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1, Issue 1, No 3, 2018. DOI: https://doi.org/10.33137/cpoj.v1i1.30009 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
 
 
 

 
 

 

 

 

 

 

 

  

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Burke J, Fiedler G. Clinicians’ Access To Peer-Reviewed Prosthetics Research Articles. Canadian Prosthetics & Orthotics Journal, 
Volume 1, Issue 1, No 3, 2018. DOI: https://doi.org/10.33137/cpoj.v1i1.30009 

1 

 
OPEN  ACCESS 

Clinicians’ Access To Peer-Reviewed Prosthetics Research Articles 
 

Volume 1, Issue 1, Article No. 3, August 2018 

 

 

RESEARCH ARTICLE  

 

CLINICIANS’ ACCESS TO PEER-REVIEWED PROSTHETICS RESEARCH ARTICLES  

 
Burke J, Fiedler G* 
 
Department of Rehabilitation Science and Technology, University of Pittsburgh, Pennsylvania, USA. 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

*CORRESPONDING AUTHOR  

Dr Goeran Fiedler, PhD, Assistant Professor, Department of Rehabilitation Science and Technology, University of Pittsburgh,  

Suite 403, Bakery Square, 6425 Penn Ave, Pittsburgh, PA 15206, USA. 

ORCID number: https://orcid.org/0000-0003-1532-1248 

Email: gfiedler@pitt.edu 

Tel: +1-412-624-6475 

 

DOI: https://doi.org/10.33137/cpoj.v1i1.30009 

 

ABSTRACT 
 

BACKGROUND: Evidence-based practice (EBP) is an important cornerstone of 

responsible clinical decision-making, and by extension, of high quality care 

provision in prosthetics and orthotics. However, many clinicians have been 

reluctant to embrace EBP, citing barriers such as high costs and time demands 

that are associated with obtaining pertinent published evidence for individual care 

scenarios. 

OBJECTIVES: The purpose of this study was to determine how accessible peer-

reviewed research articles are to prosthetists who seek to implement EBP 

techniques into their clinical work without expending unreasonable amounts of 

time and money.  

METHODOLOGY: Two approaches were utilized. An academic approach entailed 

a search through five peer-reviewed research journals, including the Journal of 

Prosthetics and Orthotics and Prosthetics and Orthotics International. A practical 

approach simulated a typical evidence search as it might occur in the field, using 

a number of different clinical questions to inform search terms in Google Scholar. 

The ratio of freely accessible articles was computed and compared for both 

approaches.  

FINDINGS: Out of a total of 796 prosthetics-relevant articles published in the 

analysed journals over the last years, 600 (75.4%) were found to be accessible to 

the public without any cost incurred. The practical approach showed that, among 

the top twenty search results for each search query, on average 40% to 75% of 

articles were freely available. 

CONCLUSIONS: A majority of pertinent research papers is already publicly 

available to anybody with internet access. Prosthetists would not be required to 

invest in journal subscriptions or have to spend time at an academic library to 

obtain these articles. However, it is a concern that evidence-based decision 

making may be flawed if not all literature on a topic is considered. There is still a 

substantial fraction of articles that are not freely available to practitioners, 

motivating a continued expansion of open-access policies in the field. 

ARTICLE INFO 

Received: July 20, 2018 

Accepted: August 2, 2018 

Published: August 10, 2018 

CITATION 

Burke J, Fiedler G. Clinicians’ 

Access To Peer-Reviewed 

Prosthetics Research Articles. 

Canadian Prosthetics & 

Orthotics Journal, Volume 1, 

Issue 1, No 3, 2018. DOI: 

https://doi.org/10.33137/cpoj.

v1i1.30009 
 

KEYWORDS 

Prosthetics, Evidence Based 

Practice, Accessibility, 

Bibliometric Study, Review, 

Peer-Reviewed, Research 

Article, Open Access Journal, 

Prosthetists. 

https://orcid.org/0000-0003-1532-1248
mailto:gfiedler@pitt.edu
https://doi.org/10.33137/cpoj.v1i1.30009
https://doi.org/10.33137/cpoj.v1i1.30009
https://doi.org/10.33137/cpoj.v1i1.30009


 

 

Burke J, Fiedler G. Clinicians’ Access To Peer-Reviewed Prosthetics Research Articles. Canadian Prosthetics & Orthotics Journal, 
Volume 1, Issue 1, No 3, 2018. DOI: https://doi.org/10.33137/cpoj.v1i1.30009 

2 

 
OPEN  ACCESS 

Clinicians’ Access To Peer-Reviewed Prosthetics Research Articles 
 

Volume 1, Issue 1, Article No. 3, August 2018 

 

 
INTRODUCTION 

Accessibility of peer-reviewed research articles has 

been cited as a barrier that prosthetists and 

orthotists must overcome in order to use evidence-

based practice (EBP) in their clinical practices.1-4 

Short of frequenting a local university library that 

may or may not hold the publications of interest 

and/or allow some access by the general public, 

there are four basic ways by which practitioners may 

acquire peer-reviewed research articles: open-

access or free-access articles (these are free to the 

public, usually online), paying for online versions of 

individual articles in peer-reviewed journals, 

subscribing to peer-reviewed journals that contain 

articles of interest, or joining an organization that 

includes journal access as one of the membership 

benefits.  

 

One example of an open access journal relevant to 

the field of Prosthetics and Orthotics (P&O) was the 

Journal of Rehabilitation Research and 

Development (JRRD), which focused on veteran-

centric rehabilitation research, including articles 

related to prosthetics, orthotics and other assistive 

technologies.5 JRRD was funded by the US 

Department of Veterans Affairs to cover operation 

costs, but ceased publishing within the Rehabilitation 

Research and Development Service in March of 

2017, referring authors to Public Library of Science 

(PLOS) instead.6  

 

The recently introduced Canadian Prosthetics & 

Orthotics Journal (CPOJ) is utilizing a more 

commonly found open-access model based on 

article-processing charges. Select open-access 

articles can also be found in the field’s specialized 

journals that utilize the classic 

membership/subscription model for revenue, 

including the Journal of Prosthetics and Orthotics 

(JPO) and Prosthetics and Orthotics International 

(POI). JPO offers open-access to articles that are 

two years or older, and POI offers open-access to all 

articles three years and older as well as select recent 

articles through Sage Publishing. Several heavily 

cited papers focusing on prosthetic research have 

also been published in journals that are not 

specialized in P&O.7 These journals include Gait and 

Posture (GP) or the Archives of Physical Medicine 

and Rehabilitation (APMR). 

In studies that focused on potential barriers P&O 

practitioners face when incorporating EBP into their 

own clinical practices, lacking accessibility has often 

been defined as any kind of cost incurred when 

attempting to access the articles desired. This cost 

includes membership requirements, individual article 

fees, and/or subscription fees that may be 

encountered when a clinician attempts to research a 

clinical question. 

 

However, it has not yet been quantified how 

prohibitive these costs actually are, and whether the 

growing open-access movement in the past decades 

has helped mitigate the problems associated with 

costs of EBP. The purpose of this study was 

therefore to determine how much of the published 

evidence in a sub-field of prosthetics research is 

freely accessible to practitioners. This information is 

useful in discussing the actual effect that cost-

barriers have on prosthetists’ ability to perform EBP 

in their clinical practice. 

 

We assumed that having access to half of the 

published body of knowledge would enable to 

perform EBP in most cases, especially when there is 

a general consensus within the literature. Based on 

this deliberation, we hypothesized that the amount of 

currently available open-access articles in the field of 

limb prosthetics exceeds this 50% threshold. We 

further hypothesized that the share of relevant open-

access articles increases over time. 

 

METHOD 

While our protocol entailed the search and review of 

a large number of literature sources, it was not with 

the intent to evaluate or summarize the scientific 

contents of those papers. Rather, all eligible 

publications were tallied by whether they were freely 

accessible online or not.8  

This study utilized two separate approaches to 

investigate the hypothesis. An academic approach 

had the aim to determine how many of the relevant 

(prosthetics) articles in a given selection of journals 

were open-access articles. The second was a 

practical approach aimed to simulate what a 

prosthetist may utilize in daily practice by searching 

for evidence on a specific clinical topic in a scholarly 

literature database. In order to also estimate the 

tendency of changes over time, this practical 



 

 

Burke J, Fiedler G. Clinicians’ Access To Peer-Reviewed Prosthetics Research Articles. Canadian Prosthetics & Orthotics Journal, 
Volume 1, Issue 1, No 3, 2018. DOI: https://doi.org/10.33137/cpoj.v1i1.30009 

 

3 

 
OPEN  ACCESS 

Clinicians’ Access To Peer-Reviewed Prosthetics Research Articles 
 

Volume 1, Issue 1, Article No. 3, August 2018 

 

 
approach was repeated after a one-year interval. 

The previously determined criterion of an 

accessibility percentage of 50% was used for 

interpretation of the findings across approaches. 

 

Academic Approach 

Of all the journals with P&O content, five of the most 

commonly read were used as sample for this study: 

JPO, POI, JRRD, APMR and GP. The number of 

prosthetics articles available in each journal was 

determined using the search terms “prosthetic,” 

“prosthetics,” “prosthetist,” “prosthesis,” and 

“prostheses” as keywords in Scopus, one of the 

largest abstract and citation databases. The five 

journal names were entered under the filter category 

“Source title”. The search was conducted in late 

March of 2017 and was narrowed to publication 

years from 2007 to 2016 (i.e., only articles and 

reviews published between January 1, 2007 and 

December 31, 2016 were included in the initial 

selection). Search results were scrutinized to 

determine whether a limb prosthesis was part of the 

study design, and only articles were included that 

either focused on the design or fabrication of a 

prosthetic device or that otherwise utilized the device 

in a significant manner in the research. For example, 

if a prosthesis was merely mentioned but was not 

substantial for the study protocol at all, the 

respective paper was excluded from analysis. 

Articles that focused on prosthetic implants (other 

than osseointegrated limb prostheses) or on 

neuroprostheses were also excluded from this study, 

as it is unlikely that papers on those topics have 

great relevance in the realm of EBP in limb 

prosthetics at this time. For the same reason, articles 

that focused exclusively on the surgical implantation 

of osseointegrated prosthesis and not any of the 

follow up care were also excluded. 

 

For the first round of filtering, article abstracts and 

titles were scanned for relevance to the study.  

During the second round of review any articles that 

were questionable for relevance were reviewed in 

full to make sure they met the inclusion 

requirements. The remaining articles were then 

looked up on each journal’s publishing website to 

determine which articles were accessible to the 

public as of March 27, 2017. The ratio of freely 

accessible articles to the total number of articles 

found was then computed separately for each 

journal. 

Practical Approach 

In order to simulate the typical process a prosthetist 

goes through when gathering evidence to address a 

clinical problem, three random clinical questions 

were formulated and appropriate search terms 

(Table 1) were entered in Google Scholar, a search 

engine that searches scholarly literature and 

academic resources.9  Formulation of the question 

was intended to reflect both recommended 

approaches (e.g., using a PICO – Population, 

Intervention, Comparison, Outcome – format) and 

less structured questions that may be posed to 

clinicians by their patients. Search terms were 

derived from the main terms contained within each 

question. To keep congruency between the two 

approaches, filters were used to limit the search 

results to only articles from peer-reviewed journals 

that were published between January 1, 2007 and 

March 27, 2017.  

 
Table 1: Research questions and search terms used in 

Google Scholar. 

 
The accessibility of the first 20 search results for 

each question was determined by clicking on the 

original hyperlinks that are provided by the Google 

Scholar website. In the event that no such link was 

listed or that the listed link did not lead to a full-text 

version of the article in question, the article was 

recorded as “not accessible”. While there may have 

been other avenues to tracking down such articles 

online through a variety of different websites (e.g., 

an article of which only the abstract is available on 

the website ScienceDirect may be – unbeknownst to 

Google Scholar – posted in full on the private 

website of the article author), it is arguably least 

complicated to just click on the links provided by 

Google Scholar. A busy clinician with limited time for 

EBP will in many cases prefer this expedited 

approach to evidence gathering. 

 

Research Question Search Terms 

Is a pin-and-lock suspension or 
a suction suspension better for 
prosthesis suspension in 
elderly patients? 

Pin and lock, suction, 
suspension, prosthesis, 
elderly 

Are microprocessor knees 
recommended for athletes? 

Microprocessor, knee, 
athletes 

What prosthetic liner is best for 
diabetic patients with a history 
of ulcers? 

Diabetes, prosthetic, liner, 
ulcer 

https://doi.org/10.33137/cpoj.v1i1.30009


 

 

Burke J, Fiedler G. Clinicians’ Access To Peer-Reviewed Prosthetics Research Articles. Canadian Prosthetics & Orthotics Journal, 
Volume 1, Issue 1, No 3, 2018. DOI: https://doi.org/10.33137/cpoj.v1i1.30009 

 

4 

 
OPEN  ACCESS 

Clinicians’ Access To Peer-Reviewed Prosthetics Research Articles 
 

Volume 1, Issue 1, Article No. 3, August 2018 

 

 
RESULTS 

Academic Approach 

The initial search in Scopus turned up 1,042 articles. 

After title, abstract, and full-text screening, 796 total 

articles were included in this analysis. With nearly 

300 articles, POI had the most prosthetics related 

articles, followed by JRRD, JPO, GP and APMR 

respectively. The amount of total free articles per 

journal followed a similar trend, with POI containing 

the largest number of accessible articles, closely 

followed by JRRD and JPO, then APMR and lastly 

GP. The ratio of accessible papers was greatest in 

JRRD, followed by APMR, JPO, POI and GP. 

Overall, about three out of every four articles in these 

journals were freely accessible by the public (Table 

2). 

 
Table 2: Number of reviewed journal articles (from 2007 

through 2016).  
 

Journal Total Articles 
Number of free 

articles 
Ratio of free 

articles 

POI 297 196 66% 

JRRD 183 183 100% 

JPO 169 151 89% 

APMR 72 67 93% 

GP 75 3 4% 

Totals 796 600 75% 

 

Practical Approach 

The total number of freely accessible articles found 

through the three searches in 2017 was 24 out of a 

total of 60 obtained articles, with an average of eight 

accessible articles per search, with a standard 

deviation of one. Out of the articles collected, 16 

(27%) were published in one of the five journals used 

in the academic approach. 

 

Repeating the same searches (using the same 

filters) one year later showed that the number of 

freely accessible articles among the top search 

results had increased to 45 out of 60 (Figure 1). 

 

DISCUSSION 

Having free access to just a small part of relevant 

published research is a significant barrier to 

incorporating EBP into clinical practice. Based on 

our initial assumption that having access to at least 

50% of papers would reasonably enable prosthetists 

to conduct EBP effectively and efficiently, our 

findings suggest that a sufficient ratio of research 

articles in prosthetics are indeed freely available to 

practitioners. Both our approaches agreed very well 

with each other that approximately three out of every 

four articles relevant to the field were accessible by 

an individual at no cost.  

 
Figure 1: Changes in the number of freely accessible 

articles among the top 20 search results for Google 

Scholar searches between March 2017 and March 2018.10  

 
Open access articles, especially in the specialized 

journals POI and JPO, can arguably be a valuable 

resource for prosthetists to utilize, given that these 

journals contain more clinically relevant research 

than other journals, like APMR or GP, that publish 

prosthetics research among research in many other 

areas.  Approximately 57% of the accessible articles 

identified in our academic approach, were gathered 

from POI and JPO. Judged by this, the conditions for 

EBP in the fields of prosthetics and orthotics appear 

to be favourable compared to other health sciences.  

 

While open accessibility of peer-reviewed articles 

through Google Scholar (the practical approach) was 

eventually found to be at around 75% as well, the 

same ratio was much lower when first investigated a 

year prior. In early 2017, only two out of every five 

peer-reviewed articles on average were accessible 

to an individual at no cost.  

 

That open access to articles on Google Scholar 

almost doubled within one year has different 

possible explanations, including a change in 

composition of the top 20 of the search rankings. 

https://doi.org/10.33137/cpoj.v1i1.30009


 

 

Burke J, Fiedler G. Clinicians’ Access To Peer-Reviewed Prosthetics Research Articles. Canadian Prosthetics & Orthotics Journal, 
Volume 1, Issue 1, No 3, 2018. DOI: https://doi.org/10.33137/cpoj.v1i1.30009 

 

5 

 
OPEN  ACCESS 

Clinicians’ Access To Peer-Reviewed Prosthetics Research Articles 
 

Volume 1, Issue 1, Article No. 3, August 2018 

 

 
Higher-impact articles (i.e., articles that are cited 

more often) are ranked higher in the search result 

listings, and it is conceivable that articles that were 

referenced frequently over the past year have moved 

up and displaced less popular articles. This would be 

supported by the circumstance that articles that are 

freely accessible are by trend read (and potentially 

cited) by more people than comparable less easily 

accessible articles. The volume of full-paper articles 

that are being shared by their authors in online 

repositories, where they are freely accessible by the 

public, may have increased over time as well. This 

would have been encouraged if the copyright rules 

that impose restrictions on that practice have been 

loosened by some publishing journals. Irrespective 

of that, many dated materials become more freely 

available over time by trend (as detailed above), 

which may have played a role in the year-on-year 

differences as well.   

 

Improvements in Google Scholar over the period 

between analyses appear to have led to a better 

selection of links to full-text papers. It was noted 

during the first data collection in 2017 that some of 

the Google Scholar links pointed to articles, already 

known to be open-access that could, however, not 

be accessed through the link provided by Google 

Scholar without a login or associated fee to the 

article.  For example, a preview of a JRRD article, 

which is open-access, was found through a Proquest 

link that was given as a result in the Google Scholar 

websearch.11  Proquest is a search engine used to 

access journals, databases and ebook resources, 

that requires a login for access. As membership 

requirements were included in what was considered 

inaccessible, this known open-access article was 

marked as inaccessible based on the study 

methods. 

 

It is possible that our results were affected by some 

limitations of this study. Only three clinical questions 

were formulated to inform the search term selection, 

resulting in a small and specific sample of data. A 

larger selection of search terms may bring about 

different results, especially if a topic is concerned 

that has only recently been widely investigated (i.e., 

has most relevant papers still subject to access 

restrictions) or has conversely not yielded much new 

research in many years (i.e., most papers fallen out 

of copyright protection). The top twenty articles that 

were included in our analysis were not filtered for 

relevance to the searched questions. This was done 

to increase replicability of the study, but may have 

led to some of the resulting papers not being 

responsive to the original question.  

 

In the same sense, it may have been possible to 

identify more articles by including more than five 

search terms in the academic approach. Likewise, 

the exact phrasing of the clinical questions in the 

practical approach, which depends on the 

practitioner’s professional judgment and on the 

peculiarities of the individual case, may influence the 

selection of search terms and thereby the eventual 

search results. It should also be noted that the 

covered periods of reviewed articles were slightly 

different between academic and practical approach 

(ending with Dec 31, 2016 and with March 27, 2017, 

respectively). We believe that the resulting 

differences in the included sample of research 

articles would not have substantially altered our 

findings. 

 

The search engine that is used will as well have an 

effect on the results. Not only do search engines 

employ different methods to determine which articles 

to display first, but not all search engines index all 

journals. For example, PubMed, a search engine 

used to retrieve data from MEDLINE, the National 

Library of Medicine journal citation database,12 has 

are not yet indexed JPO articles.13 

 

Accordingly, there are a few recommendations that 

prosthetists should consider when going through the 

process of implementing EBP into their clinical 

practices. Practitioners in our field should select 

scholarly search engines/literature databases that 

work best for the questions they wish to answer and 

be aware of the journals indexed in those databases. 

It is also worth considering that while an article may 

be inaccessible on one website, it may be freely 

accessible on another. Consulting the publishing 

journals’ websites can be helpful to determine a 

research article’s accessibility. 

 

While strategies exist that can help prosthetists 

better search for articles and overcome accessibility 

issues, the effort to learn and employ those 

strategies is still part of the initially mentioned barrier 

that needs to be overcome to properly implement 

EBP. Nonetheless, compared with the pre-internet 

necessity of frequenting a university library to sift 

https://doi.org/10.33137/cpoj.v1i1.30009


 

 

Burke J, Fiedler G. Clinicians’ Access To Peer-Reviewed Prosthetics Research Articles. Canadian Prosthetics & Orthotics Journal, 
Volume 1, Issue 1, No 3, 2018. DOI: https://doi.org/10.33137/cpoj.v1i1.30009 

 

6 

 
OPEN  ACCESS 

Clinicians’ Access To Peer-Reviewed Prosthetics Research Articles 
 

Volume 1, Issue 1, Article No. 3, August 2018 

 

 
through physical copies of countless journals for a 

literature review, this small barrier should not 

discourage prosthetists or dissuade them from 

conducting a proper evidence search. It is possible 

that other barriers that are commonly cited as an 

impediment to EBP are not as substantive as they 

are perceived either. Future research may be 

recommendable that investigates the true effects of 

time constraints, clinical relevance of scientific 

publications, and lacking incentives have on P&O 

practitioners’ attitude toward implementation of EBP 

in their daily work. 

 

CONCLUSION 

We found that about 75% of research articles in the 

field of prosthetics are freely available online. 

Whether this is indeed a big enough ratio to facilitate 

EBP in most cases should be investigated in future 

research, utilizing a more accurate simulation of 

recommended practical approaches to EBP and 

analyzing the outcomes across a larger sample of 

cases and practitioners. 

 

AUTHOR CONTRIBUTION  

• Julie Burke: Conceptualization, study design, initial 

literature search and analysis, manuscript draft.  

• Goeran Fiedler: Study oversight, secondary literature 

search and analysis, manuscript editing and revision. 

 

DECLARATION OF CONFLICTING 
INTERESTS 

The authors declared no potential conflicts of interest with 

respect to the research, authorship, and/or publication of 

this article. 

 

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