Orthotic Services


Enhancing Quality of Orthotic Services with Process and Outcome Information

Why is this study needed?


Orthotic device use is growing, yet quality measure development for orthotic services lags far behind other health specialties. Like other providers, orthotists are expected to implement evidence-based practice and are under increasing pressure to document the outcomes of interventions. While orthotists acknowledge the value of patient outcomes data, American Board for Certification in Prosthetics, Orthotics, and Pedorthics (ABC) leaders confirm the lack of consensus on quality measures and the standardized instruments that would be required to operationalize them.

How will this study help patients and rehabilitation stakeholders?


This project will lead to improvements in the quality of patient outcomes by providing orthotists and other clinicians with reliable and valid items and instruments that they can utilize to monitor and improve the quality of their services. This study extends our on-going work to develop outcome monitoring and reporting tools to measure and improve orthotic users’ outcomes. This study will operationalize ABC’s facility accreditation standards, which are designed to enhance quality healthcare delivery and are required for Medicare reimbursement. Once we define items and instruments for Ankle Foot Orthosis (AFO) users who experienced neurological disorders, including stroke or polytrauma, these items and instruments could be extended to other orthosis users and will provide information on quality of life, reintegration, and return to duty and work by patients who use an orthotic device due to limb impairment.

What are the project aims?


  • Identify issues that are important to the quality of care for AFO users as well as instruments that can be used to assess these quality issues.
  • Evaluate and validate patient-reported outcome instruments using performance instruments.
  • Specify items required for quality measure development and design data collection modules that can be used in quality improvement efforts and to demonstrate accountability of healthcare delivery.

How will the project aims be achieved?


  • This project will help us understand orthotists’ preferences, priorities, and barriers to using quality measures when providing care for AFO users by conducting focus groups and online surveys with certified orthotists.
  • We will consult with an Advisory Committee that represents key stakeholders and subject matter experts: consumer organizations, professional organizations, system-level O&P providers, orthotists, other healthcare providers, educators, rehabilitation engineers, epidemiologists, device manufacturers, and payers for additional guidance on valued outcomes for Certified Orthotists as well as performance and patient-reported outcomes that reflect these concepts of quality care.
  • We will administer advisory committee-selected patient-reported and performance measures to 100 AFO users at Shirley Ryan AbilityLab, Edward Hines Jr. Veterans Administrator Hospital, and Minneapolis Veterans Administration Health Care System to assess test-retest reliability, validate patient-reported functional status with performance measures, and assess feasibility of patient-reported and performance tests.

What agency funded the project?


The Department of Defense Orthotics and Prosthetics Outcomes Research Program (OPORP)

What is the duration of the project?


September 30, 2016 – September 29, 2019

Primary Project Staff


Principal Investigator:

Allen Heinemann, Ph.D., Shirley Ryan AbilityLab

Co – Investigators:

Anne Deutsch, PhD, RN, Shirley Ryan AbilityLab

Stefania Fatone, PhD, Northwestern University

Rodney Stuck, DPM, Edwards Hines Jr. Veterans Administration Hospital

Theresa Louise- Bender Paper, MD, Edward Hines Jr. Veterans Administration Hospital

Michelle Peterson, DPT, Minneapolis Veterans Administration Health Care System

Shirley Ryan AbilityLab Project Manager:

Erick Schuster



Contact Information:


For research and student:

Dr. Allen Heinemann


For members of the media:


For individuals interested in participating:

Erick Schuster



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