Practice Analysis of ABC Certified Therapeutic Shoe Fitters

October 2021

Practice Analysis Methodology

The practice analysis for the ABC Certified Fitter–therapeutic shoes (CFts) credential involved a methodical approach that included an expert panel review. A draft list of tasks and knowledge/skill statements was developed based on the current content outline and previous practice analysis. The draft task and knowledge/skill statements were reviewed by a panel of experts selected by ABC to serve as the Practice Analysis Task Force Committee. The purpose of the expert panel review was to obtain verification (or refutation) that the tasks and knowledge/skills identified are important to the work of certified therapeutic shoe fitter professionals.

Utilizing multiple experts to review and create the task and knowledge/skill statements functions as a check and balance on the judgments of the initial background research and reduces the likelihood that unimportant areas will be considered in the development of the test specifications. The use of multiple experts eliminates the chance that one expert’s input will influence the entire content outline.

The methodology used to conduct the practice analysis is described in detail below and included the following steps.

1. Drafting of the Domains and Task and Knowledge/Skill Statements

Prometric conducted an internal desk study to review the existing content outline, including the tasks and knowledge/skills finalized during the previous practice analysis. The purpose of a desk study is threefold: 1) to obtain descriptive information about job tasks and skills needed to complete job tasks, 2) to call attention to current research and trends in the industry and 3) to inform decisions about knowledge and task gaps on an assessment. Additional references were reviewed to identify changes in the profession since the last practice analysis and/or emerging trends. A final list of tasks and knowledge/skills were prepared for presentation to the expert panel, including additional findings for consideration.

2. Expert Panel Review and Validation

A pre-meeting document was sent to the Task Force containing information about the practice analysis and the best practices for developing domains and task and knowledge statements.

ABC and Prometric convened the expert panel in two virtual meetings on February 25 and 26, 2021. A complete list of the Task Force participants is provided in Appendix A. Prometric staff led the Task Force through the review, revision, development and validation of domains and task and knowledge/ skill statements.

The following domains were covered in the list of the task and knowledge/skill statements:

1	Patient Assessment
2	Formulation of Treatment Plan
3	Implementation of Treatment Plan
4	Follow-Up Treatment Plan
5	Practice Management

3. Development of the Test Specifications

The test specifications were developed as part of the February 25–26, 2021 Practice Analysis meetings, following the conclusion of discussions about the important task and knowledge/skill statements. Detailed edits to the previous test specifications are presented in Appendix B. The development of the test specifications included the approval of the final list of task and knowledge/ skill statements for each of the content areas and linking the knowledge statements to the task statements.

The linking exercise is not meant to be an exhaustive listing of the relationships between the tasks and knowledge/skills; instead, it is designed to provide evidence that the important knowledge and skills are related to the important tasks. The results of the linking exercise are presented in Appendix C.

Thirty tasks were identified by the Task Force Committee as important to competent performance of therapeutic shoe fitter professionals. Table 1 lists the tasks by domain.

Table 1: Approved Tasks


Domain 1 -- Patient Assessment Perform an assessment of the patient to obtain an understanding of patient’s prescribed needs
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 scope of practice for Certified Fitter--therapeutic shoes
5	Document assessment using established record-keeping techniques
Domain 2 -- Formulation of Treatment Plan Develop a specific treatment plan to meet the patient’s needs, goals, and expected outcomes
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 Treatment Plan Perform the necessary procedures to deliver the appropriate therapeutic shoes/inserts, including minor adjustments
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 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 Provide continuing patient care and periodic evaluation to assure/maintain/document optimal fit and function of therapeutic shoes/inserts
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 Comply with policies and procedures regarding the physical environment, business and financial practices, organizational management, and human resources
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)

Thirty-five knowledge and skill statements were identified by the Task Force Committee as important for CFts professionals to know or be able to do. Table 2 lists the knowledge and skills statements.

Table 2: Approved Knowledge and Skills



Knowledge of/Skill in:
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)

Table 3: Approved Practice Areas


1	Non-custom Diabetic Shoes
2	Non-custom Multi-density Diabetic Inserts

The expert panel’s next activity was to provide content weights for each of the domains. This was accomplished by having each of the participants give their individual estimates, entering those estimates into a spreadsheet and discussing the aggregated data. Table 4 below shows each domain, the percentage weights assigned and the total number of items as finalized by the Test Specifications Committee.

Table 4: Weighting Exercise Results

Domains		Percentage Weight	Number of Items
1	Patient Assessment	30%	25
2	Formulation of Treatment Plan	19%	16
3	Implementation of Treatment Plan	23%	20
4	Follow-Up Treatment Plan	13%	11
5	Practice Management	15%	13

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