Conversation with the IVO

As president of the IVO Karl-Heinz Schott answeres on the subject of a peer review process for foot&shoe.

Mr. Schott, why do pedorthists need a journal to publish scientific work on the supply of the foot and what ­significance do scientific publications internationally have for the field of orthopedic shoe technology?
Anyone who is paying for something likes to know if that what one pays for actually works. In health the consumer at times pays in full, but in many cases health care is paid for in full or partly by third parties. Those third party payers are increasingly looking at cost saving and it is easier to cut out funding for services that are not scientifically proven. That has led to many health care providers doing research and publishing it. With good publishing of their work those health care providers prove that they are contributing to the health and wellbeing of society.
Orthopaedic shoe technology and pedorthics are an area of health care with little scientific evidence, but we know that what we do works. We have plenty of anecdotes and we know we can make a real difference to individual lives, but we cannot yet systematically prove it. Orthopaedic shoe technology and pedorthics are very low cost health care interventions that have the potential to save limbs and consequently life for the diabetic population for example. That would save the health care system a lot of money and can improve many individual’s quality of life. We need to work evidence based and patient focused and we need to publish in a recognized format about it to be relevant in future. “Publish or perish” [1] are the key words.

Why – in your view – is a peer review process for this journal important?
Peer review means that others from the same or related professional field and or relevant competence check the work prior to it being published. This is a self-regulated system to assure that the work that is being published is up to a set standard. A peer reviewed publication has a greater level of credibility. The peer reviewed articles are checked prior to publication. If one reads the peer review article, one knows that others have checked it and therefore the content of that article has more credibility. After all the reputation of the author and the reviewers is on the line in regard to those articles. A peer review process is an international standard for any credible publication.

What chances do you see for pedorthists and orthopedic shoe technicians through a scientific journal that specializes in the care of the feet and the optimal production of aids?
Our clinically trained personnel, like the OSM in Germany or the CPed CM in Australia spend most of their time working clinically, with the patients. We are health care service providers like any other for example the optometrist. Without a scientific approach, I do not see a future for pedorthics in its current form. It is common only in very few countries and even there it is under pressure. To some extent, it is because of the lack of evidence.
Globally science based health care professions are developing well and are growing because there is a growing health care need. We have an aging population and increased incidences of pathologies like diabetes [2] and arthritis [3] affecting foot health.
My own experience is that it is increasingly harder to operate in the health care system as a provider of services without scientific back up. Without the scientific evidence, there will be less and less emphasis on the quality of the work we do and more and more emphasis on the price. Without scientific evidence, there will be no interest in our clinical work and manufacturing can be relocated to low cost countries or be done by low skilled and lowly paid personnel. Scientific evidence is a key measure of quality!
We have much to offer to those with health care needs. Most of what we can do is not understood outside of our profession. It is however important that those other health care professions understand what we can contribute to the health and wellbeing of our fellow citizens. It is imperative that the decision making accountants and business people in the executive levels at health care funding agencies get to see evidence that what we do actually not only helps people but also is economical. We all know that our treatment modalities of orthoses and footwear can help save limbs in the diabetic population. We know that it also saves money as the cost of an amputation or ulcer is significantly higher compared to the cost of our interventions. However we need to prove it in a recognized way and that is the peer reviewed scientific article.
For me, a scientific, evidence based and patient centered outcome based approach to education, the work we do and our publications is a do or die issue.

Thank you for your statement!
Interview by Kathrin Ernsting

[1] Archibald Cary Coolidge: Life and Letters, 1932, p. 308)
[2] Epidemiology/Health Services/Psychosocial Research: Sarah Wild et al. Global Prevalence of Diabetes: Estimates for the year 2000 and projections for 2030 Diabetes Care May 2004 27:5 1047-1053; doi:10.2337/diacare.27.5.1047 1935-5548
[3] http://www.the-rheumatologist.org/details/article/883669/Arthritis_on_the_Rise.html