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Enhancing Patient Outcomes Through Collaborative Orthotic & Prosthetic Care:

What Nurse Practitioners Need to Know

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Linda Laakso MSc CO(c) FCBC AWCCP

Certified Orthotist

Mississauga, ON

Mary Catherine Thiessen BKin CO(c)

Certified Orthotist

Shannonville, ON

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Welcome and Introductions

National credentialing body for the orthotic and prosthetic professions

Certified Orthotist CO(c)
Certified Prosthetist CP(c)
Registered Orthotic Technician RTO(c)
Registered Prosthetic Technician RTP(c)

www.opcanada.ca

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Provincial advocacy body

www.oapo.org

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Agenda

Orthotics & prosthetics overview
OPC credentialling and evidence-informed practice
O&P services in Ontario
ADP overview
Collaborative care with NPs
Why OPC members are the provider of choice
Q&A

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Orthotics and �Prosthetics - Defined

Orthoses are medical devices that are used to support, align, correct or protect a body part.

Foot orthoses (FO)
Ankle foot orthoses (AFO)
Knee ankle foot orthoses (KAFO)
Thoracolumbosacral orthoses (TLSO)
Wrist hand finger orthoses (WHFO)
Cervical orthoses (CO)
Cranial orthoses (CRO)

Certified Orthotist CO(c)

Registered Orthotic Technician RTO(c)

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Prostheses are medical devices that replace a lost or missing body part.

Certified Prosthetist CO(c)

Registered Prosthetic Technician RTO(c)

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Orthotics and �Prosthetics - Defined

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Patient Populations (Who do we treat?)

Acquired Brain Injury
Arthritis
Brachycephaly
Charcot Marie Tooth
Complications of Covid-19
Congenital Anomalies
Diabetes
Diabetic Foot Ulcers
Diabetic Neuropathy
Guillain Barre Syndrome
Hemiplegia
Multiple Sclerosis
Muscular Dystrophy
Osteoarthritis
Overuse Injuries
Patellofemoral Syndrome
Peripheral Neuropathy
Plagiocephaly
Plantar Fasciitis
Poliomyelitis
Post Polio Syndrome
Post Surgical Complications
Rheumatoid Arthritis
Seizures
Spina Bifida
Spinal Cord Injury
Stroke
Trauma

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Impact of Proper Orthotic and Prosthetic Care

Improved mobility and independence
Pain reduction
Enhanced participation in daily activities
Contracture management
Offloading plantar surface ulcers

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Credentialling: Setting the Standard

Minimum of eight years to become a Certified Orthotist or a Certified Prosthetist in Canada:

Bachelor’s Degree
Completion of an accredited, two-year, post-graduate Prosthetic and Orthotic Clinical Methods Program
Residency (2-years)
Credentialing exams

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Credentialling: Setting the Standard

Credential maintenance:

Ongoing mandatory continuing education
Adherence to:

Canons of Ethical Conduct
Scope of Practice
Standards of Practice

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Credentialling: Setting the Standard

OPC is accredited by the International Society of Prosthetics and Orthotics (ISPO) at their highest educational standard.
Education standards are guided by and aligned with:

World Health Organization (WHO) prosthetics and orthotics service standards
Global Qualification Framework
Current accreditation practices
International Labour Organization Standards of Classification of Occupations

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Evidence-Informed Practice in O&P

Integration of research and clinical guidelines
Patient-centered decision making
Demonstrate commitment to best outcomes

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Orthotic & Prosthetic Services in Ontario

https://www.oapo.org/find-a-clinic/

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Understanding the Assistive Devices Program (ADP)

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Eligible

Long Term Use
Used for multiple daily activities
Orthoses/Prostheses
Modifications

Non-Eligible

Treatment Orthoses (e.g. Cranial Remolding)
Back up Devices
Acute Conditions (e.g. Fractures)
Post-Op Devices
Intended use for only one activity

Note: Certified Orthotists and Certified Prosthetists are the only professionals recognized by the Assistive Devices Program to provide these treatments

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Understanding the Assistive Devices Program (ADP) - Prosthetics

Partially covered by ADP
Prescribed by a clinic team with Physiatrist, Physiotherapist and Prosthetist
Replacement components are authorized by a Certified Prosthetist
NP may need to write prescription if supplies are covered through NIHB
NP can refer to a prosthetist / prosthetic clinic

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Understanding the Assistive Devices Program (ADP) - Orthotics

Custom made bracing – head to toe (except teeth)
Limited custom fit (off the shelf)
75% covered by ADP (with OHIP card)
100% covered if on ODSP/OW/ACSD
NPs can prescribe / sign ADP application forms

Note:

Shoes and custom-made foot orthoses are NOT covered by ADP. Only custom-made offloading devices are covered (no wound boots or removable cast walkers).

Non-ADP devices require a prescription.

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Understanding the Assistive Devices Program (ADP) - Orthotics

NP completes sections on page one and page six
QR code to download a PDF of the form

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The NP is the prescriber, and the CO is the authorizer

If you provided a prescription, the ADP form still has to be completed to access the funding.

Form is found on the Ministry of health website – QR code will take you right there.

Download the form and open it in adobe. It will NOT open in a browser

Each clinic has their own ways to ensure that this paperwork is completed.

Some give it to the patient with instructions to take it back to you for a signature
Some will fax/email it directly to you with a letter of explanation and ask that it be faxed or mailed back or both.
It can be signed with both pen/ink, OR a digital signature is adequate if the clinic has the technology in place

All Clinics need the form returned to them for their files.

All clinics will take care of submitting these applications to ADP on behalf of the patient.

ADP pays the clinic directly for the treatment after it has been dispensed.

NOTE: if the device is not covered through ADP, a prescription is necessary. This will help them access their insurance plan or OW / ODSP.

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Impact of Proper Orthotic and Prosthetic Care

Patient with an unstable knee post fracture and failed surgical repair.
Knee hyperextends approximately 45° with about 30° varus during weight bearing.
Now wearing a KAFO successfully. Designed to prevent the hyperextension and varus.
Has a job plowing driveways in the winter using a walk behind snowblower.
"I can't walk without it"

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Impact of Proper Orthotic and Prosthetic Care

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Patient is a toddler learning to walk with severe pes planus caused by hypotonia.
Prescribed a pair of supramalleolar orthoses designed to reposition the feet and provide a stable base of support.
She takes her first steps shortly after!

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Collaborative Care: Nurse Practitioners Role

Identify the need for 'something' and the joint(s) that need to be assessed
Make the referral

write a prescription for a brace for the affected joint(s) OR
provide ADP with Sections Two and Four completed

Ongoing regular care for patient

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Collaborative Care: Certified Orthotist's Role

Full assessment of the joint(s) in question, including gait analysis if applicable
Make a recommendation for the style and design of the orthosis
Provide the appropriate paperwork
Device design, 3D shape capture, fabricate and fit the device
Ongoing follow-up

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Orthotists are trained to do a full assessent of the body part in question, as well as assess how the issue affects the patient's daily life.

Muscle strength and Range of Motion
Painful area?
Gait analysis
What goals do they have?

To walk without a limp
Manage a contracture
Decrease pain
Provide stability for an unstable joint
etc

are those goals reasonable?
can an orthosis help them achieve those goals.

Guidance from the Orthotist can be beneficial to keeping their goals realistic, while allowing them to push towards them.

Often an orthosis is just what they need to support their progress towards the goal.

Make the recommendation for the type of orthosis they need. Discuss how that orthosis will help them achieve their goals.

Paperwork – ADP form needs to be filled out by the prescriber, patient, orthotist and vendor (clinic).

The orthotics clinic will take care of applying for the funding and billing ADP directly for their share. The patient only has to pay the 25%. (final payment when they take the device home with them)

The design, 3D shape capture, fabrication and fitting of the device are all done on site, any follow up and adjustments are done while the patient waits.

Every clinic has an on site lab for fabrication and adjustments. These are usually done while the patient waits so they don't have to go without the device for extended periods of time.

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Why OPC Members Are the Providers of Choice

Highly Specialized Clinical Training and Certification

Why it matters: You’re entrusting your care to clinicians trained specifically in orthotics/prosthetics — not just technicians or retail practitioners.

Strong Professional Standards Protect Patients

Why it matters: You get not only expertise but accountability. There are formal consequences if standards aren’t met.

Comprehensive, Patient-Centered Care

Why it matters: This holistic, clinical approach leads to better mobility, comfort, function and long-term outcomes.

Recognized by Funding & Health Systems

Why it matters: Choosing an OPC Member helps ensure your provider is eligible to support you through public funding claims and insurance processes.

Part of Accredited, National Professional Network

Why it matters: You’re getting care that’s supported by the latest clinical best practices and professional oversight.

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1. OPC Members complete extensive education and training, including an accredited clinical program and a multi-year residency under supervision before they are certified.

Certification is an attestation of professional competency — meaning they’re evaluated and recognized as qualified to assess, plan, implement, and follow up on patient care.

�2. OPC develops and enforces national Standards of Practice and a strict Code of Ethical Conduct that all members must follow, which guides clinical decision-making, record keeping, hygiene standards, patient safety and more.

This ensures consistent quality, safety and integrity no matter where in Ontario you access care.

�3. OPC Members don’t just deliver a product — they provide clinical care from start to finish:

✔ Full assessment of your condition and functional needs� ✔ Individualized treatment planning� ✔ Custom design and fitting of orthotic/prosthetic devices� ✔ Follow-up and adjustment over time� ✔ Collaboration with other health professionals (therapists, physicians, surgeons, nurse practitioners)

4. In Ontario, Certified Orthotists and Prosthetists are the professionals recognized by provincial funding programs such as the Assistive Devices Program (ADP) to provide custom orthotic and prosthetic care. We are also recognized by ODSP, OW, NIHB, DVA

�5. OPC Members are part of a national professional body that is responsible for credentialing and registration, setting standards, quality assurance, investigation and discipline, and public protection

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Q&A / Discussion

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Thank You & Next Steps

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https://www.youtube.com/watch?v=cL4n_JBufDQ