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Where Should Our Focus Be? Part II
By Tom DiBello, CO, LPO, FAAOP  In my last editorial I defined a
problem--diminished reimbursement--which I argued was a symptom, in
the minds of insurance companies and employers, of our growing
irrelevance in the rehabilitation process. I also postulated that
orthotic and prosthetic care represents some of the most
cost-effective modalities used in rehabilitation today, and I gave
some examples. Since then, I have been asked how we can go about
changing this misconception in the minds of insurers and employers.
I will offer some suggestions as to how we might proceed.
Can We Validate What We Do?
Recently I had the pleasure of meeting Robert Wagenaar, PhD,
chairman, SAR Rehabilitation Sciences at Boston University. Dr.
Wagenaar has spent his career involved in the study of methods of
rehabilitation and determining their validity. I described our
situation and asked if it would be possible to effectively validate
the work we do. He responded that it was possible and is done
routinely, but that there is no shortcut to the development of
solid outcomes. The process would involve surveys, testing,
development of research protocols, and ultimately, randomized
control studies. In the short-term, some surveys could be done to
demonstrate the impact certain classes of devices had on the
recipient's quality of life. As a profession, we do not have
resources such as those Dr. Wagenaar describes. We must appreciate
this and go outside our field to obtain the expertise we need to
advance our position.
A Call to Action
As a profession, we must meet and agree that only through a
unified approach does a field as small as ours have any chance of
making an impact on this situation. This could take place in the
form of a meeting or consensus conference that would engender each
organization and entity to commit their respective resources to the
advancement of the consensus goal, both in terms of short-term
immediate action and long-term planning. We as a profession and as
a field--practitioner and manufacturer, salesman and engineer--must
realize that our salvation lies in our ability to validate what we
do. That requires a commitment to science and research. We must go
outside our field to find the expertise needed to achieve these
goals, and we must fund these studies. If the hundreds of thousands
of dollars spent fighting amongst ourselves over the years had been
directed toward this type of research, we would be far better off
today.
I challenge the leadership of our national organizations, major
manufacturers, and large and small facilities to begin the process
of examining this hypothesis and its validity. It is time to put
our differences aside and develop and execute a plan with
laser-point precision. Tom DiBello, CO, LO, FAAOP, is owner of Dynamic Orthotics and Prosthetics, Houston, Texas, and a past president of the American Academy of Orthotists & Prosthetists; tomd@dynamicoandp.com. 
Table Of Contents - June 2004
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