Numerous developements regarding Orthopaedic (Shoe) Technology takes place in the Netherlands and Belgium. A very close collaboration between FOntys, SVGB, KHKEmepen and NVOS-Orthobanda resulted in educational programs in Orthopaedic (Shoe) Technology.
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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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In the Netherlands and the Dutch speaking part of Belgium stakeholders in education and Shoe orthopaedics have formed a consotium platform. this pplatform "Forum Orthopaedic Programs (FOOT) is esthablished to reduce existing distance between cultures and backgrounds and provide a sound platform in exchanging and aggregating information. This article discussess the importance and objectives on this FOOT consortium, how it is formed and what the results are.
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Due to the ageing population, the prevalence of musculoskeletal disorders will continue to rise, as well as healthcare expenditure. To overcome these increasing expenditures, integration of orthopaedic care should be stimulated. The Primary Care Plus (PC+) intervention aimed to achieve this by facilitating collaboration between primary care and the hospital, in which specialised medical care is shifted to a primary care setting. The present study aims to evaluate the referral decision following orthopaedic care in PC+ and in particular to evaluate the influence of diagnostic tests on this decision. Therefore, retrospective monitoring data of patients visiting PC+ for orthopaedic care was used. Data was divided into two periods; P1 and P2. During P2, specialists in PC+ were able to request additional diagnostic tests (such as ultrasounds and MRIs). A total of 2,438 patients visiting PC+ for orthopaedic care were included in the analysis. The primary outcome was the referral decision following PC+ (back to the general practitioner (GP) or referral to outpatient hospital care). Independent variables were consultation- and patient-related predictors. To describe variations in the referral decision, logistic regression modelling was used. Results show that during P2, significantly more patients were referred back to their GP. Moreover, the multivariable analysis show a significant effect of patient age on the referral decision (OR 0.86, 95% CI = 0.81– 0.91) and a significant interaction was found between the treating specialist and the period (p = 0.015) and between patient’s diagnosis and the period (p < 0.001). Despite the significant impact of the possibility of requesting additional diagnostic tests in PC+, it is important to discuss the extent to which the availability of diagnostic tests fits within the vision of PC+. In addition, selecting appropriate profiles for specialists and patients for PC+ are necessary to further optimise the effectiveness and cost of care.
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This article discusses the importanceof fully integrated research activities into bachelor level programs in orthopeadic shoe technology. To work accoording evidence based principles and acquire the competences tot do so it is neseccary for students to engage in research activities from within the educational programe as soon as possible.
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Already for many centuries shoemaking exists as a craft. Orthopaedic shoemaking is a relative new profession that has emerged and evolved during the last century. Originated from the craft of shoemaking it has developed into a profession on the intersection between healthcare and technology. Important drivers were unity of language, developments in science and technology, but also developments in the relationship with society. Whereas in the past shoes were made for patients, today shoes are made with patients, driven by patients’ requirements. This development urges orthopaedic shoemaking to shift from shoe design to the design of mobility solutions, to adopt new ways of interdisciplinary cooperation and to innovate the manufacturing process. This offers many opportunities for research.
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The Forum Orthopaedic Educational Programs from the Netherlands and Belgium (Flanders)took the initiative to promote the developement of international standards for education and training in the field of orthopaedic shoe technology.
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Abstract 1 Im Laufe der Jahre haben die Orthopädieschuhmacher ihr Handwerk als eine Spezialisierung der traditionellen Schuhmacherei entwickelt. Im Gegensatz zu regulären Schuhmachern, die Schuhe für gesunde Füße machen, helfen Orthopädieschuhmacher Menschen mit Fußproblemen, welche ihre Mobilität behindern. Die Orthopädie-schuhmacher tun dies durch die Anpassung oder Änderung von Schuhen, je nach Schwere des Mangels des Fußes, in einem Bereich von einfachen Modifikationen der Standard-Schuhen bis zu vollständig maßgeschneiderten Schuhlösungen. In der Vergangenheit wurden die Orthopädieschuhmacher im Rahmen einer Lehre in der Berufspraxis ausgebildet. Auf diese Weise wurden berufliche Kenntnisse, Fähigkeiten und Fertigkeiten des Schuhmachermeisters an die Lehrlinge/Gesellen von Generation zu Generation übertragen. Diese Basiskenntnis wurde übertragen wie eine Katalog an Erfahrungswissen, zusammen gestellt aus: 1) Wissen über bekannte Probleme und 2) die dazu gehörige Lösungen. Weiterhin wurden 3) die Kenntnisse, Fähigkeiten und Erfahrungswissen formuliert und als prozedurales Wissen gelehrt, um effektive Lösungen zu entwickeln. Folge war, dass verschiedene Schuhmacher-Gruppen verschiedene Lösungen für die gleichen Probleme entwickelten, wofür jede "empirische Gültigkeit“ beanspruchte. Diese Kenntnisbasis von Orthopädieschuhmachern kann man charakterisieren als: Herstellung orientiert an impliziten, durch Tradition bestimmten Lösungsentwürfen. Da die empirischen Lösungen der Nachfrage entsprachen, waren die Begründung der Lösung und der methodische Entwurf der Orthopädieschuhe keine explizit geforderte Aktivität. Vor kurzem wurde in den Niederlanden diese traditionsbestimmte Kenntnisbasis der Orthopädieschuhmacher durch die Krankenkassen in Frage gestellt, da die Kassen wissen wollten, ob und warum ein Lösungsvorschlag wirksam wäre. Erfolgt diese Begründung nicht, wird nur die preiswerteste Lösung zurückerstattet. Die Kassen stellten die Begründungsfrage und forderten also eine akzeptable wissenschaftliche Erklärung für die Lösung des Mobilitätsproblems. Diese Erklärung ist im Prinzip erreichbar, als zum Beispiel innovative Imaging-und Messmethoden zur Verfügung stehen. Es gab großen Widerstand in den Reaktionen auf die Aufforderung, traditionelles Wissen wissenschaftlich zu begründen. Es gab abwehrende (in Zusammenhang mit den Kosten) aber auch pro-aktive / innovative Reaktionen. Fontys University of Applied Sciences nahm die innovative Perspektive und identifizierte Möglichkeiten um das Orthopädieschuhmacher-Handwerk qualitativ aufzuwerten zu einem modernen, mehr professionellen und mit wissenschaftlichen Einsichten unterstützten Beruf. Aus dieser Perspektive hat Fontys einen neuen Lehrplan gestaltet und die Schlüsselperspektiven: 1) Begründung und 2) methodischer Entwurf inkorporiert. Der Lehrplan wird die vorläufigen IVO Kriterien für eine Cat-II Akkreditierung erfüllen. Derzeit wird die Gestaltung von Lehrplänen in Vietnam als Teil der internationalen Kooperationsprojekte pilotiert. Keywords: Vom Handwerk zur Profession, Wissensarten, Methodischer Entwurf Abstract 2 Over the years, orthopaedic shoemakers developed their craft as specialisation of traditional shoemaking. In contrast of shoemakers who make shoes for the healthy feet, the orthopaedic shoemakers assist people with foot related problems causing mobility disabilities. They do this by adapting and modifying shoes in a range from simple modifications of standard shoes to complete bespoke shoe solutions depending on the severity of the deficiency of the foot. In the past, orthopaedic shoemakers were trained in a craft-apprenticeship model which was used to transfer the professional knowledge of the master shoemaker to the apprentice, from generation to generation. This transferred knowledgebase can be perceived as an catalogue of empirical knowledge consisting of 1) knowledge of known problems and 2) associate solutions (know –how). In addition, 3) the knowledge, skills, tricks and traps, formulated in procedural knowledge (do this-do that) was taught to produce the solutions. Consequently, different groups of shoemakers had different solutions for the same issues and each claimed empirical success. This orthopaedic shoemakers knowledgebase can be characterised as manufacture driven with implicit tradition based designs. As the traditional empirical solutions met the demand, explanatory knowledge and explicit methodological shoe design were no issues. In the Netherlands, recently the knowledgebase -know how- of the orthopaedic shoemakers was challenged as the insurance companies wanted to know whether and why a proposed solution is effective. If not, the cheapest solution was refunded. They requested an acceptable scientific explanation – know why- which in principle became achievable as innovative imaging- and measurement methods became available. As a result, the orthopaedic shoe branch was challenged when their mode 2 knowledge was questioned. The reactions were contrasting, from reactive(follow the money) to pro active/innovative. Fontys University of Applied Sciences took an innovative perspective and perceived possibilities to upgraded the craft of orthopaedic shoemakers into a modern, more academic, profession. Therefore, Fontys designed a new curriculum and added the key characteristic: 1) explanatory knowledge (mode 1 knowledge) and 2) methodical design. The curriculum is set up to meet the provisional IVO guidelines for a cat-II accreditation. At present, the curriculum design is piloted in Vietnam as part of international cooperation project. Keywords: from craft to profession, types of knowledge, methodical design
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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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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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