Cross-sectional survey of orthotic service provision in the UK: does where you live affect the service you receive?

Exploration of the representation of the allied health professions in senior leadership positions in the UK National Health Service

BACKGROUND

Allied health professionals (AHPs) are an important group within the National Health Service (NHS) in the UK and make up a large portion of the workforce. Investment in AHP leadership is believed to lead to improvements in patient care, resource use, collaboration and innovation. This study aims to assess the current state of AHP strategic leadership within the NHS.

METHODS

A freedom of information (FOI) request was sent to all NHS Trusts and health boards (HBs) within the UK NHS. The questions focused on the AHP workforce, with a particular interest in the chief AHPs (or equivalent roles) working in an NHS setting. Analysis of the FOI used a range of descriptive statistics.

RESULTS

Of the 217 Trusts/HBs contacted, responses were received from 160 (74%). The majority (81%) reported that they employed a Chief AHP or equivalent role, with only 14% of these having a position on the Trust/HB executive board. There were 50 different job titles reported as the titles for the chief AHP or equivalent roles: with director of AHPs (18.6%), lead AHP (13.9%) and chief AHP (11.6%) being the most reported titles. The results identified an inequity of representation of AHP professions within senior AHP leadership; with most of these roles (70%) held by physiotherapists and occupational therapists.

CONCLUSION

Changes in AHP strategic leadership are needed to address the inequities identified in this study. Addressing these issues is required to enable inclusive leadership, which is crucial to improve the contribution of AHPs to healthcare.

Orthotist involvement in early gait rehabilitation after stroke: A cross-sectional survey of orthotists in the United Kingdom

BACKGROUND

The role of the orthotist in early gait rehabilitation after stroke in the United Kingdom is currently poorly understood.

OBJECTIVES

The objective of this study was to capture current opinion and practice of orthotists on their role in early stroke gait rehabilitation in the United Kingdom.

METHODS

An anonymous web-based cross-sectional survey was developed and distributed to Health and Care Professions Council-registered orthotists by the mailing list of the British Association of Prosthetists and Orthotists professional body in the United Kingdom. Survey items were multiple-choice, Likert scale, or open-ended questions to explore the experiences and opinions of orthotists in early poststroke gait rehabilitation.

RESULTS

Responses were received from 56 participants. Orthotists reported having regular contact with patients who had a stroke within their usual clinical caseload. Multidisciplinary care was not typical with 46% respondents "rarely" seeing patients who had a stroke in joint assessment with another clinician. Confidence in managing lower limb gait difficulties was high, with 89% of orthotists feeling able to recommend a lower limb orthotic treatment. Ninety-eight percent (n = 55) of respondents agreed that orthotic assessment should be an essential element of gait re-education after stroke; however, orthotists reported limited involvement within early stroke rehabilitation.

CONCLUSION

UK orthotists surveyed in this study report that orthotic treatment is an important aspect of early gait rehabilitation after stroke. Respondents report barriers to multidisciplinary working, which may affect outcomes in this patient group.

The national profile of the prosthetic and orthotic workforce in the UK: Sociodemographics and employment characteristics

BACKGROUND

Prosthetists and orthotists (POs) are essential members of the health care workforce and one of the United Kingdom's (UK's) allied health professions. There is a paucity of information on their demographics, which is essential for the development of the profession. To fill this void, this study has attempted to comprehensively explore the sociodemographics and work-related characteristics of the entire workforce.

METHODS

Data were collected in 2022 through multiple sources, including surveys of POs, private companies employing POs, and freedom of information requests to National Health Service Trusts/Health Boards and higher education institutes offering programs leading to registration as a prosthetist/orthotist.

RESULTS

The workforce survey had 641 respondents (74% response rate). The estimated national ratio of POs per million population was 13, with all bar of the 12 regions below the World Health Organization minimum recommendation of 15 POs per million population. Most of the survey respondents were female (47.6%) and younger than male respondents, were British (75.8%), and in the White ethnic group (74.3%). Most of them were employed by private companies (59.9% vs. 31.4% employed by the National Health Service) and had clinical duties (94%), permanent contracts (90%), worked full-time (75%), and treated a wide range of clinical conditions.

CONCLUSIONS

The national UK prosthetist and orthotist ratio falls below the recommended international standards. The versatility and broad skill set of POs highlight their crucial role in multidisciplinary teams. Establishing a centralized prosthetist and orthotist workforce database system is recommended for data-driven strategic planning.

Objective Methods of Monitoring Usage of Orthotic Devices for the Extremities: A Systematic Review

Orthoses are commonly prescribed to relieve symptoms for musculoskeletal and neurological conditions; however, patients stop wearing orthoses as recommended for many reasons. When considering the effectiveness of orthoses, there needs to be an objective way to monitor whether participants wear the orthosis as instructed, because if this is not followed, the orthoses will not work as intended. This review aimed to identify, summarise, and compare objective methods used to measure compliance with orthoses applied to the extremities. Databases (Scopus, Web of Science, Embase, CINAHL, and MEDLINE) were searched for eligible studies. Twenty-three studies were accepted in the final review, including five studies that employed upper limb orthoses, two that employed hip orthoses, and fifteen that employed lower limb orthoses. To measure compliance objectively, studies utilised temperature sensors, pressure sensors, accelerometers, a step counter, or a combination of sensors. All sensor types have their own advantages and disadvantages and should be chosen based on study-specific parameters. Sensor-derived monitoring provides quantitative, objective data that are beneficial in both clinical and research settings. The ideal solution to monitoring compliance would consist of both objective and user-reported aspects that, in combination, would provide an all-encompassing picture of the orthotic treatment prescribed.

The challenge of service planning and development without adequate data: The case for orthotic services

The UK National Health Service (NHS) employs a group of 14 separate allied health professions. Prosthetics and orthotics are the smallest of these professions. Although small, orthotics is integral to many clinical care pathways and has shown to provide an essential impact on a range of clinical conditions in the health service priority lists. Previous reports acknowledged the lack of data on the UK prosthetic and orthotic workforce, appointment outcomes and cost and the service users accessing such services and thus the challenges that it poses for effective service delivery. There is still a paucity of relevant data or initiatives to support the service provision. The work within this paper has taken the first step to address this gap, presenting a summary of the information relating to appointments and costs, and provides a discussion on the implications of variations across the NHS orthotic services within England in terms of spend, staffing and skill mix for orthotic services and service users and the need for further data on service users and the UK prosthetic and orthotic workforce.

The emergence of telehealth in orthotic services across the United Kingdom

COVID-19 has impacted the National Health Service provision, creating urgency for departments to adapt and adopt new ways of delivering healthcare. The purpose of this service evaluation was to determine the emergence of telehealth in orthotic services across the UK in response to COVID-19. A survey exploring telehealth use was distributed online to orthotists approximately 6 months after the first peak of COVID-19 in the UK. It gathered information on telehealth prevalence, allocated appointment length and waiting times, clinician access to technology and clinicians' opinions on the efficacy of telehealth. The survey received 77 responses with over 90% of respondents reporting using telehealth. Most reported that they expected telehealth to remain part of the service, post COVID-19. Thematic analysis produced two main themes: the impact of COVID-19 and challenges still to overcome. Findings suggest that the pandemic has resulted in a backlog of patients waiting for an orthotic appointment, with services currently understaffed and lacking resources. For telehealth to be effective orthotists must have access to appropriate technology and training on how to use telehealth platforms, be provided with appropriate guidance on which patients are appropriate for telehealth consultations and given appropriate appointment times to enable safe and effective care.