Gazettethe THE NEWSLETTER OF THE AUSTRALIAN ORTHOTIC PROSTHETIC ASSOCIATION INC.

Volume 12 - Issue 2 / June 2012

Prosthetic management of hemipelvectomy with tibia- hindfoot rotationplasty with calcaneo-sacral fixation: a case study

In This Issue President’s Report 3 Office and Membership Report 3 The Extra Ordinary General Meeting: 4 3D reconstruction demonstrating Summary of Outcome Anterior View calcaeno-sacral fixation and the new thigh segment (Kong et al., 2008). Member Biography: Louise Puli 4 The AOPA Strategic and Operational Plan: 7 Progress Report Prosthetic management of hemipelvectomy with 8-9 tibia-hindfoot rotationplasty with calcaneo-sacral fixation – a case study State Section Reports 10-11 Report on the recent review of the NSW Prosthetic 13 Limb Scheme Consultation with DVA: Mobility and Functional 13 Posterior-Lateral Support Guidelines View AOPA PEG recipient calls for volunteers 15 AOPA Member Consultation: Preliminary notification 15 Worksafe orthotic & prosthetic: policy changes 15

President’s Report Office and Membership Report

As health reform progresses, the efficient and It’s hard to believe that half the year has disappeared already. The Office accountable means by which the nation’s health has been busy this last quarter progressing key areas that impact many care needs are addressed is still in a degree of flux. Association members. We have submitted a request for review to the The manner in which professions define themselves Australian Bureau of Statistics (ABS) regarding the Australian and New and demonstrate their ability to provide essential, Zealand Standard Classification of Occupations (ANZSCO) codes. These cost effective benefits for specific client groups, will codes are used to define occupations and occupational areas. They provide continue to determine shifts in professional ‘territory’ key statistics in workforce reform, and other workforce decisions, such as for many years to come. Public and private, rural and Immigration. The recent removal of orthotist/prosthetists from the immigration urban elements of our profession need to expand department’s Skilled Occupations List (SOL), which governs skilled in order to ensure continued access to professional migration, was in part due to projected workforce growth according to the orthotic and prosthetic services. ANZSCO code. The AOPA has submitted our concerns with the orthotist/ prosthetist classification, descriptors and key professional tasks. These will The AOPA National Council continues to correspond be addressed in the 2012 review, whilst a possible reclassification may be with some members who have concerns relating considered in future minor reviews. to the recent increase in membership fees. Considerable thought and discussion was given The AOPA Office and executive committee has also been heavily involved to the increase in AOPA Office capacity that was in the review of the recently released EnableNSW documents. Three Rivers minimally and reasonably required in this time of Consulting released their report of findings regarding the EnableNSW reform. The Association had significantly increased Prosthetic Limb Service. These were published on the EnableNSW website all other means of revenue generation and simultaneously with the new, draft Guidelines for PLS Funding. The AOPA limited options remained to meet these essential fully supports the recommendations made by Three Rivers Consulting demands. The AOPA Office continues to update the and looks forward to the development of an action plan for roll out and membership on developments, provide informed implementation. The response from AOPA regarding the draft Guidelines analysis and advise on proposed actions. for PLS Funding and Interim Services is available on the website and we encourage all NSW members to be familiar with AOPA’s stance regarding this The AOPA National Council and Office monitor the draft. Further detail of these consultations is provided in this edition. larger picture and designate available resources towards initiatives that are likely to ensure long term The EO in conjunction with Jackie O’Connor (AOPA Vice-president) has formal recognition and growth of our profession. begun consultation with Worksafe (Victoria) regarding the registration of Individuals amongst the wider membership are orthotist/prosthetists to provide clinical services with Worksafe. Worksafe vital contributors to this process, often alerting the falls under the Health Services Group which incorporates TAC, and much National Council to risks and opportunities as they of their new P&O policies will reflect TAC policies. We have been afforded arise. Demonstrating our professional indispensability an opportunity to provide feedback regarding these policies and have had and acting within an interdisciplinary context will positive and collegial meetings to date. Further information from Worksafe is greatly influence opportunities for growth that can provided in this edition. occur at the local level. One such way is to become involved with your Medicare Local advisory group In recent weeks you will have received your membership renewal notice. The as they work to identify how service gaps can most membership fee has increased to reflect the member vote for increased fees efficiently be met, whilst providing a referral link at the Extraordinary General Meeting (EGM) on May 3rd 2012. All fees have between GPs and the local allied health services. We increased proportionately, including the minimum part-time fee. The National are currently not formally linked in with online care Council has permitted a grace period for membership renewals this year, with plans and access to E-health records and referral an extension of the early-bird deadline to the 31st July 2012. CPD logs must systems, however our visibility, integration and local be updated and meet the minimum 30 points in order for the membership leadership in this area will prove invaluable. The renewal to be processed. Please visit the website and review your CPD log Office will provide further information and updates on status. To access your CPD record, log in using your member number for the roll-out of the Medicare Local scheme, which will your Username and your surname in upper case as your Password commence on the 1st July 2012. (ie. 927, SMITH).

th Members Number The National Council are currently working through Our membership statistics as of the 7 the tasks that fall directly under the 2011/12 May 2012 are outlined in the table below. Full time 230 Strategic and Operational Plan, the details of We are pleased to report an increase Part time 32 which are outlined in this edition of the Gazette. As in membership numbers. We welcome Student 30 always, the Association is grateful for contribution student members Shane Grant, Zoe Leave of absence 21 from volunteer members and I encourage anyone Johnson, Hannah Ozturk, Matthew Retired 8 interested in furthering the profession to ensure their Quigley, Edward Levy, Emma Robinson, Life 7 and Amy-Beth Seeley and full members Total practicing names are listed on the ‘Volunteer Register’ held by 262 the Office. We will be making contact with volunteers Emily Duke, Sonia Singh, Karyn Duff, members* Total Members 328 as some of these projects begin to expand and Kate Perlstein, Natalie Hobbs, and Lynne progress. Tait to the Association. * Based on ABS census 2006, AOPA members represent 76% of the profession Richard Dyson-Holland We look forward to a productive second President, The AOPA Inc. half of the year and the progression of major Association tasks. [email protected] Please continue to make your enquiries to the Office via phone or email.

Leigh Clarke and Sue Laksassi Executive Officer and Administration Officer, The AOPA Inc. [email protected]

The Gazette / Volume 12 - Issue 2 / June 2012 / 3 The Extraordinary Member General Meeting: Biography: Summary of Outcome Louise Puli

On the 3rd May 2012 the membership gathered across all states for an Please welcome to the stage Extraordinary General Meeting (EGM). This meeting was conducted Miss Louise Puli, a hardworking via teleconference, with a total of 11 sites and more than 80 members AOPA National Council member attending. A total of 80 votes were placed including proxies. This for the state of Victoria. Louise is represented 30% of the membership with voting rights. A single a clinician at the Royal Children’s motion was presented to the membership during this meeting: Hospital and has demonstrated unbelievable commitment by preparing a member biography for “We move to accept a change to the AOPA membership fee to the Gazette all the way from Cambodia! $620- GST inclusive, commencing 30th June 2012, and changes to all other membership fees that are calculated in reference to 1. What made you interested in P&O as a career? this fee (such as early bird and part time membership fees)”. I had no idea what I wanted to do upon graduating High This motion was proposed following National Council endorsement School… I chose P&O because it sounded so fascinating and at the March meeting to increase staff hours. Specifically, increasing varied – enough to keep me interested and not get bored! I love the Executive Officer by 8 hours per week (bringing the total to the ‘hands on’ nature of P&O, the behind the scene design and 23) and the Administrative Officer by 6 hours per week (bringing mechanical aspects of our profession. the total to 26), bringing our staff weighting to approximately 1.3 2. Tell us a bit about your clinical background, where you’ve FTE. The total cost of making these changes was projected to worked and what roles you’ve undertaken? be approximately $35,000 per annum. Therefore, the Honorary Treasurer and National Council called for membership dues to be I began my career at Sydney Children’s Hospital – a hospital increased by approximately 30% to fund the increase in staff hours. for kids situated by the beach, that’s hard to beat! I returned to With recent changes in practice, including the introduction of a Melbourne 3.5 years ago when I received a permanent position at National Congress to increase revenue, the Association’s finances the Royal Children’s Hospital. The RCH is amazing. We are very are in a strong position, with small surpluses recorded in previous fortunate to have a whole new department, along with some great years. The National Council believe that despite these reserves, technological updates including a CAD CAM system. We have it remains in the best interest of the Association to be aiming for a brilliant, hard working team who still find time to have a laugh balanced budgets or small surpluses. whilst doing an amazing job with their patients. By increasing the membership dues to this level, AOPA 3. What is your preferred clinical area? membership fees will still be well below the comparable range of It’s hard to say as I am always learning and yet to experience the like associations. The additional revenue will allow The AOPA to full breadth of P&O clinical work. I’m interested in corrective spinal participate more fully in: bracing, and was surprised by the relationships formed with each • aids and Equipment reforms, such as the recent SWEP child and family faced with scoliosis and kyphosis. It can be a changes, and EnableNSW consultations; stressful time for everyone involved and I find the ability of children • Health Workforce Australia reforms, including participation in to comply with wearing any form of spinal bracing very inspirational. data collection, workforce projections and migration issues; 4. What aspects of P&O service and care do you find exciting • progression of professional registration/regulation opportunities, at the moment, from a clinician and patient perspective? through our involvement with AHPA and the National Alliance of I find CAD CAM extremely exciting for the potential efficiency and Self-regulating Health Professions; improvements to our service. It cuts out a huge step in the process • National Disability Insurance Scheme integration; and of setting up, filling and modifying plaster casts (a 120kg child’s cast • general business in improving professional positioning and can take up to 6 buckets of plaster to fill and the cast can weigh conditions, including the development of a full suite of position more than 80kgs!). Allowing our technicians to allocate this time to papers, policies and procedures, to prepare the Association and other tasks is fantastic. These time savings mean we can see more profession for improved self-regulation. patients and hence increase the availability of appointments. At the May EGM, the motion for an increase to fees was carried 5. What are the best things about living in Melbourne? with a 56 to 24 vote in favour. Therefore, you will have noted the The weather? Only joking. Did I mention I am in Cambodia right increased fee structure within your membership renewal notice now? Escaping Melbourne’s winter and enjoying a balmy 34 which should have been received mid-May. With this increase in degrees… What I love about Melbourne is the ease of weekend fee, the National Council also extended the Early Bird period to camping getaways and the great hikes and mountains to climb. July 31st, ensuring a greater percentage of the membership are able to take advantage of the 20% early bird discount. 6. If every weekend was 4 days long, where would we find you? National Council would like to thank the membership for their I’m a new home owner so most weekends have found me either support and understanding of this critical step. We believe we are in my garden or navigating Bunnings to get kitted out for the next transforming AOPA into a nimble and modern association, capable of D.I.Y. project. delivering direction and value to our membership in a rapidly changing 7. What do you predict will be the next great opportunity for health and political environment. It is essential that we have the our profession? membership’s continued support, and we therefore make ourselves available for further discussion. Please contact the Office or your state I’m not sure what it will be in Australia – the NDIS, HWA, representative. We continue to urge members to become involved in registration, immigration recognition or huge pay rises for all!!? what is an exciting period for orthotics and prosthetics in Australia. Whichever it is, it will be due to the tireless work of the National Council and all the state teams. We are such a small profession Richard Dyson-Holland in the scheme of things, and the Association is working hard President, The AOPA Inc. towards some tremendous goals which will change and improve [email protected] the profession for us all.

4 / June 2012 / Volume 12 - Issue 2 / The Gazette

The AOPA Strategic and Operational Plan: Progress Report

The National Planning Day held in November 2011 enabled the The EO is part of the Health Workforce Australia Standing Advisory National Council to discuss key areas of strategy and action for Committee and is therefore aware of key workforce reform activities. In 2012. From this the 2012 Strategic and Operational plan was the last 6 months the National Council has approved a robust plan of developed. This plan provides the AOPA Office and National action for developing new Membership Application Procedures which Council with focus and direction for key activities to be undertaken will assist internal processes and aid the processing of applications throughout the year. As we have already reached the halfway from practitioners with international qualifications. We have made mark, the Office is taking this opportunity to report our progress to submission to the Immigration Department regarding the profession’s the membership in regards to the three key goals and underlying Migration status and await the outcome of this review in July 2012 objectives of the 2012 Strategic and Operational plan. with the release of a new Skilled Occupations List. Alongside our Goal One: To promote the profession and its role at the consultation with DVA we continue to strive for Medicare Benefits policy level, the professional level and to the public. recognition through the development of draft service descriptors and a The AOPA staff and National Councillors continue to promote the revision of the orthosis schedule. We are awaiting the outcome of the profession at a variety of levels through numerous activities. In the DVA review of these documents, before further review and action last 6 months the EO and NC have been active in the following with MBS and Private Health Insurance companies. committees and consultations: 4. To encourage more AOPA members to partake in achieving the • Current Member of the Board of Directors for Allied Health AOPA’s objectives through participating in working parties and Professions Association and attends monthly meetings, providing contributions. • Attends quarterly Health Workforce Australia Standing Advisory Increased member contribution has been seen in working parties Committee meetings, such as the Congress and Education Committee. Some key tasks • Attends regular meetings of the National Alliance of Self- of the Office have been distributed to volunteers, such as Gazette Regulating Health Professions Editor and Website Coordinator. We currently have a ‘Volunteer • Submission to EnableNSW regarding Draft Guidelines for the Register’ and continue to contact members from the list as Prosthetic Limb Service and The Three Rivers Consultation report relevant projects arise. In future, the Office will be emailing the list • Submission to DVA and consultation regarding service identifiers inviting member involvement in specific projects and tasks. Please and descriptors for Orthotists for the provision of pre-fabricated contact the Office to ensure your name is on this register should orthoses and associated clinical services you wish to participate in Association activities. • Submission to Australian Bureau of Statistics for review of orthotist/prosthetist classification and descriptors in the Goal Two: To provide services to members ANZSCO occupations codes 1. Update and maintain relevancy of information content and • Consultation with Worksafe regarding the prosthetic pre-approval functions of the AOPA Website pathway and minimum insurance requirements for prosthetists A Web Coordinator has been appointed and we will begin seeking • Promotion of the profession at the public level through guest quotes for website redevelopment. The Web Coordinator will be speaking opportunities and displays at conferences such as the consulting with the membership later this year to capture thoughts and Limbs4Life Expo in October 2012 and consultation with media ideas regarding the desired features and usability of the AOPA website. such as the Geelong Advertiser and BRW magazine. 2. Maintain and review the Continuing Professional Development This goal has the following four objectives and tasks, with specific processes. progress detailed underneath The CPD committee is currently reviewing the policies and 1. Participating in and ensuring inclusion of Prosthetics and Orthotics procedures of the CPD program and accreditation process. in the National Disability Insurance Scheme transition process Member consultation on a revised CPD kit will occur later this year. There has been no required action in this area since the release of the Commissioners Report. The Association can expect further Goal Three: To provide effective and sustainable consultation as the NDIS project moves towards Stage 1 roll out administration in 2013. 1. To create Operational Procedures Manuals to further 2. Ongoing development of the pathway to National Registration operational clarity, transparency and sustainability of the AOPA of the Profession office procedures. The National Alliance for Self-Regulating Health Professions The Office continues to develop procedures and policies as recently distributed a proposal for authorised self-regulation to their need comes to our attention. Publication of Guidelines and more than 80 key political stakeholders. The Alliance has received Position Statements will be ensuing over the next 12 months. numerous responses and was invited to discuss the proposal with In the very near future, members can expect to be consulted the Australian Health Practitioner Regulatory Agency. The Alliance on the recently developed Scope of Practice as well as revised is also lobbying for the proposal to be placed on the agenda of Competency Standards. the next Health Workforce Principle Committee meeting and to be reviewed by representatives of the Health Minister’s Advisory We hope that this update on the progress of the 2012 Strategic Council. This significant progress will be further supported by and Operational plan has been informative and aided the the recently developed Information Sheet which provides further understanding of AOPA National Council and Office activities. clarification of key concepts since the distribution of the original Please do not hesitate to contact the Office should you have any proposal. This document will be made available to the membership queries or if you are available to provide support in any of the key via the AOPA website once it has been publicly released. strategic areas. 3. Continued development of the Prosthetic and Orthotic Leigh Clarke workforce and recognition of the profession both domestically Executive Officer, The AOPA Inc. and internationally, [email protected]

The Gazette / Volume 12 - Issue 2 / June 2012 / 7 Prosthetic management of hemipelvectomy with tibia-hindfoot rotationplasty with calcaneo-sacral fixation: a case study

Katrina McGrath and Ella Nicolson Orthotic Prosthetic Services Tasmania

For patients diagnosed with cancerous lesions of or about the hip, hemipelvectomy amputations are often the only surgical life saving option. Unfortunately, hemipelvectomies are often associated with high morbidity and poor quality of life (Kong et al., 2008). Patients often have difficulty sitting due to the absence of the pelvic structure and thigh musculature and sometimes require the use of a customised sitting socket. Fitting of a prosthesis is often difficult and the energy cost of walking is very high. The poor cosmesis of the amputation can also lead to body image issues. Figure 2. Anterior proximal (left) and Surgeons at St. Vincent’s Hospital in Melbourne have pioneered anterior distal (right) x-ray of XP’s a reconstructive procedure aiming to improve the functional residuum following surgery. outcome and cosmesis for patients following a hemipelvectomy.

The focus of our case study is XP, a 40 year old male construction and had no significant pain issues. An x-ray of XP’s residuum manager who was diagnosed with a left hip osteosarcoma in can be seen in Figure 2. XP was very keen to commence 2010. XP was referred to St. Vincent’s Hospital for orthopaedic prosthetic management. One of his main goals was to return to management and he underwent a left hemipelvectomy with work, primarily in a more administrative role, and he was hoping tibia-hindfoot rotationplasty with calcaneo-sacral fixation in a prosthesis would assist ambulation on the uneven terrain of March 2011. The aims of the reconstructive surgery were to give a building site and give him improved function in his activities the patient improved sitting balance, improved cosmesis and of daily living. There was some delay in getting approval from improved prosthetic options. XP’s initial post surgical rehabilitation XP’s orthopaedic surgeons to allow weight bearing through his was undertaken at St. Vincent’s Hospital prior to his transfer to reconstructed limb. XP was cast for an interim prosthesis in Hobart approximately two months post amputation. September 2011.

This complex surgical procedure is described in a case report XP’s residual limb presented a number of challenges for prosthetic published by Kong and colleagues in 2008. It consists of a design as a result of the altered anatomy. The socket design had modified anterior flap hemipelvectomy, where the hemipelvis to accommodate the unusual shape of the residual limb and the and femur are initially resected, however the musculoskeletal altered weight bearing structures. XP’s mid-stump circumference and vascular structures distal to the knee are preserved, along was more than 14cms larger than the proximal circumference (see with the antero-medial thigh flap. The forefoot and midfoot are Figure 3). This meant that standard transfemoral socket designs resected and the calf is rotated 180 degrees. The calcaneus is were not possible. The altered anatomy also resulted in the then fixed to the sacrum, allowing pseudo hip movement through absence of the ischial tuberosity, usually one of the major weight the ankle joint. The quadriceps muscle flap is sutured to the calf bearing structures within a transfemoral socket. The orthopaedic musculature to form the soft tissue of the neo thigh stump. This surgeons felt that the calcaneal tubercle could function as a neo- procedure is demonstrated in Figure 1. ischium, however the calcaneus was too proximal on the sacrum to allow functional use for weightbearing. Therefore, we decided Anterior View Posterior-Lateral View to trial an end-bearing socket design with an anterior opening

Figure 1. 3D reconstruction demonstrating calcaeno-sacral fixation and the new thigh segment (Kong et al., 2008).

XP was transferred to Hobart in May 2011 and was managed by Orthotic Prosthetic Services Tasmania. At this time XP was recovering well from the surgery, his sutures were healing, he was wearing a transfemoral stump shrinker for oedema management Figure 3. Posterior view (left) and lateral view (right) of XP’s residuum.

8 / June 2012 / Volume 12 - Issue 2 / The Gazette Prosthetic management of hemipelvectomy with tibia-hindfoot rotationplasty with calcaneo-sacral fixation: a case study

with a laminated design once the fit was assessed and deemed appropriate. XP was able to ambulate comfortably in the parallel bars and had some difficultly clearing his prosthetic foot during swing, however this improved with practice. Due to XP’s ongoing cycle of hospital admissions and periods of poor health secondary to ongoing chemotherapy, his fitting appointments were delayed. He commenced outpatient physiotherapy in November 2011. XP attended very few physio appointments before severe pain lead to the diagnosis of secondary cancer. Unfortunately, XP’s prosthetic rehab ceased in December 2011 and he did not get a chance to trial his prosthesis outside the physio department.

XP’s reconstructive surgery provided a functional residual limb. There were challenges with prosthetic management and socket design, however we were able to successfully fit XP with an interim prosthesis that was safe and comfortable for ambulation. Due to the short period of prosthetic rehab it was not possible to fully assess the success of our socket design or prosthetic function.

The reconstructive surgery allowed XP good sitting balance, although he did experience some discomfort as a result of his reduced pseudo hip flexion range of motion. Although XP’s residual limb was quite bulbous, it could be considered more Figure 4. Anterior view (left) and lateral view (right) of XP’s initial cosmetic than a hemipelvectomy. XP’s atypical residual limb check socket. provided many challenges for prosthetic rehabilitation, however with the application of simple biomechanics and prosthetic (see Figure 4). We were initially concerned that the large amount principles it was possible to provide him with an appropriate of redundant tissue distally or the presence of the inter-condylar prosthetic design. Although XP was unable to progress with rehab tubercles could affect XP’s ability to end weight bear. Another due to his poor health, early signs suggested that he would have issue with the altered anatomy was the narrowing of the hips. The had successful prosthetic outcomes. pseudo hip joint was significantly more medial than the normal Reference: Kong, G.Y.X., Rudiger, H.A., Ek, E.T.H., Morrison, W.A. & Choong, hip joint. This had implications for clearance of the neo-thigh with P.F.M. (2008) Reconstruction after external hemipelvectomy using tibia-hindfoot regard to the contralateral limb and it also narrowed XP’s base rotationplasty with calcaneo-sacral fixation. International Seminars in Surgical of support. The amount of redundant tissue medially also meant Oncology, 5:1 that XP had to hold his residual limb in a significant degree of abduction.

Another consideration was XP’s ability to control the prosthesis. XP’s passive pseudo hip ROM was just less than 90 degrees flexion and 0 degrees extension, and he had a resting hip flexion angle of 15 degrees. XP had strong muscle strength through approximately the first 10 degrees of pseudo hip flexion but had little active strength past this point. He also had good abduction and adduction strength but again only through a short range of movement. His hip extension strength was very weak.

Due to the long length of the residual limb, prosthetic componentry suitable for a knee disarticulation prosthesis was utilised. Figure 5 demonstrates XP’s interim prosthesis. A Medi OP5 pneumatic four-bar knee joint was selected for the mechanical advantages of improved standing stability and shank shortening during swing. A SACH foot was used for initial prosthetic fitting and gait training, with plans to advance this to an Otto Bock Trias when appropriate.

Our concerns regarding XPs ability to end weight bear proved unfounded, he was able to fully weight bear through his residual limb with no discomfort. The socket was fabricated to apply load through the distal end of the residuum and loading within the socket was applied along the lateral shaft of the tibia and the proximal medial soft tissues. A thermoplastic check socket was fabricated with an anterior opening for front entry and an anterior shell. The socket was self suspending due to the bulbous shape of the residuum. The plan was to replace the check socket Figure 5. Initial fitting of XP’s prosthesis.

The Gazette / Volume 12 - Issue 2 / June 2012 / 9 State Section Reports State Section Reports State Section Reports State Section Reports

Queensland Report It’s been a relatively quiet quarter in Queensland so I thought I would take this opportunity to update members on some events which will be happening throughout the next quarter and beyond. The Queensland Amputee Golf Association (QAGA) will be holding the 2012 amputee golf open on the 8th, 9th & 10th June at The Glades Golf Club on The Gold Coast. Entry forms and more information can be found at http://www.qaga.org.au/ Queensland Health is in the process of implementing the integrated electronic medical record (ieMR) program to enable a patient-centric focus for health care delivery across a networked model of care. This will be achieved with the implementation of an ieMR solution that allows Queensland Health clinicians and New South Wales supporting staff to securely access a single view of a patient’s medical record. ieMR will be rolled out through a phased Report approach. The first phase, Release 1, includes setting up the There has been a lot of activity in NSW over the past 3 months. foundations of the system and scanning paper clinical documents One of the highlights was attending the 2012 AOPA Congress dated from the system launch date. This first phase will enable which took place in Melbourne on Friday 2nd March. The NSW clinicians and support staff to concurrently access a patient’s membership was well represented, and the feedback received medical record, thereby reducing the time to access charts. For from those who attended was tremendously positive. I’d like more info see the fact sheet at: http://paweb.sth.health.qld.gov. to extend a big thank you to all NSW members who presented, au/dts/ehealth/documents/20120221_PAH_ieMR_R1_FactSheet_ or contributed to the Congress, and a further thanks to Sally Overview_v2.0.pdf Cavenett and her capable team for managing such a successful and well received event. Our next CPD session will be held on the first Tuesday in October. Any topic suggestions are welcomed as we like to tailor these As our national peers will understand, the profession in NSW sessions to suit our members’ clinical caseloads. continues to face two major challenges. The first and perhaps the greatest challenge is the ability to attract P&O practitioners to Sarah Carter both metropolitan and rural areas of the state. The solid efforts NC Representative, QLD Section, The AOPA Inc. being undertaken by the Office on immigration classification [email protected] and workforce planning are greatly appreciated. Whilst these initiatives only provide potential medium to long-term solutions, it is encouraging that steps are being taken and progress is being South Australian Report made. Sadly, since our last Gazette, we have said goodbye The South Australian section recently held an extremely successful to our state secretary Stephanie Lomax, who has left the P&O CPD session covering a number of topics. The night commenced profession. It is disappointing to see the profession lose a with an introduction of current practices in Charcot management member of Steph’s abilities, but we wish her all the best and every by the P&O team from the Royal Adelaide Hospital, followed by an success in her new field and endeavours. On a more positive interesting discussion outlining the different treatment pathways note, we’d like to extend a warm welcome to Jude Hall, who between each SA facility. Membership feedback indicates this has returned to Australia and assumed the role of director at the type of forum is successful in facilitating communication and Prince of Wales Hospital orthotic department. learning at a number of levels. The second challenge we face is the ongoing decline in funding A revisit of presentations conducted at the AOPA congress also for orthotic and prosthetic services. The recent national budget occurred: Rebecca Bowes discussed the clinical application of K announcements regarding the NDIS continue to provide hope for levels and Adam Holden provided an overview of what was new the profession, and the unanticipated proposal to bring forward and exciting at the Congress. A big congratulations to our CPD pilots in NSW is most encouraging. Since the publication of the co-ordinators for organising a successful event, we look forward March gazette, NSW Health has released its response to the to more in this style. Three Rivers review. This was delivered in draft form on the 6th of May and you will find further information around this topic in an SA health has commissioned an external audit of P&O services be additional article over the page. Whilst no definitive action plan conducted in order to produce recommendations relating to the or timeline has been established, AOPA continues to make every future of P&O service provision. The SA membership look forward attempt to work closely with NSW Health to establish a concrete to hearing the outcomes of this audit and will keep AOPA informed future plan, which will improve services to our clients and build a as to when this report is available. Commentary relating to the stable, predictable and sustainable future for the profession and report’s recommendations will be provided on behalf of AOPA in AOPA members. order to help bolster the P&O workforce future in SA. Our next general meeting and CPD event will take place on As the weather gets colder the social committee has begun Tuesday the 29th of May and we look forward to seeing solid organising a Christmas in July style event which will again provide representation from the membership at this time. The election time for networking and strengthening of the union that P&O’s of a new secretary will be a central component of the upcoming have in a small state like ours. Details will be emailed to members meeting. as they become available. Harvey Blackney Phil Parish President, NSW Section, The AOPA Inc. NC Representative, SA Section, The AOPA Inc. [email protected] [email protected]

10 / June 2012 / Volume 12 - Issue 2 / The Gazette State Section Reports State Section Reports State Section Reports State Section Reports

Victorian Report Tasmanian Report The year is well and truly underway and we have already seen As Tasmanian members start to don their coats, scarves and many changes at a national and state level. Many thanks are gloves, and stock up on firewood for the coming winter months, extended to all members that were able to attend the recent EGM there is still plenty of P&O activity around the state to heat things or submitted proxies, further updates are provided in this edition up. Members on the mainland may have noticed a recent flurry of of the Gazette. There is significant documentation available jobs advertised throughout Tasmania on the AOPA website. With on the AOPA website that can assist members in gaining a 5 clinical positions to fill across Launceston, Hobart and Burnie, better understanding of the projects currently being undertaken we’re looking forward to welcoming some new faces to the state by National Council and the direction of future submissions. once all these positions have been finalised. Volunteer assistance is always welcome and I encourage The recent AOPA Congress in March was definitely a highlight of members to register their interest with the Office. the year with 70% of the Tasmanian membership in attendance. It was also great to see many Victorian members at the AOPA A big ‘shout out’ goes to Katrina McGrath, who represented the Congress in March and the feedback received was very positive. state by presenting a very interesting case study on a patient who Thank you to the organising committee and presenters for their underwent a hemipelvectomy with tibia-hindfoot rotationplasty tireless work. and calcaneo-sacral fixation. Sounds pretty funky, right? Well for those who were unable to attend the Congress we have provided The attendance at the recent Victorian CPD events has also been a follow up clinical article in this edition of the Gazette. positive. In April, Associate Professor Barry Rawicki presented an informative lecture on Spasticity Management. Prof. Rawicki provided Tasmanian members were also involved in voting at the recent an overview of spasticity and current medical treatment options EGM and are all feeling very positive about the result and the with a particularly refreshing holistic view which focused heavily on exciting prospects this creates for the Association. We’re very the functional improvement outcomes for patients. His links to and supportive of all the hard work our dedicated Office staff continue considerations of Allied Health involvement and treatment were to demonstrate and we are enthusiastic about the direction AOPA valuable for all. In May, Tim Matthews provided an overview of the is taking with the numerous submissions and projects currently Australian Paralympic Sports available for patients and encouraged being undertaken to advance our profession. clinicians to consider the numerous benefits of involving their patients within this positive and active community. Darren Pereira followed Our small member population continues to face geographical with a presentation which highlighted the challenges that prosthetists challenges as we find it difficult to meet and plan local CPD events. and orthotists face in managing and assisting in this exciting arena. We have therefore been considering utilisation of the state’s ‘Telecare Online Service’ to organise a live video conference where members In the coming months the committee has two CPD sessions can participate in a CPD session from different regions. I look forward planned. The next event will be in early July and will be focused to hearing from members to gauge interest and suggestions for on funding updates and the ongoing changes occurring in implementing such an event during the second half of the year. Victoria. Our event in September will have an Occupational Health and Safety focus. Stay tuned for updates! Go Tassie! Timothy Burke Ella Nicolson President, VIC Section, The AOPA Inc. Tasmanian State Representative, The AOPA Inc. [email protected] [email protected]

In other news, West Australian budget announcements continue Western Australian Report to allow for major health infrastructure spending. Work continues towards completing Fiona Stanley Hospital, including the new The West Australian section held its first of four events for the Statewide Rehabilitation Service, which is due to open in 2014. th year on 26 April. The event was a CPD seminar with a technical Building has also commenced on the Sir Charles Gairdner focus on the topic of CAD CAM technology in prosthetics and Hospital site for the New Children’s Hospital, due for completion orthotics, held at the The Limb Clinic (TLC) in Belmont. Mark Hills in 2015. In addition to these new hospitals, funding has been from TLC presented on his experience over the last two years announced for the existing Royal Perth Hospital redevelopment in with CAD CAM technology (see image). Mark described methods coming years. of data collection, modification software and his own choice of carver machinery. Mark discussed his decision making process in These infrastructure projects selecting software and equipment, as well as the pros and cons pose great opportunities and of this and other CAD CAM systems. The event was well attended challenges to the prosthetists with members, non-members and our visiting student members and orthotists in WA, as we from Victoria who were completing final year placements in the seek to build and justify our mild West Australian autumn. Thank you to those who attended, services to the patients of we look forward to receiving suggested topics from members for these hospitals. our next CPD event. Helke Thorpe & Our members continue to show dedication to their own Paul Sprague professional development, with five of WA’s seven facilities President & NC Representative, represented at the AOPA Congress in March and returning with WA Section, The AOPA Inc. great reports. Congratulations to the convening committee for [email protected] organising another highly successful national event. We have also had a member recently attend one of Otto Bock’s training courses Mark Hills demonstrates CAD CAM in Sydney to further progress their lamination skills. at The Limb Clinic.

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Updates on NSW Prosthetic Limb Scheme

In 2008, the responsibility for the Prosthetic Limb Scheme (PLS) • Engagement with other states regarding coordination of “limb in NSW was transferred to Enable NSW. Enable NSW is a small schemes” division of Health Support Services (HSS) and is responsible for matters as diverse as laundry purchasing and ancillary hospital In summary, the Three Rivers review document exposed the ongoing services. NSW-AOPA members have reported a progressive and long-term deficiencies in amputee care in NSW. The profession decline in engagement with the prosthetic profession; with critical has been attempting, without success, to rectify these deficiencies decisions occurring in a closed environment and in contrast to since 2001, and in particular since the release of the 2004 Cameron expert and stakeholder advice and best practice. review of NSW amputee care. Interestingly, many of the Three Rivers recommendations were previously covered in the 27 recommendations Three Rivers Consultancy Review (2012) in the Cameron review of 8 years earlier. Enable NSW released a In March 2011, Enable NSW appointed Three Rivers Consultancy highly anticipated response to the review document on 7th of May to undertake a review of NSW prosthetic funding and procurement which openly states support for all 14 recommendations. arrangements, later expanded to include the recently introduced Enable NSW Draft PLS and Interim Funding Guidelines “interim limb program tender”. Enable NSW released their Draft PLS and Interim Funding Guidelines The Three Rivers team consulted broadly with the prosthetic simultaneously with the public release of the Three Rivers Consulting profession, amputee clinic personnel, and consumers of PLS report. These guidelines were available for consultation during services across the state. NSW-AOPA members contributed openly March. Disappointingly, Enable NSW had incorporated few of the and appreciated the skill and transparency of the Three Rivers Three Rivers recommendations into these draft guidelines, which consulting group. The final report and recommendations were seemed to be developed without acknowledgement of the issues delivered to NSW Health in December 2011, and to the public and identified by the external consultants. profession on the 27th February 2012. The 14 recommendations were well received by all involved in amputee care, and when AOPA Consultation with Enable NSW implemented, will represent a positive step towards raising NSW During the consultation period the AOPA provided a brief response standards to those prevailing in other states of Australia. of support for the Three Rivers recommendations, and a lengthy response outlining concerns with the draft guidelines. These responses The key recommendations outlined in the final report include; and the original documents are available on the AOPA website. • Increased transparency within Enable • Removal of Enable from clinical decision making AOPA members and the prosthetic profession were provided an • The implementation of a shadow budget for the public clinical opportunity to meet with Enable personnel at an industry forum on th facilities operated by Enable, to permit benchmarking of actual Wednesday 9 May. Unfortunately, Enable representatives were costs of service provision in NSW unwilling to commit to a plan of action or timeline for execution of the Three Rivers recommendations. • Establishment of alternate arrangements to the “interim limb” tender • Formal procurement processes be established AOPA and industry representatives will continue to make every • Cost covering allowances be paid to service providers that effort to positively engage with NSW Health. We will continue service rural clinics and populations to offer our cooperation, experience, support and guidance in • A retention of the current prosthesis pricing structure the modernisation of amputee care in NSW. Please review the • Improved access to silicon suspension systems documents on the AOPA website or contact the AOPA Office by phone or email if you require further information. • Enable budgets be set using an activity based approach • Enable assume responsibility for patient co-contribution collection Harvey Blackney • The establishment of a terminal device “bank” at the children’s President, NSW Section, The AOPA Inc. hospital [email protected] Consultation with DVA: MFS Guidelines

In September 2011, AOPA members were updated on changes would not have been possible without the work and contributions to the supply guidelines for off-the-shelf orthoses being funded by of Leigh Clarke, Ryan Kelly, Brendan Cahill, Sue Laksassi, Ella the DVA’s Rehabilitation Appliance Program (RAP). Nicolson, Richard Dyson-Holland and Colin Aburn. Many thanks for your efforts towards this response. The National Council responded to DVA, detailing a number of concerns with the new guidelines, most significantly that When coordinating this submission, the value of many hours of Orthotists had no means of being reimbursed for their clinical time work previously contributed by AOPA members to various projects spent with clients when providing orthotic treatment. In March this became increasingly apparent. Had the AOPA been asked to year, the Office received further communication from DVA inviting address these items 5 years ago, the response would have been AOPA to respond to the following items of interest: lacking in supporting documents and submissions. Our credibility • Non-sensitive policy papers; as a profession has advanced with the introduction of compulsory • Submissions to Government Agencies, particularly any that put CPD, development of an orthosis schedule, submissions for forward a case for receiving a Medicare provider number; inclusion in the National Registration and Accreditation Scheme • A breakdown and description of services that Orthotists provide; and to the Productivity Commission Inquiry into Disability Care • Billing arrangements with Government Agencies other than DVA; and Support. • A Schedule of Fees; I invite any members who are interested in the outcome of these • The proportion of AOPA members with a Masters Degree; and consultations with DVA, and in the broader issue of professional • The extent of professional development required to maintain recognition amongst funding bodies, to contact me directly via email. professional registration. Paul Sprague A collaborative effort between members resulted in a NC Representative, WA Section, The AOPA Inc. comprehensive response to the DVA. This particular submission [email protected]

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Announcements

AOPA PEG recipient calls for AOPA Member Consultation: volunteers Preliminary notification The AOPA is pleased to announce that the 2nd quarter 2012 The AOPA Office and National Council wishes to advise Professional Enhancement Grant (PEG) has been awarded members that the Association is currently in the processing to Sarah Anderson at La Trobe University. Sarah is currently of developing a Scope of Practice document and revising conducting research into P&O workplace injuries. This research the Competency Standards 2003. Once these documents has the potential to inform the policies and procedures within our have been developed and drafted they will be made available work environments and will significantly contribute to the limited to members in draft form as a 4 week consultation. We invite knowledge in this area. Sarah will be utilising the PEG funds to member feedback via email during this period to assist us in support the employment of professional interviewers to conduct the developing member relevant and profession specific documents focus groups, a key component of data collection. Sarah’s invitation by which the Association can operate. Members will be notified to participate in these focus groups can be seen below. Please of the opening of this consultation period via eBlast. Please do note that participation will accrue CPD points for the 2012/13 year. not hesitate to contact the office should you have any queries The PEG is allocated on a quarterly basis. This grant aims to regarding these documents or the consultation process. promote professional development of members and is available to all full members. Further details are available on the AOPA website. Should you have any queries regarding this grant or the application process, please do not hesitate to contact the Office. Worksafe orthotic & prosthetic

Dear AOPA member, policy changes We are seeking volunteers to participate in a focus group discussion Are you currently treating Victorian injured workers or TAC clients? for a research project titled “Work-related musculoskeletal WorkSafe Victoria (WorkSafe) has been working with the disorders in the Prosthetics and Orthotics profession”. Transport Accident Commission (TAC) on the alignment of Musculoskeletal injuries and disorders (MSDs) constitute processes and policy to deliver a consistent experience for Australia’s largest OH&S problem, both in numbers and in health providers treating injured workers and TAC clients. compensation costs. To date there has been little focus on WorkSafe has identified a need to improve its processes MSDs in Prosthetics and Orthotics. around the provision of prostheses and orthoses for injured This project aims to identify key hazards and risk in relation to workers. In accordance with the work being undertaken with MSDs. This forms part of a Master of Applied Science being the TAC, WorkSafe will be aligning its policy and supporting undertaken by myself and supervised by Dr. Jodi Oakman at La tools with those of the TAC. Trobe University. We are looking for participants to take part in For Prosthetists and Orthotists, this will improve the focus groups where you will be asked to respond to a range of information available and provide a consistent experience in questions regarding your work as a Prosthetist/Orthotist. These the treatment of injured workers and TAC clients. responses will assist in the development of a survey to identify From August 2012, WorkSafe will be introducing the following the key hazards and risks relating to work-related injuries, which to assist in the prosthetic and orthotic management of injured can lead to significant musculoskeletal disorders. workers: The focus group interview should take 60-90 minutes and will • External Prosthetics and Orthotics Policy be completed outside of working hours. These interviews will be • Prosthetic Treatment Request Form held at La Trobe University city campus (adjacent to the Queen • Orthotic Treatment Request Form for customised orthoses Victoria Market). Please contact me by email of phone if you are • Fee schedule for Prosthetists & Orthotists interested in participating. Further information for Prosthetists and Orthotists will follow Kind Regards, to ensure a better understanding of the considerations and requirements needed for faster pre-approval of services. Sarah Anderson Lecturer For more information please call 5225 7328 Email: [email protected] Phone: (03) 9479 1662 La Trobe University Human Research Ethics application reference number: FHEC11/208 Gazettethe

For further information on items in this Gazette please contact: Editor, AOPA Office, PO Box 1219, Greythorn VIC 3104 Ph: 1300 668 194 / (03) 9816 4620 / Fax: (03) 9816 4305 / E-Mail: [email protected] The Gazette is produced in March, June, September and December and is sent out to all AOPA members. Please contact the editor if you would like any information regarding advertising rates. The inclusion of advertising in no way implies endorsement by the Association.

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