This article discusses the importance of fully integrating research activities into the Bachelor level programs (undergraduate programs) in orthopaedic engineering / prosthetics and orthotics. To work according to evidence based principles and acquire the competences to do so it is necessary for students to engage in research activities from within the educational programme as soon as possible. Involvement in research not only creates more insight in what research means and what the effects are, but also generates a number of cross links with the stakeholders involved in P&O education (see fig 1) which were not apparent before for the student. Also, the interaction with orthopaedic companies is stimulated in a broader context than is traditionally the case. A structure enhancing the interaction of educational institution, companies, research groups and institutions is presented which operates at the intersection of these stakeholders. A whole new world is therefore coming into range which will generate all kinds of new and unexplored opportunities.
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Abstract about the design and review of Bachelor level education in prosthetics and orthotics in the Netherland.
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A keynote address, introducing the pdca quality systeem into education in prosthetics and orthotcs.
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This paper explains the history of the graduate course in prosthetics and orthotics in the Netherlands. It also explains the schoolstystem in relationship towards vocational education and postgraduate education.
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Dissertatie met als onderwerp het ontwerp en evaluatie van de Hogere Beroepsopleidding Orthopedische Technologie in Nederland. In deze dissertatie wordt naast het ontwerp van de opleiding ingegaan op een vergelijking die is gemaakt met andere opleidingen op het gebied van hoger orthopedisch technologisch onderwijs in de wereld.
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In OE a more holistic approach in the design process is needed. This requires a shift of thinking from just the OD to overall goal setting: meeting the functional needs of the patients. This can only be achieved by upgrading the traditional orthopaedic engineering educational programs. Analysing the patient's problem, explicitly formulate OD requirements, the design, the manufacturing, tuning and evaluation must become seamlessly integrated parts of OE education.
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Ankle Foot Orthoses (AFOs) to promote walking ability are a common treatment in patients with neurological or muscular diseases. However, guidelines on the prescription of AFOs are currently based on a low level of evidence regarding their efficacy. Recent studies aiming to demonstrate the efficacy of wearing an AFO in respect to walking ability are not always conclusive. In this paper it is argued to recognize two levels of evidence related to the ICF levels. Activity level evidence expresses the gain in walking ability for the patient, while mechanical evidence expresses the correct functioning of the AFO. Used in combination for the purpose of evaluating the efficacy of orthotic treatment, a conjunct improvement at both levels reinforces the treatment algorithm that is used. Conversely, conflicting outcomes will challenge current treatment algorithms and the supposed working mechanism of the AFO. A treatment algorithm must use relevant information as an input, derived from measurements with a high precision. Its result will be a specific AFO that matches the patient's needs, specified by the mechanical characterization of the AFO footwear combination. It is concluded that research on the efficacy of AFOs should use parameters from two levels of evidence, to prove the efficacy of a treatment algorithm, i.e., how to prescribe a well-matched AFO.
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Dissertatie met als onderwerp het ontwerp en evaluatie van de Hogere Beroepsopleidding Orthopedische Technologie in Nederland. In deze dissertatie wordt naast het ontwerp van de opleiding ingegaan op een vergelijking die is gemaakt met andere opleidingen op het gebied van hoger orthopedisch technologisch onderwijs in de wereld.
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Assistive technology supports maintenance or improvement of an individual’s functioning and independence, though for people in need the access to assistive products is not always guaranteed. This paper presents a generic quality framework for assistive technology service delivery that can be used independent of the setting, context, legislative framework, or type of technology. Based on available literature and a series of discussions among the authors, a framework was developed. It consists of 7 general quality criteria and four indicators for each of these criteria. The criteria are: accessibility; competence; coordination; efficiency; flexibility; user centeredness, and infrastructure. This framework can be used at a micro level (processes around individual users), meso level (the service delivery scheme or programme) or at a macro level (the whole country). It aims to help identify in an easy way the main strengths and weaknesses of a system or process, and thus guide possible improvements. As a next step in the development of this quality framework the authors propose to organise a global consultancy process to obtain responses from stakeholders across the world and to plan a number of case studies in which the framework is applied to different service delivery systems and processes in different countries.
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Objective: The aim of this study was to obtain insight in specific elements influencing the use, non-use, satisfaction, and dissatisfaction of ankle foot orthoses (AFOs) and the presence of underexposed problems with respect to AFOs. Methods: A questionnaire was composed to obtain information from AFO users to investigate the variables associated with satisfaction and the relation between these variables. A specific feature of this study was the systematic analysis of the remarks made by the respondents about their AFO. Quantitative data analyses were used for analysing the satisfaction and qualitative analyses were used analysing the remarks of the respondents. A total of 211 users completed the questionnaire. Results: Our survey showed that 1 out of 15 AFOs were not used at all. About three quarters of the AFO users were satisfied and about one quarter was dissatisfied. Females and users living alone reported relatively high levels of dissatisfaction, especially in the field of dimensions, comfort, weight, safety and effectiveness. Dissatisfaction with respect to off-the-shelf AFOs for the item durability was higher than that for custom-made AFOs. In the delivery and maintenance process the items ‘maintenance’, ‘professionalism’ and ‘delivery follow-up’ were judged to be unsatisfactory. A large number of comments were made by the respondents to improve the device or process, mainly by the satisfied AFO users. These comments show that even satisfied users experience many problems and that a lot of problems of AFO users are ‘underexposed’. Conclusion: To improve user satisfaction, the user practice has to be identified as an important sub-process of the whole orthopaedic chain especially in the diagnosis and prescription, delivery tuning and maintenance, and evaluation phase.
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