First line and additional interventions

First line intervention provides the patient with guidance on self management of their condition. This advice can provide benefit at any juncture in the treatment pathway and should be reinforced as appropriate.

Orthotists should offer guidance on the following, where appropriate:

• Weight loss advice / referral to weight management services
• Activity modification advice
• Sign posting to GP regarding Analgesia & Non-Steroidal Anti-Inflammatory Drugs
• PRICE / POLICE guidance (protection, Rest/OPTIMAL LOADING, ice, compression, elevation)
• Exercise prescription, mobilisation and conditioning exercises

In many instances the use of orthoses combined with strengthening and conditioning regimes have been shown to improve patient outcomes and should therefore be considered in addition to the provision of an orthosis where appropriate.

Within their scope of practice and where there is a clinical justification and evidence base, Orthotists may also consider the addition of alternative treatment modalities. Depending on the presenting condition and duration of symptoms, these may include:

• Taping
• Corticosteroid injection
• Local anaesthetic injection
• Shockwave therapy
• Manipulations

Goal setting and outcome measures should be used to assess patient progress within expected and agreed time scales. Discharge should be considered when goals have been achieved or if care is being escalated. Orthotists should be aware of the escalation process within their place of work and instigate this in appropriate circumstances. This may include:

• Onward referral for further diagnostic testing where this is not available within the Orthotic service
• Onward referral for consideration of treatment from another department
• Urgent referral when Red Flag presentations are suspected