Orthotists and prosthetists are constantly put in the position of making significant treatment decisions with scanty and imperfect information. We decry the lack of evidence for what is often posed as a question in a simple form: What is the best prosthetic foot? Which orthosis returns the most function for the patient?
When I taught prosthetics courses I would often find that I had to guard my answers to these simple questions posed by my students. I could neither give them the clear “book answer” that they desperately wanted, nor tell them it didn't matter. Instead, each question became an opportunity to get the future professionals to think about what they specifically needed to know to help the patient and then how to search out the best answer. I could explain what we do know about clinical effectiveness or biomechanical reasoning, and then how to apply that knowledge.
The truth is that there are multiple answers to these questions, because they are not as simple as we would think them to be. When we ask, “Which is the best foot?” we are implying that it is best at something in particular, or maybe that it is best by the sum of many measures. There is an assumption that such a basic, natural question must have already been answered, when in fact there is generally just supporting evidence for very specific findings.
At the JPO we help to distill and record what evidence there is. We will continue to consider adjusting the format and the content of the journal to help you in that process as best we can. In the end, though, the reader must digest the specifics and consider how the details might be applied to answering the myriad questions that clinical care will inevitably raise. Read on.
David A. Boone, CP, MPH, PhD
Journal of Prosthetics and Orthotics