Exploring the roles of the Australian prosthetist

Submission note: A thesis submitted in total fulfilment of the requirements for the degree of Doctor of Philosophy to the National Centre for Prosthetics and Orthotics, Collage of Science, Health and Engineering, La Trobe University, Bundoora.

The role of the prosthetist has undergone substantial change over the past century. As prosthetists have transitioned from ‘technicians’ to ‘clinicians’, it is likely that expectations regarding the role have become more diverse. A key theory of organisational psychology (Katz and Kahn, 1978) states that conflicting or ambiguous role expectations can create stress for those in an organisation. This ‘organisational role theory’ was used as a suitable framework to explore the current expectations of the role of the prosthetist in this thesis. There were three major aims of this research. The first was to develop a scale to quantify opinions of the role of the prosthetist from the perspective of Australian amputee clients, prosthetists, orthotists, rehabilitation specialists, prosthetic orthotic technicians and physiotherapists. The second was to determine the extent to which the reported views aligned with descriptions of the role in professional documentation and literature. The final aim was to explore whether conflicting expectations existed between different participant groups of health professionals, technicians and consumers. The Prosthetist Role Expectations Scale (PRES) developed in this thesis, comprised 72 items describing prosthetist behaviour, divided into 11 behavioural subscales. Prior to distribution, the PRES was tested for validity and reliability. Content and construct validity, internal consistency, test retest and interrater reliability were also confirmed. Prosthetists, orthotists, prosthetic technicians, physiotherapists, rehabilitation specialists and amputee clients were recruited from across Australia. A total of 1064 surveys were distributed with a 25% return rate. Data analysis included descriptive statistics, analysis of variance and Tukey’s post hoc testing. ROLES OF THE AUSTRALIAN PROSTHETIST 8 The results showed that opinions of role of the prosthetist generally aligned with the literature in six of the 11 PRES subscales. These were the Interdisciplinary Functioning, Medical History, Research, Prosthesis Communication, Prosthesis Provision and Prosthesis Function subscales. No conflict between groups was identified for the behaviours described in these subscales. Professional documentation and relevant literature concerning the role in these areas was clearly described and consistent. Results from the remaining subscales indicated opinions of the role were more variable when compared to the published literature. Literature concerning behaviours in these subscales was less descriptive and conflicted in some areas. Conflict and ambiguity in group expectations concerning the role of the prosthetist was shown in the Independent Prescription subscale and seven items from the Independent Prescription subscale and Shared Prescription subscale, Referral subscale, Adjustment Communication subscale and Advanced Communication subscale. The first distribution of the PRES supported the prosthetist’s role as a highly skilled, autonomous clinical professional, who operates in the context of a health care team environment and uses a combination of technical and clinical training to provide prosthetic devices to amputee clients. This description of the role was also affirmed by professional literature concerning the competencies of the prosthetist. Conflict between groups in the PRES results did indicate some tensions from unclear or conflicting expectations of the role of the prosthetist in Australia. These were most likely to occur in specific areas of referral procedures, prescription authority and communication of client’s emotional concerns.