient and/or caregiver regarding comfort, satisfaction, and achievement of goals concerning the therapeutic shoes and inserts |
| 2. Re-assess fit and function of therapeutic shoes and inserts |
| 3. Assess tolerance, compliance with wear schedule, ability to don/doff/fasten, and proper use of therapeutic shoes and inserts |
| 4. Re-assess patient’s skin integrity |
| 5. Make adjustments to therapeutic shoe/insert based on assessment of patient’s current status |
| 6. Review usage, wear schedule, and risk precautions with patient and/or caregiver |
| 7. Develop and communicate with the patient and/or caregiver the long-term follow-up plan |
| 8. Document follow-up using established record-keeping techniques |
Domain 5 -- Practice Management 15% |
| 1. Comply with all applicable federal, state, and local laws and regulations (e.g., CMS, HIPAA, FDA, ADA, OSHA) |
| 2. Adhere to professional and ethical guidelines per accrediting organization (e.g., ABC Code of Professional Responsibility) |
| 3. Comply with established documentation requirements related to billing and claims development (e.g., Medicare and/or other third-party payer required documentation, ABC facility accreditation standards) |
| 4. Promote a safe and professional environment for patient care (e.g., universal precautions, ABC Facility Accreditation standards, CDC recommendations, discrete treatment area) |
Approved Knowledge and Skill Statements
| 1 | Basic anatomy and physiology of the foot and ankle, gait and their relation to proper shoe fitting |
| 2 | Anatomical landmarks related to the foot and ankle |
| 3 | Common foot pathologies |
| 4 | Pathophysiology of diabetes |
| 5 | Signs, symptoms, risk factors and complications associated with the diabetic foot |
| 6 | Basic medical terminology for communication and documentation |
| 7 | Interpreting prescription and referral documents |
| 8 | Physical and visual evaluation of the foot and ankle (e.g., skin integrity, sensation, deformities, ranges of motion, circulation) |
| 9 | Roles of other healthcare providers associated with the provision of shoes and inserts |
| 10 | Universal/Standard precautions |
| 11 | Interviewing techniques |
| 12 | Communicating with patients, caregivers and referral sources |
| 13 | When to refer patient to other healthcare providers or back to the prescribing physician |
| 14 | Therapeutic shoe eligibility criteria (e.g., Medicare Local Coverage Determination/policy articles requirements) |
| 15 | Appropriate shoe and insert selection for the diabetic foot |
| 16 | Foot measurement tools (e.g., Brannock device) |
| 17 | Shoe components and construction (e.g., toe box, heel counter, vamp, last, closures) |
| 18 | Common materials used in therapeutic shoes and inserts |
| 19 | Therapeutic shoe and insert fitting criteria |
| 20 | Weight-bearing assessment of therapeutic shoes and inserts |
| 21 | Ambulatory assessment of therapeutic shoes and inserts |
| 22 | Tools to facilitate fit of therapeutic shoes and inserts (e.g., heat gun, low temperature oven, shoe stretcher) |
| 23 | Modification of the fit of the shoes and/or inserts (e.g., scaphoid pad, metatarsal pad, tongue pad, lacing techniques) |
| 24 | Care and maintenance of therapeutic shoes and inserts |
| 25 | Assessing patient’s ability to don, doff and fasten shoes |
| 26 | Shoe and insert warranty and warranty limitations |
| 27 | Available patient education materials |
| 28 | Clinical documentation |
| 29 | Assessing patient’s and/or caregiver’s ability to comply with use and care instructions, (e.g., using interface when wearing shoes, checking skin for evidence of excessive pressure) |
| 30 | Material safety procedures and standards (e.g., OSHA, SDS) |
| 31 | Scope of practice related to Certified Fitter of Therapeutic Shoes |
| 32 | Federal, state and third-party payer documentation requirements |
| 33 | Federal and state rules, regulations and guidelines |
| 34 | Protected healthcare and confidential information (e.g., HIPAA) |
| 35 | Professional ethical responsibilities (e.g., ABC Code of Professional Responsibility) |
