We recently attended a premiere event, a seminar focused on Evidence-Based Practice put on by the American Academy of Orthotists and Prosthetists.
When treating amputees, the prosthetist is required by the paying agents to justify the prosthetic intervention. Our advertisement states that we provide comfortable, well-fi tting artifi cial limbs. Prosthetics is an art. We try always to achieve our objective and are usually successful; however, sometimes chronic pain associated with the residual limb prevents this. In some situations, further medical or surgical intervention may not be an option. In search of other possible remedies, we turned to science. What we found there was also not the answer to our concern, but it did point to a new role for prosthetists.
Assisting an individual with chronic pain from amputation takes considerable effort by a group of professionals willing to work collaboratively. With certain medications and alternate prosthetic approaches, most amputees’ conditions can be managed. Nevertheless, when we have spent considerable resources and the amputee is left with a “compromise” of sorts, it is disheartening to all concerned.
Dr. Ed Neumann, PhD, CP, PE, spoke about the foundation of Evidence-Based Practice (EBP). Dr. Neumann described the history of physicians and surgeons. The development of surgery had much to do with the results of war. In an attempt to save lives on the battlefield, surgeries were performed. On the other hand, physical medicine developed largely as a result of demand by affluent society who wished to receive treatments for their ailments. We know today that the two professions have merged and that society is better off for it. Fortunately today, in Canada, our national healthcare program enables all of us, not just the affl uent, to receive decent healthcare.
Prosthetists (who replace missing limbs) and orthotists (who brace existing limbs) likewise have two distinct heritages. Prosthetists got their beginnings as makers of armor, while orthotists evolved from the orthopaedic arena (orthos (straight), pais (child)), straightening the bones of children of the affluent. These two disciplines continue to grow in cooperation and in fact can cross disciplines, as, for example, a partial foot amputee.
The majority of speakers who presented at the EBP seminar held a Doctor of Philosophy degree. In Canada, particularly in western Canada, prosthetic and orthotic services are delivered by individuals who have matriculated in certain subjects, and who then obtain their experience in the fi eld. What became apparent during the seminar was that those who practice art and those who practice science must cooperate to deliver the best of care to amputees. Prosthetists need to know how to read and understand scientifi c material, and scientists need more and more to work with those in the front line of patient care. Prosthetists must begin to base the art of making prostheses on sound science for their decision-making. One branch of learning does not have more value than the other. It is good to see the philosophies of art and science moving in this direction.