Prosthetist / Orthotist

A Prosthetist/Orthotist is a registered clinician. This unique occupation provides the opportunity to practice in two areas of healthcare. Most will specialise in Prosthetics or Orthotics; a small number continue in both. Prosthetists Provide gait (walking) analysis & engineering solutions to patients with limb(s) loss. They are trained in mechanics, bio-mechanics, & material science along with anatomy, physiology & pathophysiology. They are able to design, provide & modify prostheses that replicate the structural or functional characteristics of a patient’s absent limb(s). They provide care to patients with congenital (from birth) loss as well as loss due to conditions including diabetes, reduced vascularity, infection & trauma. Orthotists Provide gait (walking) analysis & engineering solutions to patients with problems of the neuro, muscular & skeletal systems. They apply mechanics, bio-mechanics, & material science along with anatomy, physiology & pathophysiology when assessing patients. They design & provide orthoses that modify the structural or functional characteristics of a patient’s neuro, muscular & skeletal systems enabling them to mobilise, eliminate gait deviations (improve walking), reduce falls, reduce pain, prevent & facilitate healing of ulcers & prevent physical deformities from progressing. They fit & modify Orthoses, an accountable and responsible for the impact of any changes. They provide care to patients with a wide range of conditions. Prosthetists / Orthotists manage their own patient caseloads, work across all age ranges & with a wide variety of conditions, often providing lifetime care. Whilst autonomous practitioner with leadership & management responsibilities they work as key part of a Multi-Disciplinary Team (MDT) to provide holistic care to patients & work collaboratively with members of the MDT through the provision of rehabilitation & long-term care. Prosthetists & Orthotists work for both the NHS & independent companies. Prosthetists/Orthotists demonstrate confidence, compassion, competency & effective judgement about risk & be responsible & accountable for their decisions. Prosthetist & Orthotists instruct and guide their technicians in the specification and manufacture of prostheses and orthoses. They also advise them in matters of patient interaction and care when the technicians are dealing directly with patients for example for repairs. They use current evidence to evaluate the effectiveness of their practice with the aim of continually improving outcomes for patients. They are responsible for ensuring their own knowledge & skills are current & support the development of others.

Day to Day Activities include:

Provide prosthetic/ Orthotic care to patients, most commonly within a hospital environment, working closely with medical staff, physio and occupational therapists
Assess & prescribe tailored orthoses &/or prostheses treatment; working in partnership with patients to tailor treatments to their needs & develop a treatment plan (which may be part of a wider MDT package of care)
Analyse patient’s needs & involve them in the design & choice of their devise, take measurements (including moulds) &/or use computer modelling to produce a design of the prostheses or orthoses suited to the patient
Provide and fit the orthoses & prostheses; educate the patient on how to manage and adjust their device to improve function further
Support patients to maximise their potential over the time of treatment – which could be life long
Carry out clinical follow-up checks with a patient to see how they are managing with their device & being able to spot ill-fitting/sub-optimal functioning & take appropriate action
Use research, evidence & clinical experience to develop professionally & improve outcomes for patients & the profession (Including participation in clinical audit)

Skills

Prosthetic/ Orthotic Care

Work with patients to analyse their needs & involve them in the design & choice of their device as appropriate
Analyse & critically evaluate the information collected
Analyse & compare normal & abnormal gait, locomotor function & movement using both qualitative & quantitative means
Select & use appropriate investigation & assessment techniques, completing an accurate clinical assessment
Develop & implement a treatment plan, adjusting & changing as required to meet the patient’s needs (including necessary practical skills)
Assess factors important to the relevant design, using appropriate techniques to capture body shape
Develop the model required to manufacture the device & modify/adjust the model where necessary
Prescribe orthotic or prosthetic intervention including, where necessary, the specification for manufacture
Undertake analyses where required for unapproved combinations or applications of components
Recognise when devices require rectification/repair & take appropriate action
Demonstrate a logical & systematic approach to problem solving using research reasoning to determine appropriate actions

Person Centred Care

Work in partnership with patients to assess their needs & exercise professional judgement, utilising the best research evidence available, clinical experience & patient aspiration
Work in partnership with patients to identify goals & agree appropriate treatment plans & that work is based on mutual respect & trust-always maintaining high standards of care
Apply a range of communication interventions & interpersonal skills to support patients receiving prosthetic/orthotic care
Recognise & take account of the wide range of needs a patient has including physical, psychological, social & cultural needs (recognising when to refer to other professionals)
Demonstrate clinical reasoning & the processes that underpin decision-making & problem solving
Recognise the value of case conferences & other methods of review

Governance & Safety

Receive, act on & make referrals (to others) as appropriate
Practice safely, according to available evidence & within competency level, maintaining fitness to practice
Work collaboratively in partnership with other professionals, patients & carers focussed on achieving agreed goals
Obtain informed consent for prosthetic/orthotic care
Safeguard patients, including vulnerable adults & children
Conduct risk assessment of the environment, patient & the device prescribed & supplied
Safeguard confidential information relating to patients at all times
Maintain records that are fit for purpose & process them accordingly
Manage & lead colleagues & staff as appropriate
Comply with local & national standards regarding reporting of medical device failures & incidents
Practice within the scope of HCPC Standards of proficiency
Evaluate research & other evidence to inform practice
Work safely, including being able to select appropriate hazard control & risk management, reduction or elimination techniques in a safe manner in accordance with health & safety legislation
Select appropriate personal protective equipment & use it correctly
Establish safe environments for practice, which minimise risks to service users, those treating them & others, including the use of hazard control & particularly infection control

Knowledge

Prosthetic/ Orthotic Care

The structure & function of the human body, together with knowledge of health, disease, disorder & dysfunction including: human structure & function of the musculoskeletal system; the aetiology & pathophysiology of human disease & general genetic principles; & a range of disorders that are amenable to prosthetic or orthotic treatment & their limitations
Gait, locomotor & movement functions & ways to check them
How to undertake & record a thorough, sensitive & detailed assessment
How to formulate & evaluate a treatment plan for a patient including setting appropriate review goals & timelines; the range of prosthetic & orthotic devices available; how to position or immobilise patients correctly for safe & effective interventions including fitting a prosthesis or orthotic device
The theoretical basis of prosthetic & orthotic science & design; a range of techniques for capturing body shape
The structure & properties of materials & their appropriate application to prosthetic or orthotic hardware & clinical practice; a range of modelling techniques; how to measure & adjust a model
Biomechanical principles & the appropriate application of forces to the human body following prescription & supply of a device in a manner which makes the application of such forces safe & effective in an episode of treatment
How to undertake analyses when required for unapproved combiniations or applications of components
How equipment works & how to maintain it to a high standard at all times, when & where to report faults; quality control & how it applies in prosthetic/orthotic design & delivery
The range of orthotic & prosthetic products available allowing the most appropriate product to be provided/manufactured to meet the specific needs of the patient
How to identify changes in the fit of prostheses/orthoses over time (due to changes in the patient &/or materials) & how best to return the device to optimum effectiveness or where appropriate to renew & replace

Person Centred Care

Equality, diversity & inclusion legislation; how to treat people with dignity & respect; how to assess the nature & complexity of a patient’s needs including how to empathise with patients; understanding how disability affects & influences prosthetic & orthotic management; the requirement to adapt practice to meet the needs of patients dealing with emotional needs due to a range of circumstances & experiences
Ways to use your judgement to develop treatment plans that reflect a patient’s needs & preferences
How to recognise how communication affects assessment & engagement of a patient & to be able to apply a range of communication techniques; taking into account a patient’s emotional state, The stages and processes of clinical reasoning and understand how they underpin effective decision makingage, capacity, understanding, learning & physical ability, culture, ethnicity & religious beliefs
Ways to assist the communication requirements of patients; including recognising the need to use interpersonal skills to encourage the active participation of patients; how to recognise the limits of prosthetic/orthotic practice in the context of patient care; including when not to proceed with a treatment intervention in the best interests of a patient
The stages and processes of clinical reasoning and understand how they underpin effective decision making

Governance & Safety

How to work collaboratively with those who provide services to patients; recognising the limits of prosthetic/orthotic practice & when to seek advice &/or refer to another professional
What is meant by fitness to practice; how to work within legislation, standards, protocols & codes of conduct (e.g. Medicines & Healthcare products Regulatory Agency HCPC); the limits of your own competence & role
How to be able to apply professional knowledge, skills & experience as part of a multi-professional team to ensure a patient’s needs are met
What is meant by informed consent & how to secure it across the age range & in line with cognitive ability; the importance of providing patients with information that allows them to make informed decisions & safely manage their condition & supplied devices
What is meant by duty of care; medical ethics; safeguarding of adults & children & how it applies to your role
Health & safety legislation, policies & procedures; ways to assess risks that ensures safety & security of the prescribed device; how to balance the needs of the patient & personal risk taking; a range of evidence-based models of risk assessment related to prosthetics/orthotics & your own role
Concepts & theories of leadership & management and how they apply the clinical environment
How to maintain confidentiality & apply the principles of information & clinical governance
The importance of managing records & data in accordance with legislation, protocols & best practice
The need to participate in training, supervision & mentoring
Quality guidelines & device design principles that apply to patient devices; incident reporting & escalation
The national standards & legal framework within your scope of practice; including maintaining a high standard of personal professional conduct; the need to keep skills & knowledge up to date & the importance of career-long learning
Ways to reduce occupational stress & the importance of maintaining your own health & well-being
The value of critical reflection on practice & the need to record the outcome of such reflection
The structure & function of health & social care services in the UK
A range of research methodologies

Behaviours

You will treat people with dignity, respecting patient's diversity, beliefs, culture, needs, values, privacy & preferences. You will show respect & empathy for those with whom you work with, have the courage to challenge areas of concern & work to evidence based best practice/consensus. You will also be adaptable, reflective, reliable & consistent, show discretion, resilience, self-awareness & demonstrate leadership. You will be focussed on problem solving & demonstrate tenacity.

Entry Requirements

Employers will set selection criteria. This might include GCSEs, A levels, other relevant qualifications, relevant experience &/or an aptitude test.

Qualification requirements:

Apprentices will be required to complete a Health & Care Professions Council (HCPC) approved BSc (Hons) programme in Prosthetics & Orthotics. Apprentices without level 2 English & maths will need to achieve this level prior to completing the end-point assessment. For those with an education, health & care plan or a legacy statement the apprenticeships English & maths minimum requirement is Entry Level 3 & British Sign Language qualification are an alternative to English qualifications for whom this is their primary language.

Level:

Duration:

Typically 4 years

Originally published on Gov.uk, this information has been re-used under the terms of the Open Government Licence.