







































VOLUME 6, ISSUE 2 

 2023 
 

Articles in this special issue has been invited and reviewed by Dr. Silvia Ursula Raschke and Dr. Hossein Gholizadeh. 

 

D E S I G N I N G  T H E  F U T U R E :  3 D  P R I N T I N G ' S  

R E VO L U T I O N  I N  P RO S T H E T I C S  &  O R T HO T I C S  

S T A K E H O L D E R  P E R S P E C T I V E S   

PRINTING 

3D 

PUBLISHER: CANADIAN ONLINE PUBLICATION GROUP   

S P E C I A L  I S S U E  

CPOJ 

ISSN: 2561-987X 

https://jps.library.utoronto.ca/index.php/cpoj/EDitorinchief


 

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Hovorka C.F. Leveraging digital workflows to transition the Orthotics and Prosthetics profession toward a client-centric and values-based care model. Canadian 

Prosthetics & Orthotics Journal. 2023; Volume 6, Issue 2, No.6. https://doi.org/10.33137/cpoj.v6i2.42221 

 

 

STAKEHOLDER PERSPECTIVES 

 

LEVERAGING DIGITAL WORKFLOWS TO TRANSITION THE ORTHOTICS AND 

PROSTHETICS PROFESSION TOWARD A CLIENT-CENTRIC AND VALUES-BASED 

CARE MODEL 

Hovorka C.F1-3*  

1 Center for the Intrepid, Department of Rehabilitation Medicine, Brooke Army Medical Center, San Antonio, TX, USA. 
2 Defense Health Agency, Falls Church, VA, USA. 
3 Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA. 
 
 
 

 

 

 

  

 

 

 
 

 

 

 

INTRODUCTION 

This commentary was adapted from a presentation that was 

awarded Best Paper for Advancing Education at the 19th 

World Congress of the International Society for Prosthetics 

and Orthotics in Guadalajara, Mexico. It was also presented 

at the British Columbia Institute of Technology’s Center for 

Applied Research and Innovation Workshop regarding the 

use of 3-D printing and digital workflows in the O&P and 

Assistive Technology professions. It addressed the 

question: “How do professional O&P clinician education 

programs keep pace with changing technology and make 

informed decisions on what to include in curriculum and 

when? Part 1 examines critical changes in healthcare and 

technology. Part 2 summarizes key challenges to the O&P 

profession  that  hinder  the  value  of  care. Finally,  Part  3  

 

 

 

proposes a solution that leverages the use of digital 

technologies in the O&P workflow process as a strategy to 

update the care delivery model to a client-centric and 

values-based approach and updates the role of the clinician 

as an O&P expert and healthcare technology manager. 

PART 1:  Changes in healthcare and technology impose 

challenges to the O&P profession. 

The Orthotics and Prosthetics (O&P) profession can only 

estimate the future healthcare economic determinants and 

market impacts and strategically position itself for change 

and likely cost-cutting measures ahead. In part 1, key 

challenges to U.S. healthcare that impact O&P are 

examined. A major challenge to the U.S. healthcare system 

is the persistent rise in expenditures which has influenced 

how healthcare is provided. Between 1970 and 2020, 

inflation-adjusted healthcare expenditures in the U.S. have 

risen from $300 billion to over $4 trillion and by 2030 are 

projected to exceed $6.7 trillion.1,2 Among the many 

reasons for this, five are notable including: a.) the rise in an 

aging population, b.) increasing multimorbidity, c.) 

proliferation of subspecialities, d.) culture of defensive 

medicine, and e.) increases in price/cost for care.3-5  

 
OPEN  ACCESS 

ABSTRACT 

The orthotics and prosthetics (O&P) profession has a history of responding to market demands in a 

reactive rather than proactive manner. This has created significant impacts including shrinkage in 

scope of practice and constraint in remuneration for professional services due to a fee-for-device 

third party payer system.  Rapid changes in technology and healthcare combined with an outdated 

device-centric reimbursement system are creating unprecedented challenges that threaten 

sustainability of the O&P profession. Hence, a reassessment of the value of O&P care, and the O&P 

workflow process is necessary to inform an update to the value proposition and practice model for 

sustainability. This article reviews key factors contributing to the current state of O&P, and potential 

solutions involving an update in practitioner competencies, and the care delivery model (from device-

centric to client-centric and values-based). Updates could be achieved by leveraging the use of 

digital workflows that increase efficiencies and enhance the value of clinical outcomes. Eventually, 

these updates could enable the O&P profession to elevate the value proposition that aligns with its 

most important stakeholders: client-patients and third-party reimbursement agencies in a rapidly 

changing technology and healthcare landscape. 

CITATION 

Hovorka C.F. Leveraging digital 

workflows to transition the Orthotics and 

Prosthetics profession toward a client-

centric and values-based care model. 

Canadian Prosthetics & Orthotics 

Journal. 2023; Volume 6, Issue 2, No.6. 

https://doi.org/10.33137/cpoj.v6i2.42221 

KEYWORDS 

Healthcare, Client-Centric, Values-

Based, Digital Workflow, Digital 

Technology, Competency, Curriculum, 

Orthotics, Prosthetics 

* CORRESPONDING AUTHOR: 

Christopher F. Hovorka, PhD, CPO, FAAOP 

Center for the Intrepid, Department of Rehabilitation Medicine, Brooke 
Army Medical Center, San Antonio, TX, USA. 

E-Mail: hovorkac@gmail.com 

ORCID ID: https://orcid.org/0000-0002-7147-3134 

Journal Homepage: https://jps.library.utoronto.ca/index.php/cpoj/index 

Volume 6, Issue 2, Article No.6, 2023 

 

 

Special Issue 

https://doi.org/10.33137/cpoj.v6i2.42221
https://doi.org/10.33137/cpoj.v6i2.42221
https://orcid.org/0000-0002-7147-3134
https://jps.library.utoronto.ca/index.php/cpoj/index


 

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Hovorka C.F. Leveraging digital workflows to transition the Orthotics and Prosthetics profession toward a client-centric and values-based care model. Canadian 

Prosthetics & Orthotics Journal. 2023; Volume 6, Issue 2, No.6. https://doi.org/10.33137/cpoj.v6i2.42221 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X LEVERAGING DIGITAL WORKFLOWS TO TRANSITION THE O&P PROFESSION 
Hovorka C.F, 2023 (Special Issue) 

a.) Rise in an aging population  

Recently, the share of the U.S. population age 65 and over 

has risen to 16% and is projected to reach 20% by 2030.6 

This is significant because aged persons over 65 spend 

more on healthcare than any other age group, hence growth 

in the number of older Americans is expected to increase 

total healthcare costs over time.7,8 Concomitantly, Medicare 

spending is projected to double over the next 30 years 

relative to the size of the economy.3  

b.) Increasing multimorbidity  

Over the past two decades, the U.S. population has 

experienced earlier onset of multimorbidity (>2 chronic 

diseases or medical conditions) which is associated with 

adverse health outcomes.5,9-12 In particular, the increase in 

multimorbidity burden has seen significant increases in 

cardiovascular, metabolic, endocrine, orthopedic, and 

behavioral disorders. Over the past decade, the onset of 

multimorbidity in the U.S. has occurred at comparatively 

younger ages beginning in midlife (e.g., persons aged 

between 40-50 years) resulting in an increasingly complex 

combination of conditions similar to older adults.11,12 This 

contributes to substantial costs for patients and health care 

systems. 

For rehabilitation professionals, the dramatic rise in 

prevalence of multimorbidity, particularly obesity,13,14 

cardiovascular disease, diabetes, arthritis, and cancer 15 

create challenges in the complexity of client-patient 

assessment and treatment due to the number of 

overlapping body systems influenced by these 

conditions.16,17 Adding to the complexity of care are 

emerging epidemics in opioid addiction and mental health 

disorders.18 

c.) Proliferation of subspecialities  

In 2010, nearly 65% of physicians practiced in non-primary 

care subspecialties and the number of subspecialists is 

projected to grow an additional 21% by 2025.19 This is due 

in part to the increasing number and complexities of client-

patients with multimorbidity. The proliferation of non-primary 

care subspecialists has produced a gap in primary care 

providers which is progressively being filled by nurse 

practitioner and physician assistant and expansion of their 

scope of practice.19,20 Substantial growth in non-physician 

providers is projected to increase to 43% of all non-primary 

care subspecialists by 2025.19 The impacts of these trends 

on O&P may influence the accuracy in referrals for O&P 

services as formal training and education in O&P for 

physicians, nurse practitioners and physician assistants is 

minimal.21-23   

d.) Culture of defensive medicine 

The practice of defensive medicine – a strategy of 

healthcare provision to adhere to standards of care in 

addition to reducing risk of litigation has contributed to 

redundancies in care delivery. This has been associated 

with a proliferation of diagnostic tests and other 

redundancies and inefficiencies in the care delivery 

process24 and may be associated with the decline of primary 

care physicians.4,5 These redundancies and inefficiencies 

contribute to increases in the costs for healthcare.  

e.) Increases in price/cost for care 

Increases in the price/cost for healthcare are due to a 

multitude of factors including those previously discussed 

that create a culture of fragmentation of care due to the 

multitude of subspecialist care providers delivering 

overlapping services with limited collaboration and 

communication.1,16,17,25-27 Given the persistent rise in 

healthcare expenditures and costs, is not surprising that 

alternative strategies and care delivery models are 

emerging as cost containment strategies,27 These 

strategies will be covered in Part 2. 

PART 2: U.S. Healthcare is transitioning toward client-

centric and values-based care. 

Client-centric and values-based care is part of a larger U.S. 

national quality strategy to reform how healthcare is 

delivered and reimbursed.28 The end goal of this approach 

is that third party payers incentivize and reimburse health 

care professionals for quality rather than quantity of 

services they provide.29 In O&P, the traditional device-

centric model of care may minimize the wider value 

proposition for client centric and values-based care. The 

fee-for-device model of care in O&P not only constrains the 

economic sustainability of O&P provision of care, but it also 

erodes the value proposition by neglecting the impact on the 

client-patient’s function and wellbeing. This is a major 

challenge for the O&P profession because it hinders the 

O&P profession in providing what reimbursement agencies 

want to know regarding the value of O&P service to the 

client-patient that answers key questions such as: 

•How effectively does O&P service provision meet the 

client-patient’s values, needs and goals? 

•How effectively does O&P service provision improve the 

client-patient’s health and reduce their disability including 

the costs for healthcare?  

U.S. O&P Masters Curriculum Guidelines are device 

(not client) centric 

Academic programs training O&P clinicians can influence 

the quality and capabilities of the workforce.30 Hence, the 

nature of the curriculum and training influences the 

capabilities of graduates and their ability to adapt to market 

demands. But when curriculum does not address market 

demands, challenges to its workforce become evident.  This 

is the case with current U.S. O&P master’s curriculum 

consisting of device-centric accreditation guidelines and 

https://doi.org/10.33137/cpoj.v6i2.42221


 

3 
Hovorka C.F. Leveraging digital workflows to transition the Orthotics and Prosthetics profession toward a client-centric and values-based care model. Canadian 

Prosthetics & Orthotics Journal. 2023; Volume 6, Issue 2, No.6. https://doi.org/10.33137/cpoj.v6i2.42221 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X LEVERAGING DIGITAL WORKFLOWS TO TRANSITION THE O&P PROFESSION 
Hovorka C.F, 2023 (Special Issue) 

standards for teaching O&P device design, manufacturing 

and fitting.31 Content on client-centric and values-based 

care principles and care provision methods is limited. 

Notable omissions in core curriculum are: a.) evaluating 

client-patient’s additional body systems function beyond the 

muscular, neurological, skeletal and integumentary 

systems, b.) creating and prioritizing the client-patient 

problem list, c.) creating / defining client-patient goals and 

values using systematic and measurable strategies, d.) 

formulating and executing evidence-based treatment plans 

to achieve client-patient goals and values, e.) systematically 

assessing treatment outcome, and f.) updating the 

treatment plan as changes occur over the course of the 

client-patient’s diseases or conditions, and g.) engagement 

in substantive scholarly activity. Further, there are limited 

guidelines regarding practitioner competencies (knowledge, 

skills, behaviors, traits) in the following key roles including: 

a.) research and scholarship, leadership, collaboration, 

communication, professionalism; and management of 

healthcare technologies. 

Recently, the National Commission on O&P Education 

(NCOPE) spearheaded a summit meeting to evaluate the 

state of U.S. O&P curriculum.32 Stakeholders included were 

educators, accreditation agencies, clinicians and 

representatives from the scientific, business and 

credentialing agencies in O&P (e.g., NCOPE, American 

Board for Certification in O&P and Pedorthics, American 

Academy of O&P, American O&P Association). 

Unfortunately, other key stakeholders such as third-party 

payers, other healthcare and related professions (e.g., 

Medicine, Dentistry, Podiatry, Occupational Therapy, 

Physician Assistant, Nursing, Engineering) and O&P 

technology disruptors were omitted. 

The goal of the meeting was to identify critical challenges to 

the O&P workforce and the requisite updates to curriculum 

needed to align the workforce for changes in technology and 

healthcare. Preliminary findings were that the device-centric 

model of reimbursement hindered the practice model of 

care and the need to consider methods that increase 

efficiencies in the O&P workflow.32  

PART 3: Leverage digital technologies that enable an 

update in the O&P curriculum to client-centric and 

values-based care. 

Healthcare in the U.S. is moving from the traditional fee-for-

service (e.g., fee-for-device in O&P) and volume-based 

reimbursement to one that is value based, due to national 

mandates.33 In order to improve value in health care 

delivery, we must improve the education for those providing 

health care.34 In Orthotics and Prosthetics, there is 

opportunity to update education through strategic 

curriculum changes that focus on strengthening a 

practitioner’s skillsets in digital health technologies (i.e., 

data science, artificial intelligence) to enable evidence-

based clinical decision-making, combined with the mastery 

of digital shape capture and additive manufacturing 

processes to improve efficiencies in the O&P workflow. By 

doing so, future O&P clinicians could solidify their role.30 

Strategic implementation of digital health technologies 

(including 3-D shape capture, 3-D printing) has shown 

promise in improving efficiencies in the O&P manufacturing 

workflow compared to traditional artisanal workflow 

methods which require specific skills of the craft including 

substantial capital investment such as large overhead costs 

for production, machinery, equipment and skilled labor35  

(Figure 1). 

 

 

Figure 1: Comparison of workflow processes in Orthotics and Prosthetics. Typical artisanal workflow (top image) and digital workflow 

(bottom image). 

 

 

 

 

 

3   Scanning 

D
IG
IT
 
L

 

3    igital  ectification 3   Printing 

DIGIT L  OR SHOP 

Cast Impression Taking Create Positive Model  ectify Positive Model Thermoforming Laminating Trimming &  inishing 

T
 
P
IC
 
L

 

T PIC L PH SIC L   NUF CTURING  OR SHOP 

https://doi.org/10.33137/cpoj.v6i2.42221


 

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Hovorka C.F. Leveraging digital workflows to transition the Orthotics and Prosthetics profession toward a client-centric and values-based care model. Canadian 

Prosthetics & Orthotics Journal. 2023; Volume 6, Issue 2, No.6. https://doi.org/10.33137/cpoj.v6i2.42221 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X LEVERAGING DIGITAL WORKFLOWS TO TRANSITION THE O&P PROFESSION 
Hovorka C.F, 2023 (Special Issue) 

The digital workflow has the potential to enable efficiencies 

in time, resources and costs compared to the typical 

artisanal workflow process. Specifically, there is potential 

for digital workflow to improve efficiencies in the design and 

manufacturing process in O&P as these methods are 

innovative and highly scalable utilizing less subjective, more 

reproducible and potentially cost-effective methods.36 

Advances in digital technology keep transforming 

healthcare, and from a training and education perspective 

these technologies have the advantage of providing more 

reliable feedback than traditional artisanal methods.30,37-40 

Specifically, 3-D digital shape and rectification technologies 

can be used to characterize and quantify student 

competencies in executing task-specific methods in client-

patient functional assessment and in the design and 

manufacturing process.38 Historical logs that quantify 

student performance in achieving milestones for shape 

capture, rectification and manufacturing quality can be 

quantified and characterized using digital records whereas 

traditional artisanal methods are less reliable and more 

subjective. Hence digital technologies can leverage new 

opportunities to target student learning and retention.41 As 

such, the potential for digital technologies to add utility and 

workflow efficiency creates opportunity to update other key 

elements of curriculum and education. This is discussed in 

the next section. 

FRAMEWORK 1: CanMEDS client-centered practitioner  

Training and education of clinical care providers requires 

that students achieve a level of competence in knowledge, 

skills, abilities, and traits and demonstrating these safely 

and effectively within a scope of practice. Measuring 

competence is essential for determining the ability and 

readiness of healthcare professionals to provide quality 

services.42 Because the O&P Master’s Curriculum Guide 

lists curricular topics and device-specific standards, a 

proposed competency-based framework that clearly 

identifies roles of the practitioner that enable service 

delivery could address gaps in content and conceptual 

framework of an O&P practitioner with transferrable 

knowledge, skills, abilities, and traits. A practitioner 

framework known as the Canadian Medical Education 

Directives for Specialists (CanMEDS) provides a 

practitioner competency framework developed by the Royal 

College of Physicians and Surgeons and contains many 

elements that can be adapted to the roles and 

competencies of an O&P practitioner.43-45 The CanMEDS is 

a set of competencies that are grouped thematically into 

seven roles (health advocate, communicator, collaborator, 

leader, scholar, professional and medical expert) deemed 

essential for effective healthcare provision. The framework 

is used for the education of physicians in Canada and is 

aimed at enhancing client-patient care and has been 

recognized globally. Each role is subdivided into key 

competencies that describe the knowledge, skills, abilities 

and traits in measurable and relevant elements that can be 

used to gauge student learning. Therefore, the CanMEDS 

practitioner framework provides a competency-based 

teaching structure that has the potential for more targeted 

and measurable learning outcomes.   

 

Figure 2: Modified CanMEDS practitioner framework for Orthotists 

and Prosthetists. The original practitioner framework created by the 

Royal College of Physicians and Surgeons was modified for O&P 

by updating the roles from “Medical Expert” and ‘Healthcare 

Advocate” to “O&P Expert” and “Technology Management”. Image 

adapted from the CanMEDS Physician Competency Diagram with 

permission of the Royal College of Physicians and Surgeons of 

Canada.  

The CanMEDS framework can be adapted to the O&P 

clinical practitioner and scope of practice by replacing the 

roles of “Medical Expert” to “O&P Expert” and “Health 

Advocate” to “Technology Management” (Figure 2). These 

updates expand the O&P scope of practice for adapting to 

changes in technology and healthcare. 

The Technology Management role expands the O&P 

practitioner competency for adapting to changes in 

technology.45 The O&P Expert is the integrator role that 

further expands the O&P practitioner competency required 

for managing the values, needs and priorities of the client-

patient as well as other stakeholders such as the referral 

source and third-party payers. Hence, the role of O&P 

Expert requires the integration of all other roles (e.g., 

scholar, communicator, collaborator, professional, leader, 

technology management). As such, the revised O&P 

practitioner framework broadens the roles that includes 

medical-clinical focus and guidance of client-patients in 

navigating the increasing number of technology options.44,45  

Professional Communicator 

Collaborator 

Leader 

Scholar 

O&P 
Expert 

Technology 

Management 

https://doi.org/10.33137/cpoj.v6i2.42221
https://www.royalcollege.ca/en/canmeds/about-canmeds.html
https://www.royalcollege.ca/en/canmeds/about-canmeds.html


 

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Hovorka C.F. Leveraging digital workflows to transition the Orthotics and Prosthetics profession toward a client-centric and values-based care model. Canadian 

Prosthetics & Orthotics Journal. 2023; Volume 6, Issue 2, No.6. https://doi.org/10.33137/cpoj.v6i2.42221 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X LEVERAGING DIGITAL WORKFLOWS TO TRANSITION THE O&P PROFESSION 
Hovorka C.F, 2023 (Special Issue) 

Two additional complimentary curricular frameworks (ICF 

and POP) are needed to address demands on the O&P 

clinician for the provision of client-centric and values-based 

care that includes the client-patient in decision making. One 

framework (ICF) is needed for clinician thoroughness by 

employing the International Classification of Functioning, 

Disability and Health (ICF) and another framework (POP) is 

needed for clinician efficiency by employing the Prosthetic 

Orthotic Process. 

FRAMEWORK 2: ICF client-centric and values-based 

care provision 

The International Classification of Functioning, Disability 

and Health (ICF)46-48 is a framework for understanding the 

“whole” client using a broader perspective. The IC  views 

function and disability as an interaction between the person 

and his/her/their world (Figure 3). It is used as a clinical 

practice framework for O&P professionals to develop more 

informed client-centric and values-based perspectives. The 

approach has been implemented globally in O&P in 

Australia, Europe and India.49-52 It encourages the O&P 

practitioner to consider additional factors in the plan of care 

as part of a more comprehensive and holistic 

biopsychosocial perspective. 

 

Figure 3: International Classification of Functioning, Disability and 

Health. Adopted from ICF, Geneva, Switzerland, World Health 

Organization, 2001; License CC BY-NC-SA 3.0 IGO 

 

FRAMEWORK 3: POP client-centric and values-based 

care provision 

The Prosthetic and Orthotic Process (POP) is a service 

delivery framework that adapts the ICF to clinical O&P 

processes (Figure 4).52 Using this approach, the client-

patient’s goals related to activities are realized by an O&P 

treatment plan. This method utilized by the O&P 

professional, enables the client-patient to achieve goals 

related to body functions and structures. It consists of four 

steps in a cycle: 1.) Assessment (including medical history 

and physical examination/review of systems of the client-

patient. 2.) Goals, specified on four levels including those 

related to participation, activity, body functions and 

structures and technical requirements of the O&P 

technologies. 3.) Intervention, in which the appropriate 

course of action is determined based on the specified goal 

and evidence-based practice. 4.) Evaluation of outcomes, 

where the outcomes are assessed and compared to the 

corresponding goals. After evaluation of goal fulfillment, a 

broad evaluation is then made including questions about the 

client-patient’s satisfaction with the outcomes and the 

process. This evaluation determines if the process is ended 

or if another cycle in the process should be initiated.52 

CALL TO ACTION 

Increasing costs of care and the need for cost cutting, the 

complexity of healthcare, and advances in technology, 

continue to challenge the O&P profession. There is an 

opportunity to proactively address gaps in the O&P master’s 

curriculum that omit the wider scope of competencies to 

manage client-patients for client-centric and values-based 

care. These gaps could be addressed by including the 

modified CanMEDS competency-based framework to 

enhance the knowledge, skills, abilities and traits of the O&P 

practitioner.  Two complimentary practice frameworks (ICF 

and POP) can further enable O&P practitioners to overcome 

increasing demands for thoroughness and efficiency 

required in modern healthcare by leveraging the use of 

digital technologies to improve efficiencies in the O&P 

workflow. Hence, the three frameworks can inform a more 

comprehensive approach for O&P client-centric and values-

based care.  

Transition of the proposed new curriculum has the potential 

to more effectively enable O&P clinicians to address the 

client-patient’s values and priorities and select the optimal 

combination of technologies that meet client-patients’ needs 

and to deliver the wider value proposition. Moreover, a 

modernized and reconceived practitioner as O&P Expert 

and Healthcare Technology Manager that directs greater 

attention to client-centric and values-based care would be 

able to distinguish themselves as a unique and valuable 

professional asset as an interdisciplinary health care team 

member. Therefore O&P education transition is crucial to 

the evolution of the profession, especially considering 

unprecedented challenges ahead. 

 

 

 

Health Condition  
(disorder or disease) 

 

Participation 

 

Activities 

 

Body Functions 

and Structures 

 

Environmental 

Factors 

 

Personal 

Factors 

https://doi.org/10.33137/cpoj.v6i2.42221


 

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Hovorka C.F. Leveraging digital workflows to transition the Orthotics and Prosthetics profession toward a client-centric and values-based care model. Canadian 

Prosthetics & Orthotics Journal. 2023; Volume 6, Issue 2, No.6. https://doi.org/10.33137/cpoj.v6i2.42221 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X LEVERAGING DIGITAL WORKFLOWS TO TRANSITION THE O&P PROFESSION 
Hovorka C.F, 2023 (Special Issue) 

ACKNOWLEDGEMENTS 

The author acknowledges Ben Lucas, MSPO, CPO who 

contributed to this paper by sharing his perspectives regarding the 

CanMEDS and ICF frameworks from the lens of a clinician and 

educator; Silvia Raschke, PhD, CO(c) who shared her perspectives 

regarding a proposed technology management competency in the 

O&P practitioner framework from prior O&P future scan and 

workforce needs analyses; and Kristin Carnahan, MSPO, CPO, 

FAAOP and Kari Pichora, MSPO, CPO who shared their 

perspectives as clinician educators. 

DECLARATION OF CONFLICTING INTERESTS 

The views expressed herein are those of the author and do not 

reflect the official policy or position of the Brooke Army Medical 

Center, the Department of Defense, Defense Health Agency, or any 

agencies under the U.S. Government. 

SOURCES OF SUPPORT 

No grants or support. The author was employed as a member of 

the faculty at Midwestern University, Glendale, AZ, USA during a 

portion of development of the three curricular frameworks. 

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Figure 4: The Prosthetic and Orthotic Process. Adopted from Jarl G and Ramstrand N. A model to facilitate implementation of the 

International Classification of Functioning, Disability and Health into prosthetics and orthotics. Prosthet. Orthot. Int. 2018:42(5):248-275. DOI: 

10.1177/0309364617729925 

 

 

2. Goals 
Participation  

Activities 

Body functions and structures 

Device 

4. Evaluation of outcomes 
Participation  

Activities 

Body functions and structures 

Device 

 

3. Intervention 

 

1. Assessment 

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Hovorka C.F. Leveraging digital workflows to transition the Orthotics and Prosthetics profession toward a client-centric and values-based care model. Canadian 

Prosthetics & Orthotics Journal. 2023; Volume 6, Issue 2, No.6. https://doi.org/10.33137/cpoj.v6i2.42221 

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AUTHOR SCIENTIFIC BIOGRAPHY 

Christopher F. Hovorka, PhD, 

CPO, LPO, FAAOP. Dr. Hovorka 

completed Bachelor’s degrees in 

Exercise Science (University of 

New Mexico) and Prosthetics and 

Orthotics (University of 

Washington), clinical residencies 

in Orthotics (Southern Illinois 

University School of Medicine) 

and Prosthetics (Connecticut 

Children’s Medical Center, 

formerly Newington Children’s Hospital), a Master’s degree in Allied 

Health Science (University of Connecticut) and PhD in Applied 

Physiology with focus in Biomechanics and Neuromotor Control 

(Georgia Tech). He held faculty appointments at the University of 

Texas Southwestern Medical Center, St. Ambrose University, 

Georgia Tech, University of Pittsburgh, East Tennessee State 

University and Midwestern University. He has received continuous 

research grant funding for over 20 years, in areas ranging from 

cognitive / skills learning and curriculum development to the 

neuromechanics and clinical outcomes of persons using lower limb 

prostheses, orthoses and footwear. He also developed the nation’s 

first accredited entry-level master’s degree in Orthotics and 

Prosthetics (O&P) at Georgia Tech. Creation of that program 

sparked a national reassessment of the entry-level standards in 

O&P, and eventually adoption of the master’s degree as the entry-

level standard for O&P in the United States. Currently, he is an 

Established Scientist Fellow at the Center for the Intrepid, 

Department of Rehabilitation Medicine, Brooke Army Medical 

Center, San Antonio, TX, USA and is affiliated with the Defense 

Health Agency, Falls Church, VA, USA and Oak Ridge Institute for 

Science and Education, Oak Ridge, TN, USA. 

https://doi.org/10.33137/cpoj.v6i2.42221
https://www.royalcollege.ca/rcsite/canmeds/canmeds-framework-e
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https://www.google.com/books/edition/International_Classification_of_Function/SWFQDXyU-rcC?hl=en&gpv=1&pg=PR5&printsec=frontcover
https://www.google.com/books/edition/International_Classification_of_Function/SWFQDXyU-rcC?hl=en&gpv=1&pg=PR5&printsec=frontcover

