Canadian Prosthetics Orthotics Journal最新文献

{"title":"Letter to the Editor Regarding: Evolving Business Models in Orthotics.","authors":"L Laakso","doi":"10.33137/cpoj.v5i1.37717","DOIUrl":"10.33137/cpoj.v5i1.37717","url":null,"abstract":"","PeriodicalId":32763,"journal":{"name":"Canadian Prosthetics Orthotics Journal","volume":"5 1","pages":"37717"},"PeriodicalIF":0.0,"publicationDate":"2022-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10443470/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10421725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Psychosocial Adjustment Measure for Persons With Upper Limb Amputation.","authors":"L J Resnik, P Ni, M L Borgia, M A Clark","doi":"10.33137/cpoj.v5i1.37873","DOIUrl":"10.33137/cpoj.v5i1.37873","url":null,"abstract":"<p><strong>Background: </strong>Measurement of psychosocial adjustment after upper limb amputation (ULA) could be helpful in identifying persons who may benefit from interventions, such as psychotherapy and/or support groups. However, available measures of psychosocial adjustment after limb loss are currently designed for prosthetic users only.</p><p><strong>Objective: </strong>To create a measure of psychosocial adjustment for persons with ULA that could be completed by individuals regardless of whether a prosthesis is use.</p><p><strong>Methodology: </strong>We modified items from an existing Trinity Amputation and Prosthesis Experience Survey (TAPES) measure and generated new items pertinent to persons who did not use a prosthesis. Item content was refined through cognitive interviewing and pilot testing. A telephone survey of 727 persons with major ULA (63.6% male, mean age of 54.4) was conducted after pilot-testing. After exploratory and confirmatory factor analyses (EFA and CFA), Rasch analyses were used to evaluate response categories, item fit and differential item functioning (DIF). Item-person maps, score distributions, and person and item reliability were examined. Test-retest reliability was evaluated in a 50-person subsample.</p><p><strong>Findings: </strong>EFA and CFA indicated a two-factor solution. Rasch analyses resulted in a 7-item Adjustment to Limitation subscale (CFI=0.96, TLI=0.95, RMSEA=0.128) and a 9-item Work and Independence subscale (CFI=0.935, TLI=0.913, RMSEA=0.193). Cronbach alpha and ICC were 0.82 and 0.63 for the Adjustment to Limitation subscale and 0.90 and 0.80 for the Work and Independence subscale, respectively.</p><p><strong>Conclusions: </strong>This study developed the Psychosocial Adjustment to Amputation measure, which contains two subscales: 1) Adjustment to Limitation and 2) Work and Independence. The measure has sound structural validity, good person and item reliability, and moderate to good test-retest reliability.</p>","PeriodicalId":32763,"journal":{"name":"Canadian Prosthetics Orthotics Journal","volume":"5 1","pages":"37873"},"PeriodicalIF":0.0,"publicationDate":"2022-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10443488/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10442087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Short-Term Effects of Rhythmic Vibrotactile and Auditory Biofeedback on the Gait of Individuals After Weight-Induced Asymmetry.","authors":"A Michelini, H Sivasambu, J Andrysek","doi":"10.33137/cpoj.v5i1.36223","DOIUrl":"10.33137/cpoj.v5i1.36223","url":null,"abstract":"<p><strong>Background: </strong>Biofeedback (BFB), the practice of providing real-time sensory feedback has been shown to improve gait rehabilitation outcomes. BFB training through rhythmic stimulation has the potential to improve spatiotemporal gait asymmetries while minimizing cognitive load by encouraging a synchronization between the user's gait cycle and an external rhythm.</p><p><strong>Objective: </strong>The purpose of this work was to evaluate if rhythmic stimulation can improve the stance time symmetry ratio (STSR) and to compare vibrotactile to auditory stimulation. Gait parameters including velocity, cadence, stride length, double support time, and step length symmetry, were also examined.</p><p><strong>Methodology: </strong>An experimental rhythmic stimulation system was developed, and twelve healthy adults (5 males), age 28.42 ± 10.93 years, were recruited to participate in walking trials. A unilateral ankle weight was used to induce a gait asymmetry to simulate asymmetry as commonly exhibited by individuals with lower limb amputation and other clinical disorders. Four conditions were evaluated: 1) No ankle weight baseline, 2) ankle weight without rhythmic stimulation, 3) ankle weight + rhythmic vibrotactile stimulation (RVS) using alternating motors and 4) ankle weight + rhythmic auditory stimulation (RAS) using a singletone metronome at the participant's self-selected cadence.</p><p><strong>Findings: </strong>As expected the STSR became significantly more asymmetrical with the ankle weight (i.e. induced asymmetry condition). STSR improved significantly with RVS and RAS when compared to the ankle weight without rhythmic stimulation. Cadence also significantly improved with RVS and RAS compared to ankle weight without rhythmic stimulation. With the exception of double support time, the other gait parameters were unchanged from the ankle weight condition. There were no statistically significant differences between RVS and RAS.</p><p><strong>Conclusion: </strong>This study found that rhythmic stimulation can improve the STSR when an asymmetry is induced. Moreover, RVS is at least as effective as auditory stimulation in improving STSR in healthy adults with an induced gait asymmetry. Future work should be extended to populations with mobility impairments and outside of laboratory settings.</p>","PeriodicalId":32763,"journal":{"name":"Canadian Prosthetics Orthotics Journal","volume":"5 1","pages":"36223"},"PeriodicalIF":0.0,"publicationDate":"2022-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10443516/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10065865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Trans-radial Longitudinal Compression Influence Myoelectric Control?","authors":"J Olsen,&nbsp;S Day,&nbsp;S Dupan,&nbsp;K Nazarpour,&nbsp;M Dyson","doi":"10.33137/cpoj.v5i2.37963","DOIUrl":"https://doi.org/10.33137/cpoj.v5i2.37963","url":null,"abstract":"<p><strong>Background: </strong>Existing trans-radial prosthetic socket designs are not optimised to facilitate reliable myoelectric control. Many socket designs pre-date the introduction of myoelectric devices. However, socket designs featuring improved biomechanical stability, notably longitudinal compression sockets, have emerged in more recent years. Neither the subsequent effects, if any, of stabilising the limb on myoelectric control nor in which arrangement to apply the compression have been reported.</p><p><strong>Methodology: </strong>Twelve able-bodied participants completed two tasks whilst wearing a longitudinal compression socket simulator in three different configurations: 1) compressed, where the compression strut was placed on top of the muscle of interest, 2) relief, where the compression struts were placed either side of the muscle being recorded and 3) uncompressed, with no external compression. The tasks were 1) a single-channel myoelectric target tracking exercise, followed by 2), a high-intensity grasping task. The wearers' accuracy during the tracking task, the pressure at opposing sides of the simulator during contractions and the rate at which the limb fatigued were observed.</p><p><strong>Findings: </strong>No significant difference between the tracking-task accuracy scores or rate of fatigue was observed for the different compression configurations. Pressure recordings from the compressed configuration showed that pressure was maintained at opposing sides of the simulator during muscle contractions.</p><p><strong>Conclusion: </strong>Longitudinal compression does not inhibit single-channel EMG control, nor improve fatigue performance. Longitudinal compression sockets have the potential to improve the reliability of multi-channel EMG control due to the maintenance of pressure during muscle contractions.</p>","PeriodicalId":32763,"journal":{"name":"Canadian Prosthetics Orthotics Journal","volume":"5 2","pages":"37963"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10443505/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10067474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Novel Quick Release Mechanism for Ankle Foot Orthosis Struts.","authors":"W Li,&nbsp;N Baddour,&nbsp;E D Lemaire","doi":"10.33137/cpoj.v5i2.38802","DOIUrl":"https://doi.org/10.33137/cpoj.v5i2.38802","url":null,"abstract":"<p><strong>Background: </strong>A posterior dynamic element ankle-foot orthosis (PDEAFO) uses a stiff carbon fibre strut to store and release energy during various mobility tasks, with the strut securely attached to the foot and shank-cuff sections. A design that allows the user to swap struts for specific activities could improve mobility by varying PDEAFO stiffness, but current approaches where bolts securely connect the strut to the orthosis make quick strut swapping time-consuming and impractical.</p><p><strong>Objectives: </strong>Design a novel quick release AFO (QRAFO) that can enable daily living strut-swapping and thereby enable better ankle biomechanics for the person's chosen activity.</p><p><strong>Methodology: </strong>The novel QRAFO enables device stiffness changes through a quick release mechanism that includes a quick-release key, weight-bearing pin, receptacle anchor, and immobilization pin. A prototype was modelled and simulated with SolidWorks. Mechanical tests were performed with an Instron 4482 machine to evaluate quick release mechanism strength with running and 20° slope downhill walking loads. Quick release efficiency was then evaluated via two quick release functional tests, with four participants wearing a 3D printed QRAFO.</p><p><strong>Findings: </strong>Simulated stress on the weight bearing pin, anchor, and surrounding carbon fibre structure under running and downhill walking loads did not exceed the yielding stress. Mechanical tests verified the simulation results. Four participants successfully swapped the strut within 25.01 ± 3.66 seconds, outperforming the 60.48 ± 10.88 seconds result for the hand-tightened bolted strut. A learning evaluation with one participant showed that, after approximately 30 swapping iterations, swap time was consistently below 10 seconds.</p><p><strong>Conclusion: </strong>The quick release mechanism accommodated running and slope walking loads, and allowed easy and fast strut removal and attachment, greatly reducing strut swap time compared to screw-anchor connections. Overall, the novel quick release AFO improved strut-swapping time without sacrificing device strength, thereby enabling people to use the most appropriate AFO stiffness for their current activity and hence improve mobility and quality of life.</p>","PeriodicalId":32763,"journal":{"name":"Canadian Prosthetics Orthotics Journal","volume":"5 2","pages":"38802"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10443491/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10063582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differences in Hip Muscle Strength and Static Balance in Patients with Transfemoral Amputations Classified at Different K-Levels: A Preliminary Cross-Sectional Study.","authors":"S John,&nbsp;K Orlowski,&nbsp;K U Mrkor,&nbsp;J Edelmann-Nusser,&nbsp;K Witte","doi":"10.33137/cpoj.v5i1.37456","DOIUrl":"https://doi.org/10.33137/cpoj.v5i1.37456","url":null,"abstract":"<p><strong>Background: </strong>Following amputation, patients with lower limb amputations (LLA) are classified into different functional mobility levels (K-levels) ranging from K0 (lowest) to K4 (highest). However, K-level classification is often based on subjective criteria. Objective measures that are able to differentiate between K-levels can help to enhance the objectivity of K-level classification.</p><p><strong>Objectives: </strong>The goal of this preliminary cross-sectional study was to investigate whether differences in hip muscle strength and balance parameters exist among patients with transfemoral amputations (TFA) assigned to different K-levels.</p><p><strong>Methodology: </strong>Twenty-two participants with unilateral TFA were recruited for this study, with four participants assigned to K1 or K2, six assigned to K3 and twelve assigned to K4. Maximum isometric hip strength of the residual limb was assessed in hip flexion, abduction, extension, and adduction using a custom-made diagnostic device. Static balance was investigated in the bipedal stance on a force plate in eyes open (EO) and eyes closed (EC) conditions. Kruskal-Wallis tests were used to evaluate differences between K-level groups.</p><p><strong>Findings: </strong>Statistical analyses revealed no significant differences in the parameters between the three K-level groups (p>0.05). Descriptive analysis showed that all hip strength parameters differed among K-level groups showing an increase in maximum hip torque from K1/2-classified participants to those classified as K4. Group differences were also present in all balance parameters. Increased sway was observed in the K1/2 group compared to the K4 group, especially for the EC condition.</p><p><strong>Conclusion: </strong>Although not statistically significant, the magnitude of the differences indicates a distinction between K-level groups. These results suggest that residual limb strength and balance parameters may have the potential to be used as objective measures to assist K-level assignment for patients with TFA. This potential needs to be confirmed in future studies with a larger number of participants.</p>","PeriodicalId":32763,"journal":{"name":"Canadian Prosthetics Orthotics Journal","volume":"5 1","pages":"37456"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10443478/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10421728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Experts' Perceived Patient Burden and Outcomes of Knee-ankle-foot-orthoses (Kafos) Vs. Microprocessor-stance-and-swing-phase-controlled-knee-ankle-foot Orthoses (Mp-sscos).","authors":"B Brüggenjürgen,&nbsp;F Braatz,&nbsp;B Greitemann,&nbsp;H Drewitz,&nbsp;A Ruetz,&nbsp;M Schäfer,&nbsp;W Seifert,&nbsp;F Steinfeldt,&nbsp;C Weichold,&nbsp;D Yao,&nbsp;C Stukenborg-Colsman","doi":"10.33137/cpoj.v5i1.37795","DOIUrl":"https://doi.org/10.33137/cpoj.v5i1.37795","url":null,"abstract":"<p><strong>Background: </strong>Patients with neuromuscular knee-instability assisted with orthotic devices experience problems including pain, falls, mobility issues and limited engagement in daily activities.</p><p><strong>Objectives: </strong>The aim of this study was to analyse current real-life burden, needs and orthotic device outcomes in patients in need for advanced orthotic knee-ankle-foot-orthoses (KAFOs).</p><p><strong>Methodology: </strong>An observer-based semi-structured telephone interview with orthotic care experts in Germany was applied. Interviews were transcribed and content-analysed. Quantitative questions were analysed descriptively.</p><p><strong>Findings: </strong>Clinical experts from eight centres which delivered an average of 49.9 KAFOs per year and 13.3 microprocessor-stance-and-swing-phase-controlled-knee-ankle-foot orthoses (MP-SSCOs) since product availability participated. Reported underlying conditions comprised incomplete paraplegia (18%), peripheral nerve lesions (20%), poliomyelitis (41%), post-traumatic lesions (8%) and other disorders (13%). The leading observed patient burdens were \"restriction of mobility\" (n=6), followed by \"emotional strain\" (n=5) and \"impaired gait pattern\" (n=4). Corresponding results for potential patient benefits were seen in \"improved quality-of-life\" (n=8) as well as \"improved gait pattern\" (n=8) followed by \"high reliability of the orthosis\" (n=7). In total, experts reported falls occurring in 71.5% of patients at a combined annual frequency of 7.0 fall events per year when using KAFOs or stance control orthoses (SCOs). In contrast, falls were observed in only 7.2 % of MPSSCO users.</p><p><strong>Conclusion: </strong>Advanced orthotic technology might contribute to better quality of life of patients, improved gait pattern and perceived reliability of orthosis. In terms of safety a substantial decrease in frequency of falls was observed when comparing KAFO and MP-SSCO users.</p>","PeriodicalId":32763,"journal":{"name":"Canadian Prosthetics Orthotics Journal","volume":"5 1","pages":"37795"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10443469/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10421726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Technology Management as a Core Component of a Client-centric Prosthetic Orthotic Practice Model.","authors":"S U Raschke","doi":"10.33137/cpoj.v5i2.39001","DOIUrl":"https://doi.org/10.33137/cpoj.v5i2.39001","url":null,"abstract":"<p><p>Technological innovation has transformed how we communicate, work, and conduct business. Over the next decade how we experience health care both as health care professionals and as client-patients will also change significantly. This presents both an opportunity and a challenge to medical clinical professionals that are device-focused, including prosthetists orthotists, as they consider how best to adapt. Current prosthetic orthotic education and practice is heavily clinically weighted, with less emphasis being given to engineering and business skills. Yet all three are essential core elements of a successful, sustainable prosthetics orthotics practice. Furthermore, it is the latter two that will heavily influence the future face of prosthetics & orthotics. It is not certain how current prosthetic orthotic practitioners can best adapt in response. One solution, proposed in this editorial, could be by rebalancing their professional persona to equally weight the three essential core elements. The result, a Clinical Prosthetic Orthotic Technology Management Professional, would engage in a professional practice that is functionally grounded, uses a client-centric model and incorporate eight professional attributes: professional, advocate, scholar, leader, communicator, collaborator, assistive technology expert and business justification specialist.</p>","PeriodicalId":32763,"journal":{"name":"Canadian Prosthetics Orthotics Journal","volume":"6 2","pages":"39001"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10443474/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10067482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of User's Satisfaction With Orthotic and Prosthetic Devices and Services in Orthotics and Prosthetics Center of Iran University of Medical Sciences.","authors":"A Baghbanbashi,&nbsp;B Farahmand,&nbsp;F Azadinia,&nbsp;M Jalali","doi":"10.33137/cpoj.v5i1.37981","DOIUrl":"https://doi.org/10.33137/cpoj.v5i1.37981","url":null,"abstract":"<p><strong>Background: </strong>The number of patients receiving orthotics and prosthetic services is increasing globally. A way to investigate patients' insight about services provided to them is to evaluate their satisfaction with the received services. Furthermore, incorporating patients' preferences into practice is an inseparable part of evidence-based practice. Applying such information in practice can contribute to the enhancement of the quality of services, the effectiveness of therapeutic interventions, and finally, the economic growth of service centers.</p><p><strong>Objectives: </strong>To evaluate patients' satisfaction with the orthotic and prosthetic devices and services provided by the orthotics and prosthetics clinic of Iran University of Medical Sciences.</p><p><strong>Methodology: </strong>In this study, 173 people referring to the orthotics and prosthetics clinic of Iran University of Medical Sciences were recruited, and their satisfaction level was examined using the Orthotics and Prosthetics Users' Survey questionnaire (OPUS) through a phone interview.</p><p><strong>Findings: </strong>Concerning the devices, the mean value of total satisfaction score was 74:00±19.80 and the highest score belonged to no wear or rupture of the clothes with their devices (mean value = 4.76±0.84). In terms of services, the mean value of total satisfaction score was 72.12 ± 15.90 with the highest score belonging to the politeness of the clinic staff (mean value = 4.92±0.57). When the time point from receiving service was taken into account, the patients who received the service for less than a year showed higher satisfaction level with the service (p=0.024). Although satisfaction with the device was slightly higher among the participants who used the devices for more than a year, no significant difference was observed between the two groups in terms of device satisfaction.</p><p><strong>Conclusions: </strong>The overall satisfaction level from the devices and services was relatively high. However, the satisfaction level with the costs and coordination of the staff with the physicians showed a decline.</p>","PeriodicalId":32763,"journal":{"name":"Canadian Prosthetics Orthotics Journal","volume":"5 1","pages":"37981"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10443524/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10065861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial Opinion: Value Within the Prosthetic and Orthotic Provision Process.","authors":"S U Raschke","doi":"10.33137/cpoj.v5i1.38442","DOIUrl":"https://doi.org/10.33137/cpoj.v5i1.38442","url":null,"abstract":"<p><p>This Editorial presents an overview of the uptake of clinical outcome measures in the prosthetics and orthotics sector and considers how the use of objective measures contribute to demonstrating value provided. A decade ago, payors began to demand objective data to document costs vs. benefits from prosthetic and orthotic providers. The speed with which the sector responded to help develop measures and to begin to integrate them into practice is remarkable. This suggests an encouraging resilience and ability to adapt on the part of the sector as other trends such as Values-Based Health Care emerge to challenge the sector.</p>","PeriodicalId":32763,"journal":{"name":"Canadian Prosthetics Orthotics Journal","volume":"5 1","pages":"38442"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10443494/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10065863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}