In this issue of JPO we have a guest editorial article by a CPO intent on asking the question of whether we can adapt a validated prosthetics outcome instrument for orthotics, and his own preliminary data indicates that there may be useful crossover of outcome metrics. This makes some sense to me, having been a part of the team of people that originally secured the funding and developed the Prosthesis Evaluation Questionnaire, or PEQ. The intent of the PEQ was really focused on real-world issues faced in mobility impairment and assistive device utilization, both equally important to the orthosis user as they are to the prosthesis user. I applaud the effort to this end; however, also having the history I do, I must reflect on the large amount of work, the careful human subjects design, and specialized statistics required to create a truly validated outcomes instrument for orthotics. Just look at the massive NIH Patient-Reported Outcome Measurement Information System projects currently under way! My hope is that this article in JPO will inspire building the body of work on orthotics outcomes as well.
Prosthetists and orthotists haven’t done a good job (there are exceptions!) of documenting and reporting patient outcomes because it is still actually harder to do than it seems. Clinicians are told that they could do simple clinical measures, like the Timed Up and Go test or a 6 minute walk test, to document patient outcomes, but it’s not that easy, because that is not the end of it. These are useful measures, as are others, and they can be done anywhere and they don’t need specialized equipment as promised, but they provide just a glimpse of the patient for a moment in time. Outcomes in O&P are dynamic. Results must be accurate and recorded, then collated, then analyzed and re-analyzed constantly. On top of that, there are really multiple salient viewpoints of outcomes that we must consider. Measuring outcomes in one domain or with a single modality is always going to be more limited than the complex reality of human function and satisfaction of our patients. Instead O&P outcomes measurement demands multiple measures of physical function, device function, and patient perception, tracked over time.
This is tremendously hard to do manually, but computerization and smart orthotic and prosthetic devices can potentially automate the process. People don’t generally track the performance of the car they use every day, but diagnostic computers on board do. My belief is that making the measurement and reporting of function an automated and integral part of assistive device operation is what is needed. Real-time access to outcomes information that actually helps you change your clinical decision-making will ultimately lead to the necessary dynamic flow of information required to unlock the promise of outcomes measurement in O&P. In other words, when O&P practitioners are eager consumers of useful outcomes information about their patients, and when they hardly have to lift a finger to be part of the data collection process, O&P outcomes measurement will finally be universal and done well.
David A. Boone, CP, MPH, PhD
Journal of Prosthetics and Orthotics