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Orthotics and Prosthetics Workforce Planning
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An Evidence Check rapid review brokered by the Sax Institute for NSW Health Health Workforce. Planning and Development,This report was prepared by. D Tivey A Scarfe J Duncan N Marlow A Cameron W Babidge. November 2015,Sax Institute 2015, This work is copyright It may be reproduced in whole or in part for study training purposes subject to. the inclusions of an acknowledgement of the source It may not be reproduced for commercial usage. or sale Reproduction for purposes other than those indicated above requires written permission from. the copyright owners, Enquiries regarding this report may be directed to the. Knowledge Exchange Program,Sax Institute,www saxinstitute org au. knowledge exchange saxinstitute org au,Phone 61 2 91889500.
Suggested Citation, D Tivey A Scarfe J Duncan N Marlow A Cameron W Babidge Orthotics and prosthetics workforce. planning an Evidence Check review brokered by the Sax Institute www saxinstitute org au for NSW Healtht. Disclaimer, This Evidence Check Review was produced using the Evidence Check methodology in response to. specific questions from the commissioning agency, It is not necessarily a comprehensive review of all literature relating to the topic area It was current at. the time of production but not necessarily at the time of publication It is reproduced for general. information and third parties rely upon it at their own risk. Orthotics and prosthetics,workforce planning,a rapid review. An Evidence Check rapid review brokered by the Sax Institute for NSW Health July 2015. This report was prepared by D Tivey A Scarfe J Duncan N Marlow A Cameron W Babidge. Abbreviations 8,1 Executive summary 10, Question 1 What is the evidence regarding the adequacy of the training pathway for OPs in NSW 10.
Question 2 What is the evidence regarding the factors that may determine the retention of the OP. workforce in NSW 11, Question 3 What is the evidence regarding how new technologies and a changing population. composition are shaping the future role and scope of practice of OPs in NSW 11. Question 4 What is the evidence regarding which OP models of care are currently in use and what drivers. may affect these models in the future What is the evidence regarding how the process of fabrication. currently enters the OP workflow and what drivers may affect it in the future 11. 2 Introduction 13,3 Review methodology 14,Evidence selection and appraisal 14. Evidence prioritisation and synthesis 14,4 Results 15. 1 Adequacy of the training pathway What is the evidence regarding the adequacy of the training. pathway for OPs in NSW 15,Evidence 15,Summary of evidence base 17. Gaps in the literature 18, 2 Retention in the workforce What is the evidence regarding the factors that may determine the.
retention of the OP workforce in NSW 18, Background and description of the NSW workforce 18. Retention in the OP workforce 18, Peer reviewed literature on retention of allied health workers 19. Summary of literature base 19,Gaps in literature 20. 3 Future role and scope of practice What is the evidence regarding how new technologies and a. changing population composition are shaping the future role and scope of practice of OPs in NSW 20. Evidence on how new technologies are shaping the future role of practice of OPs in NSW 20. Points reported in peer reviewed literature 20,Points reported in grey literature 21. Evidence on how a changing population composition is shaping the future scope of practice of OPs in. Points reported in peer reviewed literature 21,Points reported in grey literature 22.
Figure 1 Orthotic and Prosthetic allied healthcare interventions ACHI 7th edition AIHW 22. National Disability Insurance Scheme 23,Gaps in the literature 23. 4 Current model of care 23, What is the evidence regarding which OP models of care are currently in use and what drivers may affect. these models in the future 23, a What is the evidence regarding how the process of fabrication currently enters the OP workflow and. what drivers may affect it in the future 23, What is the current model of care for prosthetic provision in NSW 23. Figure 2 Model of care for prosthetic provision in NSW This care pathway was informed using resources. from EnableNSW50 53 24,Role of prosthetist 24, How does fabrication enter the prosthetists workflow 25.
Comparative models of care 25,Future changes challenges 26. Summary of the literature 27,Gaps in the literature 27. What is the current model of care for orthotic provision in NSW 28. How does fabrication enter the orthotists workflow 28. Comparative models of care 28,Future changes challenges 29. Summary of the literature 29,Gaps in the literature 30. 5 References 31,6 Appendices 38,Appendix 1 Research questions and scope 38.
Research question 1 What is the evidence regarding the adequacy of the training pathway for OPs in. Research question 2 What is the evidence regarding the factors that may determine the retention of the. OP workforce in NSW 38, Research question 3 What is the evidence regarding how new technologies and a changing population. composition are shaping the future role and scope of practice of OPs in NSW 38. Research question 4 What is the evidence regarding which OP models of care are currently in use and. what drivers may affect these models in the future 39. Research question 4a What is the evidence regarding how the process of fabrication currently enters the. OP workflow and what drivers may affect it in the future 39. Research question 5 What is the evidence regarding additional factors not outlined in questions 3 and. 4 that may affect the future of the OP workforce 40. Appendix 2 Methods 41,Peer reviewed literature searches 41. Table 1 MeSH terms and Text words optimised for PubMed searches 41. Table 2 Databases searched for peer reviewed literature 42. Targeted searches PubMed only 42,Internet searches 42. Table 3 Specific websites search to identify relevant grey literature 43. General databases 44, Table 4 Databases that index grey literature as searched on 9 July 2015 44. Study selection 44, Table 5 Inclusion and exclusion criteria for study selection 45.
Data extraction 45,Quality appraisal 45,Appendix 3 PRISMA diagram 46. Figure 3 PRIMSA diagram for the selection process for peer reviewed and grey literature related to OP. Workforce planning 46,Appendix 4 Quality appraisal tools 47. Table 6 Modified CASP checklist for appraisal of qualitative literature35 47. Table 7 Modified JBI NOTARI checklist for appraisal of narrative reviews79 49. Table 8 Tool used to appraise grey literature adapted from the JBI NOTARI tool and the AACODS. checklist 79 81 50, Appendix 5 Included studies and data extraction for Question 1 51. Table 9 Peer reviewed publications regarding the adequacy of the training pathway for OPs in NSW 51. Table 10 Grey literature regarding the adequacy of the training pathway for OPs in NSW 54. Table 11 Curriculum for Bachelor of Applied Science and Master of Clinical Prosthetics and Orthotics at. La Trobe University 58, Appendix 6 Included studies and data extraction for Question 2 60. Table 12 Grey literature used to describe the makeup of the OP workforce in NSW 60. Table 13 Peer reviewed publications used to inform on factors that may determine the retention of. allied health workers in Australia 63, Appendix 7 Included studies and data extraction for question 3 68.
Table 14 Peer reviewed publications regarding how new technologies and a changing population. composition are shaping the future role of OPs scope of practice of OPs in NSW 68. Table 15 Grey literature regarding how new technologies and a changing population composition are. shaping the future role and scope of practice of OPs in NSW 70. Summary of new skills and technologies in orthotic and prosthetic provision Table 14 and Table 15 72. Epidemiological data 73, Figure 4 Amputations for all states from Jul 2008 to May 2015 73. Figure 5 Per capita amputations all states from Jul 2010 to May 2015 excluding Tasmania 73. Table 16 NSW amputations by item from July 2010 to May 2015 MBS data 74. Table 17 Diabetes in Australia 2011 12 to 2012 13 AIHW 74. Table 18 Most commonly used O P diagnoses Principal Diagnoses ICD 10 AM AIHW 74. Figure 6 Orthotic and Prosthetic allied healthcare interventions ACHI 7th edition AIHW 75. Appendix 8 Included studies and data extraction for question 4 76. Prosthetics 76, Table 19 Peer reviewed publications used to inform the model of care for prosthetic provision in NSW76. Table 20 Grey literature used to inform the model of care for prosthetic provision in NSW 77. Table 21 K Classification for describing functional levels of prosthetic users 80. Table 22 Peer reviewed publications used to inform the model of care for prosthetic provision. internationally 80, Table 23 Grey literature used to inform the model of care for prosthetic provision in Victoria NZ the UK. and the USA 81,Orthotics 84, Table 24 Grey literature used to inform the model of care for orthoses provision in NSW 84. Table 25 Grey literature used to inform the model of care for orthotic provision in Victoria NZ and the. Abbreviations, AACODS Authority Accuracy Coverage Objectivity Date Significance.
ACC Accident Compensation Corporation, ACCC Australian Competition and Consumer Commission. AHN Area Health Network,AHPA Allied Health Professions Australia. AIHW Australian Institute of Health and Welfare,ALS Artificial Limb Service. AOPA Australian Orthotic Prosthetic Association Ltd. CAD Computer aided design,CASP Critical Appraisal Skills Programme. CNC Computer Numerical Controlled,CPD Continuing Professional Development.
DVA Department of Veterans Affairs,HARP Hospital Admission Risk Program. HECS Higher Education Contribution Scheme,HRF High risk foot. HRFS High risk foot services, IELTS International English Language Testing System. IT Information technology,MBS Medicare Benefits Schedule. MDT Multidisciplinary team,MeSH Medical Subject Headings.
NDIS National Disability Insurance Scheme, NOTARI Narrative Opinion and Text Assessment and Review Instrument. 8 ORTHOTICS AND PROSTHETICS WORKFORCE PLANNING SAX INSTITUTE. NSW New South Wales,NT Northern Territory,NZALS NZ Artificial Limb Service. OECD Organisation for Economic Co operation and Development. OP orthotist and or prosthetist,PPO Preferred Provider Organisation. PRISMA Preferred Reporting Items for Systematic Reviews and Meta Analyses. QLD Queensland,QOL Quality of Life,QUT Queensland University of Technology. SA South Australia,SOL Skilled Occupations List,SpOL Specialised occupation list.
STROBE Strengthening of Reporting in Observational studies in Epidemiology tool. SWEP State Wide Equipment Program,USC University of the Sunshine Coast. VALP Victorian Artificial Limb Program,VET Vocational education and training. VIC Victoria,WA Western Australia, 9 ORTHOTICS AND PROSTHETICS WORKFORCE PLANNING SAX INSTITUTE. 1 Executive summary, ASERNIP S was commissioned by the Sax Institute on behalf of the NSW Health. Workforce Planning and Development branch to provide evidence on five research. questions pertaining to workforce planning for orthotists and or prosthetists OPs. The scope of the questions was structured around understanding the role that OPs. and technical support staff play in the health system and whether the current model. of care for OP services is appropriate for current and future demands The OP. workforce has been identified has being a small but critical workforce for the. delivery of a high quality and comprehensive service for the provision of orthoses and. prostheses to NSW residents 1, Question 1 What is the evidence regarding the adequacy of the training pathway for OPs in NSW.
The Bachelor of Applied Science and Master of Clinical Prosthetics and Orthotics at La Trobe. University Melbourne Victoria is currently the solitary training program for OPs in Australia There. is a focus on clinical scope of work client assessment clinical decision making and evidence based. clinical practice throughout the course In 2016 the University of the Sunshine Coast Queensland. will offer a Bachelor of Health Science Prosthetics and Orthotics This course is yet to be. accredited by the Australian Orthotic Prosthetic Association Ltd AOPA. Technical skills can be learnt via a technician course offered by the Queensland Government No. accredited training courses are available in NSW and a lack of training for the technical workforce in. the future is anticipated, There are currently no minimum standards to practice as an OP in Australia. Recent work has considered implementing minimum Competency Standards for OPs at the point of. accreditation with AOPA Gaps in current competency were found to be a lack of emphasis on. evidence based and ethical practice with a client patient focus identification of scope of practice. and the need for continuing professional development and or mentoring to remain professionally. Evidence suggests distance education a clearly defined program and protected time for. participation could be used for improving access to continuing professional development. 10 ORTHOTICS AND PROSTHETICS WORKFORCE PLANNING SAX INSTITUTE. Question 2 What is the evidence regarding the factors that may determine the retention of the OP. workforce in NSW, No literature was identified to inform on retention strategies specific to OPs. Based on evidence of recruitment and retention of allied health workers in Australia key factors. that may influence OP retention include incorporation of mentorships and formal supervision. arrangements more communication between healthcare workers on the role of OPs in the. healthcare system strengthening career advancement and CPD opportunities targeted training and. recruitment to fill skills shortages, No peer reviewed literature was available describing workforce data and retention in NSW OPs The. AOPA has prepared a manuscript on the Australian OP workforce which is due to be published in. Question 3 What is the evidence regarding how new technologies and a changing population. composition are shaping the future role and scope of practice of OPs in NSW. New technologies will cause a shift in how fabrication enters OP practice from measure. manufacture and fit to the use of pre fabricated devices Traditional skills and devices may remain. best clinical practice for certain patient groups resulting in OPs having to retain a diverse skill set. Diabetic foot a High Risk Foot disorder is a leading cause of non traumatic lower extremity. amputation The evidence indicates prevalence of diabetes in Australia is rising which will lead to a. commensurate increase in demand for services provided by High Risk Foot HRF clinics. The National Disability Insurance Scheme NDIS being rolled out across NSW in 2018 will provide. more access to orthotic and prosthetic services, Question 4 What is the evidence regarding which OP models of care are currently in use and what. drivers may affect these models in the future What is the evidence regarding how the process of. fabrication currently enters the OP workflow and what drivers may affect it in the future. Government funded prosthetics are available via EnableNSW for NSW residents who are Australian. citizens Prosthetists work as part of multidisciplinary teams in amputee clinics accredited by. EnableNSW to provide an interim limb as well as advice and patient training in use of the limb. Fabrication and customisation of prostheses forms a major component of the prosthetists. workflow The finishing of the interim limb to become the definitive limb may be performed by the. prosthetist contracted to the amputee clinic or by another prosthetist of the patient s choice. Future changes to the model of care may arise from an increase in obesity requiring more. advanced componentry a possible diminishing in the role of fabrication as experienced prosthetists. retire and increased use of pre fabricated prostheses client care becomes a bigger part of the. workflow the NDIS may increase demand and change funding arrangements for amputee care. 11 ORTHOTICS AND PROSTHETICS WORKFORCE PLANNING SAX INSTITUTE. Orthotic devices are available to patients in NSW who are referred to a hospital for treatment or. who elect to see an orthotist privately some of the cost may be reimbursed by private health. insurance Fabrication of orthotics is a major component of the OPs workflow. Future changes to the model of care may arise if the revised Medicare Benefits Schedule MBS. includes a new item number for reimbursement under Chronic Disease Management arrangements. and if greater private health insurance reimbursements for orthotic services are introduced An. increase in high risk foot clinics and partial foot amputations may also impact on the mode of care. Reports from the UK suggest that improved access to orthotics can reduce overall healthcare costs. 12 ORTHOTICS AND PROSTHETICS WORKFORCE PLANNING SAX INSTITUTE. 2 Introduction, ASERNIP S a was commissioned by the Sax Institute on behalf of the NSW Health Workforce Planning and.
Development Branch to review questions related to orthotist and or prosthetist OP workforce planning. The scope of the questions was structured around understanding the role that OPs and technical support. staff play in the health system OPs are involved in client care as well as device manufacture and. customisation Technical staff provide support for OPs through device fabrication The OP workforce has. been identified has being a small but critical workforce for the delivery of high quality comprehensive. healthcare to the population of NSW 1 Such workforces are defined as those that supply critical and. essential healthcare services and they are experiencing threats to meeting both current and future needs. In response to this threat the NSW Health Professionals Workforce Plan Taskforce identified that more of. the same is no longer the answer 1 to workforce planning The Taskforce went on to highlight the need to. have the the right people with the right skills in the right place However to achieve this for OP there is a. need to ensure,The workforce is maintained, The profession is attractive and provides fulfilling careers to those already in the workforce as well. as those entering the workforce, OPs are appropriately trained and maintain their currency of required skills. The number of OPs is appropriate to meet the system s needs. Failure in any one of these elements could have negative effects on delivery of OP services in NSW. Key areas of interest were identified in terms of OP workforce planning in NSW These included training. decisions regarding the allocation of educational resources such as scholarships placements and mentors. as well as understanding the role that OPs play in the health system and whether the current model of care. for OP services is appropriate for current and future demands. Based on these key areas the following research questions were investigated for this Evidence Check. 1 What is the evidence regarding the adequacy of the training pathway for OPs in NSW. 2 What is the evidence regarding the factors that may determine the retention of the OP workforce in. 3 What is the evidence regarding how new technologies and a changing population composition are. shaping the future role and scope of practice of OPs in NSW. 4 What is the evidence regarding which OP models of care are currently in use and what drivers may. affect these models in the future, a What is the evidence regarding how the process of fabrication currently enters the OP. workflow and what drivers may affect it in the future. The scope of each question is detailed in Appendix 1. Australian Safety and Efficacy Register of New Interventional Procedures Surgical Royal Australasian College of Surgeons. 13 ORTHOTICS AND PROSTHETICS WORKFORCE PLANNING SAX INSTITUTE. 3 Review methodology, This review was conducted in accordance with the Sax Institute s methodology for Evidence Checks. Two search strategies were developed one to search databases for peer reviewed literature the other to. identify relevant grey literature Search terms and strategy were translated from both the research questions. and scope provided by NSW Health Table 1 Appendix 2 Search terms included items for orthotists and. prosthetists workforce and training These terms were used to search the listed range of relevant databases. for peer reviewed literature Table 2 Appendix 2 Grey literature searches for relevant reports submissions. training course details and reviews were conducted using the Google Advanced search utility to target. relevant websites Table 3 Appendix 2, Detailed descriptions of methods including search terms search strategy databases and relevant websites.
are listed in Appendix 2,Evidence selection and appraisal. Evidence selection was conducted by a single reviewer Selections were double checked by a second. reviewer Any disagreement was discussed and if a consensus could not be achieved the selection was. referred to a third reviewer Quality appraisal of evidence was subject to the same review process. Evidence prioritisation and synthesis, For research questions 1 3 and 4 the evidence was prioritised by jurisdiction with studies specific to NSW. having the highest priority for inclusion If the research question could not be answered comprehensively. using data from NSW or in the absence of data inclusion was broadened to include evidence from. Australia and New Zealand If there was still insufficient evidence then the inclusion was broadened to. include relevant literature from international sources prioritising literature from Organisation for Economic. Co operation and Development OECD countries with a similar socioeconomic profile to Australia. For research question 2 if no relevant literature was found from Australia and New Zealand specific to. retention of OPs literature relevant to other allied health professions was included A jurisdiction specific. prioritisation was also employed, Results from the included articles are tabulated in Appendices 5 9 of this report. ORTHOTICS AND PROSTHETICS WORKFORCE PLANNING SAX INSTITUTE 14. 1 Adequacy of the training pathway, What is the evidence regarding the adequacy of the training pathway for OPs in NSW. A further description of the included studies and relevant data used to inform the answer to this research. question is detailed in Table 9 and Table 10 of Appendix 5. Graduate training, The graduate training information is supported by grey literature including reports websites and personal.
communication Two peer reviewed articles determine factors that have increased OP training adequacy in. foreign countries, At present the Master of Clinical Prosthetics and Orthotics at La Trobe University Melbourne Victoria is the. solitary training program for OPs in Australia which is accredited locally by the Australian Orthotic Prosthetic. Association AOPA and internationally by the International Society for Prosthetics and Orthotics ISPO 1 A. Bachelor of Health Science Prosthetics and Orthotics is commencing in 2016 at the University of the. Sunshine Coast Queensland It is anticipated that 10 students will enrol in the course annually personal. communication University of Sunshine Coast and AOPA 2 This course is yet to be accredited by AOPA. The course outline of the Bachelor of Applied Science and Master of Clinical Prosthetics and Orthotics at La. Trobe University reveals a focus on clinical scope of work client assessment clinical decision making and. evidence based clinical practice throughout the course Table 11 Appendix 5 The course includes using. external staff members from across the industry to expose students to new technologies that enhance the. core foundation of clinical skills The Course Coordinator confirmed the course structure was designed to. provide graduates with the framework to understand and adopt future advancements in the field 3. Every year approximately 40 students graduate from the La Trobe course It is not known however how. many of those go on to work in NSW The AOPA acknowledges that there is a group of unemployed. graduates from this degree 4 Whether this speaks to the adequacy of training or a lack of employment. opportunities is not known, Published research on undergraduate OP students at the University of Jordan showed that a research based. clinical practice module helped students provide a higher standard of patient care in terms of diagnosing. prescribing and manufacturing prostheses Students also expressed increased interest in using evidence in. clinical decision making 5, A review in the USA reported on OP curriculums lack of uniform vision for the future no contemporary. curricular design and lack of texts designed for comprehensive overview to teach about evolving. fragmented and complex subject matter 6 It is critical that OP courses are improved as technology and. healthcare evolves 7 Wong et al 2007 reported training in developing critical thinking skills allows OPs to. improve their practice 8, 15 ORTHOTICS AND PROSTHETICS WORKFORCE PLANNING SAX INSTITUTE.


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