Prosthetics-Orthotics Rehabilitation Awareness

Orthotic and prosthetic devices are essential rehabilitation tools that facilitate the participation of individuals experiencing functional limitations-due to various health issues such as amputation, musculoskeletal pathologies, neurological disorders, and congenital anomalies-in daily social life, while enhancing their quality of life and supporting their overall well-being. In recent years, rapid advances in the fields of biomedical engineering, materials science, and digital health technologies have enabled these devices to be designed in an increasingly durable, lightweight, and functionally superior manner. However, technological development alone is insufficient, and optimal outcomes can only be achieved through a personalized rehabilitation approach based on interdisciplinary collaboration.

Physiotherapists are among the important members of the rehabilitation team in this process, with core competencies such as ambulation assessment, functional rehabilitation planning, and orthosis/prosthesis design and rehabilitation, and they work in direct collaboration with orthotist-prosthetists. In orthotic rehabilitation, the core responsibilities of the physiotherapist include increasing range of motion, reducing pain, developing muscle strength, improving muscle function, enhancing independence, preventing possible complications through early detection, and improving quality of life. Physiotherapists also play an important role in educating patients and their relatives on device use, integrating the orthosis into activities of daily living, and managing long-term follow-up. Their responsibilities in the orthotic rehabilitation process include determining the need for an orthosis, selecting the device appropriate to the individual and the condition, evaluating its effect on functionality, teaching donning/doffing and other usage features, monitoring device-related complications, and planning the exercise and rehabilitation process.

In prosthetic rehabilitation, the contribution of physiotherapists begins in the pre-amputation period, including preparing the individual for amputation surgery, strengthening exercises, and pre-prosthetic preparation programs. In the post-amputation period, physiotherapists are actively involved in prosthesis selection, ensuring prosthesis fit, gait training, balance and coordination exercises, and adaptation to different suspension systems. Facilitating individuals' return to daily life, social environments, and school/occupation is also among the core goals of physiotherapists in prosthetic rehabilitation.

Despite these critical roles, research on professional knowledge and awareness in this field remains limited. A cross-sectional study conducted among students in orthotics and prosthetics departments in Turkey found that participants correctly answered only about one-third of the questions in a professional awareness questionnaire, clearly demonstrating the need for educational interventions aimed at increasing awareness. Considering that the professional knowledge, self-efficacy perception, and attitudes that students acquire during their undergraduate education directly shape their post-graduation clinical practices and their functioning within the rehabilitation team, determining these variables at an early stage is of great importance for effectively guiding educational programs. Systematic reviews in the field of orthotic and prosthetic education indicate that research on this subject remains limited, and studies from the perspective of undergraduate education are particularly insufficient. Furthermore, no study has been found in the existing literature that jointly addresses the knowledge levels, self-efficacy perceptions, and attitudes of physiotherapy and rehabilitation students specific to the field of orthotics-prosthetics. This gap is considered notable given the critical role this professional group undertakes in the rehabilitation process.

Objectives: The main purpose of this study is to determine the knowledge levels, self-efficacy perceptions, and attitudes of students enrolled in the undergraduate Physiotherapy and Rehabilitation program regarding orthotic and prosthetic rehabilitation. The secondary purpose is to examine whether these variables differ according to class level, clinical experience, and demographic/academic characteristics. The findings are expected to contribute to the development of physiotherapy and rehabilitation education programs, strengthen interprofessional collaboration, and improve the quality of rehabilitation services.

Study Design: This study was designed as a descriptive, cross-sectional study. Study Population and Setting: The study population consists of third- and fourth-year students enrolled in the Physiotherapy and Rehabilitation undergraduate program at Lokman Hekim University, Faculty of Health Sciences. Students who were actively enrolled in the program, had taken courses related to orthotic and prosthetic rehabilitation, and voluntarily agreed to participate were included. Students with auditory, visual, or sensory impairments to a degree that could affect the study, as well as those who completed the data collection tools incompletely or incorrectly, were excluded.

Data Collection Tools: Two data collection tools were used. The first is a demographic information form prepared by the investigators, including participants' age, gender, class level, grade point average (GPA), status of having taken theoretical courses on orthotic and prosthetic rehabilitation, and clinical internship experience. The second is the Orthotics and Prosthetics Awareness Questionnaire, developed by the investigators based on the relevant literature. This questionnaire consists of a total of 32 items across three subdimensions: Knowledge (11 items), Self-Efficacy (9 items), and Attitude (12 items). Each item is rated on a 5-point Likert-type scale, where 1 indicates "Strongly Disagree" and 5 indicates "Strongly Agree." Prior to data collection, the questionnaire was developed using the Delphi technique, based on the opinions of experts (n=10) with at least 5 years of experience in orthotics-prosthetics and physiotherapy and rehabilitation; the questionnaire was finalized following expert review. This instrument is not a validated scale but a structured survey designed to descriptively assess students' knowledge, self-efficacy, and attitudes in the relevant fields, used solely for group comparisons and as descriptive data in this study.

Data Collection Procedure: Data were collected online via the Google Forms platform in July 2026. Participants were reached through digital platforms, and the purpose of the study and its voluntary basis were clearly explained. Collected data are anonymous, and no identifying information was requested from participants.

Ethical Approval: The study was approved by the Lokman Hekim University Scientific Research and Non-Drug and Non-Medical Device Clinical Research Ethics Committee and was conducted in accordance with the principles of the Declaration of Helsinki.

Statistical Analysis: Data were analyzed using IBM SPSS Statistics for Windows, Version 26.0 (IBM Corp., NY, USA). Distribution characteristics of continuous variables were assessed using histograms, normal Q-Q plots, and the Shapiro-Wilk test. Continuous variables with normal distribution were presented as mean±standard deviation, while those without normal distribution were presented as median (minimum-maximum). Categorical variables were expressed as n (%). Although a psychometric validity and reliability study of the questionnaire was not the aim of this study, Cronbach's alpha coefficients were calculated and reported to evaluate the internal consistency of items grouped under the knowledge, self-efficacy, and attitude subdimensions and to support the usability of subdimension total scores in descriptive and comparative analyses. The Mann-Whitney U test was used to compare age, knowledge, self-efficacy, and attitude scores according to class level. An independent samples t-test was applied to compare GPA according to class level. The Pearson chi-square test was used to compare categorical variables according to class level. In the comparison of knowledge, self-efficacy, and attitude scores according to clinical experience variables, the Mann-Whitney U test was used for two-category variables, and the Kruskal-Wallis test was used for the four-category variable of participation in application processes. For variables with a significant difference on the Kruskal-Wallis test, pairwise comparisons were performed using the Mann-Whitney U test with Bonferroni correction (significance level accepted as 0.0083). The relationships between GPA and knowledge, self-efficacy, and attitude scores were evaluated using Spearman's rank correlation analysis. Statistical significance was accepted as p\<0.05 in all analyses.

Expected Outcomes: This study is expected to provide novel data on the knowledge, self-efficacy, and attitudes of physiotherapy and rehabilitation students regarding orthotic and prosthetic rehabilitation-an area with a critical but understudied role within undergraduate education. The findings are anticipated to identify specific gaps, such as limited self-efficacy in technical application skills and role recognition of orthotic and prosthetic specialists, and to inform curriculum development, the design of skills laboratories and simulation-based training, and strategies to strengthen interprofessional collaboration between physiotherapy and orthotics-prosthetics professionals, ultimately contributing to improved quality of rehabilitation services for patients using orthotic and prosthetic devices.