Abstract

Evidence-based practice (EBP) is an essential element of safe and effective healthcare. As digital technologies advance, computer-aided design and computer-aided manufacture (CAD/CAM) is being increasingly used in orthotic practice, and it is therefore important to build an evidence base that supports its clinical application.

This thesis presents a collection of studies investigating the integration of EBP and CAD/CAM technologies within United Kingdom (UK) orthotic services. In synthesis, these studies support the use of EBP, enhance our understanding of how CAD/CAM workflows affect patient outcomes, and have contributed to the development of an Advanced Practice role in orthotics.

The first study, a cross-sectional survey of UK orthotists, found that 64.8% had accessed the Orthotics Evidence Portal, a resource designed to assist EBP, with over 80% reporting increased engagement with scientific publications. Importantly, 68.6% indicated that the Portal had influenced their clinical decisions, supporting its role in promoting EBP. The second study evaluated 3D-printed insoles for musculoskeletal conditions unresponsive to standard care. Among 36 patients, significant improvements in pain, function, and foot health were observed over eight weeks, with 26 patients requiring no additional treatment after two years. A third study reported on a national cross-sectional survey using Freedom of Information requests, examining CAD/CAM insole provision across UK National Health Service (NHS) Trusts and Health Boards. Responses from 131 services revealed widespread use of CAD/CAM (70.5%), with foam-box impression casting being the predominant shape capture method. Finally, a double-blinded randomised controlled trial compared two CAD/CAM workflows: direct foot scanning and foam-box casting. Among 112 participants, both methods yielded similar clinical outcomes at 12 weeks. However, foot scanning was associated with higher patient satisfaction, better adherence, and lower production costs.

Collectively, these findings highlight the role of EBP and CAD/CAM in orthotic practice, demonstrating their potential to enhance clinical outcomes, streamline workflows, and support orthotists in providing evidence-based care.