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Osteoarthritis often affects joints of the hand. When the thumb is involved, the condition can be particularly debilitating because of its importance in virtually all hand movements. Orthotic stabilization of the affected carpometacarpal joint of the thumb is an important intervention to reduce pain and facilitate hand function but high level evidence for the effectiveness of this treatment is scarce. De Alimeda and colleagues (2017)have reviewed the existing literature on orthotic management of thumb OA and presented a scoping review published in the current (August) issue of Prosthetics and Orthotics International. The  authors found substantial evidence that short hand-based orthoses were effective for reducing pain and improving function but they were unable to distinguish between a number of designs available for treating the condition.
 
It has long been assumed that reduced toe clearance during swing in individuals using prostheses or orthoses contributes to a higher incidence of trip-related falls but this relationship has not been empirically demonstrated. In a study of eight transtibial amputees, Rosenblatt, Bauer and Grabiner (2017)have measured minimum toe clearance druing swing phase during walking on a treadmill and related this index to subsequent self-reported stumbles during ambulation in the community. They found that toe clearance was significantly lower in participants who reported stumbles in a one-year follow up. Prosthetic foot-ankle designs which dorsiflex during swing phase may increase toe clearance and reduce trips and falls for amputees. The study is published in the current issue of POI.
 
ISPO has been involved since its inception in formulating educational standards for training P&O technicians and clinicians and in the accreditation of education programs around the world. The WHO/ISPO guidelines identify three levels of training for Catefory I clinicians, Category II clinicians wwho have more limited training but provide clinical services, ideally under supervision and Category III technologists who do not have a clinical role. Although we have assumed that a higher level of training results in a higher standard of service delivery, there is little evidence to support this assumption. Given the limited training opportunities and high cost of training around the world, it is important to make evidence-based decisions about allocation of limited resources. In a paper recently published in OnlineFirst (Forghany et al.) describes a scoping review of existing literature to determine the extent to which training influences service quality. Unfortunately there is little evidence to support the assumed relationship. There is a clear need for research in this important area. 
 
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Tim Bach

Editor-in-Chief
Prosthetics and Orthotics International (POI)