Practice Analysis of Certified Practitioners in the Disciplines of Orthotics and Prosthetics

A practice analysis study is designed to obtain descriptive information about the tasks performed on a job and the knowledge and skills needed to adequately perform those tasks. The purpose of this practice analysis study was to:

• validate the tasks, knowledge, and skills important for the orthotist and/or prosthetist profession; and,
• develop test specifications for the O&P practitioner exams.

Conduct of the Practice Analysis Study

The practice analysis study consisted of several activities: background research, collaboration with subject matter experts to ensure representativeness of the tasks, knowledge, skills, and practice areas; survey development; survey dissemination; compilation and analysis of survey results; and test specifications development. The successful outcome of the practice analysis study depended on the excellent information provided by ABC certified practitioners actively working as orthotists and/or prosthetists.

Survey Development

Survey research is an effective way to identify the tasks, knowledge, and skills that are important for orthotists and prosthetists. The task, knowledge, and skill statements included on the survey covered six domains of practice. The development of the survey was based on a draft of task and knowledge statements developed from a variety of resources, but primarily on the previous practice analysis conducted in 2015.

Survey Content

The survey consisted of six sections: 
Section 1: Tasks
Section 2: Domains of Practice
Section 3: Knowledge and Skills
Section 4: Orthotic Practice Areas, Orthoses and Additional Questions
..................OR
..................Practice Areas, Devices and Additional Questions
Section 5: Work and Patient Characteristics
Section 6: Background & General Information

Survey Ratings

Participants were asked to rate each task statement by its importance for a newly certified orthotist’s and/or prosthetist’s job performance using a five-point scale (0 = Of no importance to 4 = Very important). Additionally, participants were asked how frequently they perform the task in their current role, on average, using a five-point scale (0 = Never/Not applicable to 4 = Very often). Participants were asked to rate each knowledge and skill statement by its importance for a newly certified orthotist’s and/or prosthetist’s job performance using a five-point scale (0 = Of no importance to 4 = Very important). 

Content Coverage

Evidence was provided for the comprehensiveness of the content coverage within the domains. If the task statements within a domain are adequately defined, then it should be judged as being well covered. Respondents indicated that the content within each task domain was well to very well covered, thus supporting the comprehensiveness of the defined domains.

Study Summary

In summary, this study used a multi-method approach to identify the tasks, knowledge, skills, and practice areas that are important to the work performed by O&P practitioners. The practice analysis process allowed for input from a representative group of orthotists and prosthetists and was conducted within the guidelines of professionally sound practice. ABC will use the results of the practice analysis to guide development of ABC’s examinations.  The list of tasks, knowledge, and skills that resulted from the study are intended to inform students in O&P and candidates for the exams regarding what they can expect in the profession, and what will be expected of them when they enter the profession. The study provides a snapshot of current practice, and results can also be used in other areas of the profession as a reference tool, such as to inform training activities, research priorities or materials development. Practice analysis is a critical tool for any profession and should be repeated at regular intervals to ensure that exam content and practices remain current.

2022 Survey Findings Highlights

Twenty-seven percent of the orthotic credentialed sample had one to five years of experience and 52% had 11 or more years of experience. Eighteen percent of the prosthetic credentialed sample had one to five years of experience and 62% had 11 or more years of experience. (See Table 2)

Forty-eight percent of the Certified Practitioners in orthotics and prosthetics earned a baccalaureate degree in O/P or a baccalaureate degree and an O/P post-graduate certificate to initially qualify for practice and 32% of the Certified Practitioners in orthotics and prosthetics earned a master’s degree in O/P to initially qualify for practice. (See Table 3 )

The largest percentage of patients of the orthotic credentialed sample present with conditions that reflect the chronic phase of care (42%), and the next most frequent phase was the rehabilitative phase of care (33%). In the prosthetic credentialed sample, the largest percentage of patients is in the rehabilitative phase of care (50%) and the second most are the chronic phase of care (37%). Both disciplines see the least number of patients in the acute phase of care (25% for orthotics, 18% for prosthetics). (See Table 16)

Regarding the etiology of the conditions, nearly two thirds of prosthetic patients (63%) present with disease, while less than half of orthotic patients (37%) do so. About one quarter of patients in each discipline present with trauma. A large difference was found regarding congenital etiologies; 42% of orthotic patients, but only 12% of prosthetic patients are in this category. (See Table 17 )

Less than half of all orthotic devices provided to patients are fabricated onsite (39%) with the remainder outsourced. Prosthetic devices are somewhat more likely to be fabricated onsite (61%). (See Table 19)

Certified Orthotists indicated that they spend the most time performing tasks associated with Patient Evaluation (24%), while Certified Prosthetists spent the most time in Implementation of the Treatment Plan (24%). Respondents from both disciplines spent the least amount of time performing tasks associated with Promotion of Professional Practice (about 7.5% regardless of discipline). (See Table 21 )

Certified Orthotists spend more than one half of their time (54%) performing tasks in connection with lower extremity orthoses. Of that time, they spend about 19% performing tasks in connection with AFOs, and somewhat less time performing tasks in connection with FOs (7%) and SMOs (6%). Certified Orthotists spend about 14% of their time performing tasks in connection with spinal orthoses, most typically with TLSOs / LSOs, semirigid (5%). Certified Orthotists spend 10% of their performing tasks in connection with scoliosis-related orthoses and 8% with upper extremity orthoses. Time spent in regard to scoliosis-related orthoses is most likely to be spent with TLSOs, and time spent in regard to upper extremity orthoses is most likely to be spent with WHOs. Certified Orthotists also spent about 13% of their time with cranial orthoses. (See Table 25 )

Certified Prosthetists spend more than half of their time performing tasks associated with transtibial prostheses (51%), with most prostheses typically incorporating a hybrid socket design and roll-on liner type suspension system. Certified Prosthetists spend more than one fourth of their work time performing tasks associated with transfemoral and knee disarticulation prostheses (26%), with most typically incorporating ischial containment sockets and roll-on liner with locking mechanism type suspension. Certified Prosthetists spend no more than a total of 4%, 2% and 4% of their time, respectively, in connection with transradial, transhumeral and Symes prostheses. (See Table 35 )