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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:
1Basic anatomy and physiology of the foot and ankle, gait and their relation to proper shoe fitting 
2Anatomical landmarks related to the foot and ankle
3    Common foot pathologies
4Pathophysiology of diabetes
5Signs, symptoms, risk factors and complications associated with the diabetic foot
6Basic 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
10Universal/Standard precautions
11  Interviewing techniques
12Communicating with patients, caregivers and referral sources
13When to refer patient to other healthcare providers or back to the prescribing physician
14Therapeutic shoe eligibility criteria (e.g., Medicare Local Coverage Determination/policy articles requirements)
15  Appropriate shoe and insert selection for the diabetic foot
16Foot measurement tools (e.g., Brannock device)
17 Shoe components and construction (e.g., toe box, heel counter, vamp, last, closures)
18Common materials used in therapeutic shoes and inserts
19Therapeutic shoe and insert fitting criteria
20Weight-bearing assessment of therapeutic shoes and inserts
21Ambulatory assessment of therapeutic shoes and inserts
22Tools to facilitate fit of therapeutic shoes and inserts (e.g., heat gun, low temperature oven, shoe stretcher)
23Modification of the fit of the shoes and/or inserts (e.g., scaphoid pad, metatarsal pad, tongue pad, lacing techniques)
24Care and maintenance of therapeutic shoes and inserts
25Assessing patient’s ability to don, doff and fasten shoes
26Shoe and insert warranty and warranty limitations
27Available patient education materials
28Clinical documentation
29Assessing 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)
30Material safety procedures and standards (e.g., OSHA, SDS)
31Scope of practice related to Certified Fitter of Therapeutic Shoes
32Federal, state and third-party payer documentation requirements
33Federal and state rules, regulations and guidelines
34Protected healthcare and confidential information (e.g., HIPAA)
35Professional 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 WeightNumber 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