Introduction The implementations of a structured consensus process can facilitate agreement among experts on varied and inconsistent clinical and educational practices. Recommendations exist for use of the Delphi consensus process in health care research. Most Delphi studies in orthotics and prosthetics research occurred after these recommendations were published, and it is unclear how closely these recommendations have been followed when applying this method. The aim of this review is to summarize the characteristics of Delphi processes in orthotics and prosthetics in order to guide future research. Materials and Methods A review was undertaken of published reports of Delphi processes used to research some aspect of the orthotics and prosthetics profession. Research methods were evaluated to identify and characterize features of the application of the Delphi process. These features were compared with the recommendations for Delphi processes in health care research. Results The application of the Delphi method in the 19 reviewed studies varied significantly in regards to topic, qualifications and number of experts, survey item creation, number of rounds, consensus requirements, outcomes, inclusion of a final conference, dropout rate, and final output. Although some studies closely followed the recommendations for the use of the Delphi method in health care, others deviated greatly. Conclusions Although the Delphi method is a common consensus process used in orthotics and prosthetics research, study methods vary and do not always follow recommended guidelines. Guidelines for future Delphi processes in orthotics and prosthetics research can be developed based on the data collected in this review. It is likely that there will be an increase in the number of Delphi studies conducted in this field in the future. Understanding the way this method has been implemented in previous studies can inform the design of future studies and may result in a more consistent application of this valuable research method.

Study Design This is a narrative review. Introduction Consensus techniques are an increasingly common research tool used to define levels of expert agreement on a topic where evidence is inconsistent or lacking. An assessment of commonly used consensus techniques can inform future education and research. Objective The aim of this study was to describe the use of various consensus techniques used in education and research in orthotics and prosthetics and closely related medical professions, to aid in choosing the most appropriate consensus technique for future research. Methods A systematic search of the literature was conducted using specific terms and keywords related to various consensus techniques, applications of consensus techniques in research and education, and medical disciplines related to orthotics and prosthetics. Studies were included if they described the use of a consensus technique for medical education or research and explained why the specific technique was used. Results Common consensus techniques were identified in the literature. To allow comparison of the techniques, the advantages, disadvantages, limitations, and previous applications of each were extracted from the literature. Conclusion Using the information from the literature, the most prevalent consensus techniques can be compared, aiding educators and researchers in choosing the technique most suitable for their topic of inquiry.

Introduction Good communication between doctors and patients is an important element of care, with benefits for both patients and doctors. However, research also suggests that there are numerous and common problems related to poor communication that adversely affect patient outcomes. Unfortunately, similar research does not exist in orthotics and prosthetics. Hence, we reviewed the literature regarding good communication between doctors and patients to identify potential benefits for orthotists and prosthetists that may motivate them to use good communication in their clinical practice. Methods A literature search was performed using PubMed, Ovid Medline, Cumulative Index of Nursing and Allied Health Literature, and Google Scholar, as well as hand searching the references of included articles. Articles were reviewed, and the benefits of good communication to the medical provider were identified and extracted. The medical benefits identified were then considered in the context of a typical orthotic/prosthetic encounter. Results A total of 71 articles were included in this review, yielding 17 benefits to medical practitioners of using good patient-practitioner communication. These benefits were then classified into five beneficial themes that potentially apply to orthotics and prosthetics clinical practice: lessens the risk of litigation, makes efficient and effective use of appointment time, improves patient outcomes, improves patient satisfaction and increases referrals, and improves practitioner job satisfaction. Conclusions Our review of the literature suggests that benefits exist to the medical provider of using good patient-practitioner communication that are likely relevant to orthotic and prosthetic practitioners.

We systematically investigate in-vivo the effect of increasing prosthetic knee flexion damping on key features of the swing phase of individuals with transfemoral amputation during walking. Five experienced prosthesis users walked using a prototype device in a motion capture laboratory. A range of interchangeable hydraulic rotary dampers was used to progressively modify swing phase flexion resistance in isolation. Toe clearance (TC; vertical distance toe to floor), effective leg length (ELL; distance hip to toe), and knee flexion angle during swing phase were computed, alongside the sensitivities of vertical toe position to angular displacements at the hip, knee and ankle. Key features of these profiles were compared across 5 damping conditions. With higher damping, knee extension occurred earlier in swing phase, promoting greater symmetry. However, with implications for toe catch, minimum TC reduced, and minimum TC and maximum ELL occurred earlier; temporally closer to mid-swing, when the limb must pass the stance limb. Further, TC became less sensitive to changes in hip flexion, suggesting a lesser ability to control toe clearance without employing proximal or contralateral compensations. There is a trade-off between key features related to gait safety when selecting an appropriate resistance for a mechanical prosthetic knee. In addition to highlighting broader implications surrounding swing phase damping selection for the optimization of mechanical knees, this work reveals design considerations that may be of utility in the formulation of control strategies for computerized devices.

IntroductionIntentional interruption of upper-limb and lower-limb coordination of able-bodied subjects alters their gait biomechanics. However, the effect of upper-limb loss (ULL) on lower-limb gait biomechanics is not fully understood. The aim of this secondary study was to perform a follow-up analysis of a previous dataset to characterize the spatiotemporal parameters and lower-limb kinematics and kinetics of gait for persons with ULL when wearing and not wearing an upper-limb prosthesis (ULP). We were particularly interested in quantifying the effects of matching the mass and inertia of the prosthetic limb to the sound limb.Materials and MethodsTen persons with unilateral ULL walked at a self-selected speed under three randomly presented conditions: 1) not wearing a prosthesis; 2) wearing their customary prosthesis; and 3) wearing a mock prosthesis that can be adjusted to match the length, mass, and inertial properties of each subject's sound limb. Walkway-embedded force plates and a 12-camera digital motion capture system recorded ground reaction forces (GRFs) and retroreflective marker position data, respectively. Average spatiotemporal (walking speed, cadence, stance time, swing time, step length, double support time), lower-limb kinematic (joint angles), and lower-limb kinetic (ground forces, joint moments and powers) data were processed, and their statistical significance values were analyzed.ResultWalking speed for each condition was nearly equivalent (1.20 ± 0.01 m/s), and differences between condition were nonsignificant (P = 0.769). The interaction effect (side × prosthesis) was significant for peak hip extension (P = 0.01) and second peak (propulsive) vertical GRF (P = 0.028), but separate follow-up analyses of both main effects were not significant (P ≥ 0.099). All other main effect comparisons were not significant (P ≥ 0.102).ConclusionsAlthough the sample cohort was small and heterogeneous, the results of this study suggest that persons with unilateral ULL did not display significant limb side asymmetry in lower-limb gait spatiotemporal, kinetic, and kinematic parameters, regardless of ULP use.