Practice Analysis of ABC Certified Assistants in the Disciplines of Orthotics and Prosthetics

 

As shown in Table 3, across all six COA panelists, the majority of work time was focused on the lower extremity practice area, averaging 44% of their time. This was followed by spinal work at 20%, while upper extremity and cranial each accounted for approximately 13% and 12%, respectively. Scoliosis made up a smaller portion at 7%, and other practice areas comprised the remaining 3%. Overall, lower extremity care represented the primary area of focus among COA panelists.

Table 3

Percentage of Work Time Spent by COAs in Each Practice Area

	N Panelists	Average
Lower Extremity	6	44%
Spinal	6	20%
Scoliosis	6	7%
Upper Extremity	6	13%
Cranial	6	12%
Other	6	3%
Total	6	100%

Note: Panelists rated the areas using the following question: Overall, what percentage of orthotic assistant work time did you spend performing the tasks related to each practice area during the past year? Enter a whole number between 0 to 100. The total must equal 100.

Orthotic Practice Areas and Devices

The COA panel reviewed various devices within each practice area and rated how frequently they had used each one over the past 12 months, using a scale from 0 (Never) to 4 (Daily). As shown in Table 4, the COA devices used most frequently—on at least a weekly to daily basis (ratings of 3 or higher)—included the Ankle-Foot Orthosis (AFO), Knee Orthosis (KO), Lumbosacral Orthosis (LSO), Thoracolumbosacral Orthosis (TLSO), Cervical Orthosis (CO), Wrist-Hand Orthosis (WHO), and Cranial Remolding Orthosis.

Table 4

Frequency of Device Use by COAs Across Practice Areas

	Average
Lower Extremity	44%
Shoes	2.67%
Foot Orthosis (FO)	2.33%
Ankle-Foot Orthosis (AFO)	3.5%
Knee Orthosis (KO)	3.5%
Knee-Ankle-Foot Orthosis (KAFO)	1.83%
Hip Orthosis (HO)	2.33%
Hip-Knee-Ankle-Foot Orthosis (HKAFO)	1.0%
Other	0.67%
Spinal	20%
Lumbosacral Orthosis (LSO)	3.5%
Thoracolumbosacral Orthosis (TLSO)	3.0%
Thoracolumbar Orthosis (TLO)	1.33%
Cervicothoracic Orthosis (CTO)	1.5%
Cervical Orthosis (CO)	3.17%
Other	0.67%
Scoliosis	7%
Lumbosacral Orthosis (LSO)	1.17%
Thoracolumbosacral Orthosis (TLSO)	2.33%
Cervicothoracolumbosacral Orthosis (CTLSO)	0.5%
Upper Extremity	16.0%
Hand Orthosis (HO)	1.83%
Wrist-Hand Orthosis (WHO)	3.0%
Wrist Orthosis (WO)	2.17%
Elbow-Wrist-Hand Orthosis (EWHO)	1.5%
Elbow Orthosis (EO)	2.17%
Shoulder-Elbow-Wrist-Hand Orthosis (SEWHO)	1.17%
Shoulder Orthosis (SO)	2.17%
Other	0.5%
Cranial	16.0%
Cranial Remolding Orthosis	3.0%
Protective Helmet	2.67

Note: Panelists rated the devices using the following question: In the past 12 months, how often did you use each device?  0 = Never | 1 = Rarely (quarterly or less) | 2 = Occasionally (monthly) | 3 = Often (weekly) | 4 = Daily

 

Prosthetic Practice Areas and Devices

Respondents answering from the perspective of prosthetic assistants were likewise asked the percentage of time they spent performing tasks associated with each prosthetic practice area. In addition, they were asked to provide detailed percentage of time distributions for the prosthetic practice areas in which they worked.

Table 22

Percentage of Prosthetic Assistant Work Time in Practice Areas

Transtibial	52.8%
Transfemoral	26.3%
Transradial	9.3%
Transhumeral	5.0%
Symes	6.6%

Details of the practice areas and the time spent on various devices are presented below.

Table 23

Prosthetic Assistant Percent of Time with Regard to Prostheses, Sockets, Control Schemes and Suspension Mechanisms

Transtibial	52.8%
Sockets
Patella tendon bearing	8.3%
Total surface bearing (no locking mechanism employed)	7.0%
Suspension Mechanisms
Roll-on liner with lock	17.5%
Roll-on liner with valve	5.5%
Sleeve	6.0%
Vacuum	6.7%
Supracondylar	1.8%
Transfemoral	26.3%
Sockets
Quadrilateral	0.8%
Ischial containment	7.4%
M.A.S. design	0.9%
Control Schemes
Fluid control	0.8%
Microprocessor	3.4%
Mechanical	2.6%
Suspension Mechanisms
Roll-on with locking mechanism	4.9%
Vacuum-assisted	1.1%
Traditional suction with expulsion valve	3.8%
Hip joint/pelvic band/waist belt	0.6%
Transradial	9.3%
Control Schemes
Myoelectric	2.4%
Body-powered	2.7%
Passive	0.4%
Suspension Mechanisms
Self	0.3%
Roll-on	0.8%
Suction	0.7%
Harness	2.0%
Transhumeral	5.0%
Control Schemes
Myoelectric	1.2%
Body-powered	1.4%
Hybrid	0.2%
Passive	0.3%
Suspension Mechanisms
Roll-on	0.3%
Suction	0.3%
Harness	0.3%
Symes	6.6%
Sockets
Patella tendon bearing	1.4%
End bearing	1.3%
Medial opening	1.7%
Posterior opening	0.5%
Expandable wall	0.7%
Suspension Mechanisms
Silicone liner with expulsion valve	0.6%
Suspension pad	0.4%

Prosthetic assistants were asked to indicate which of seven specific activities they perform in each practice area. Similar to the orthotic assistants, it is likely that respondents were participating in these activities under supervision, rather than performing them independently.

Table 24

Percentage of Prosthetic Respondents Performing Activity for Prosthetic Devices

	Participate in initial patient evaluation	Measure/ mold	Rectify model/ delineation	Fabricate	Initial fit/ align	Delivery	Perform follow-up
Transtibial	85%	73%	72%	82%	88%	83%	90%
Transfemoral	82%	67%	60%	78%	83%	71%	82%
Transradial	39%	37%	33%	55%	57%	45%	44%
Transhumeral	35%	32%	24%	48%	44%	29%	40%
Symes	59%	45%	44%	70%	62%	55%	71%