Identifying the Values and Preferences of Prosthetic Users

Schaffalitzky, Elisabeth; NiMhurchadha, Sinead; Gallagher, Pamela; Hofkamp, Susan E.; MacLachlan, Malcolm; Wegener, Stephen T.

doi:10.1080/03093640902855571

Cited by 41 publications

(43 citation statements)

References 28 publications

(50 reference statements)

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“…This again raises interesting and important questions regarding component candidacy and prescription criteria for MPKs. While user choice has been identified as an important factor when matching prosthetic technology to the patient [193], further investigation into component preferences among individuals with TFLL is warranted to better understand the social, physical, and psychological characteristics associated with prosthetic knee preferences. Notably, patient characteristics such as time since amputation, previous prosthesis experience, and activity level may all be factors that influence prosthetic knee preference.…”

Section: Preference and Satisfactionmentioning

confidence: 99%

“…However, without further assessment of the factors that influence prosthetic knee preference, a strong and unbiased link between MPKs and user satisfaction cannot be established. The relationships between patient preference, opinions on new or emerging technology, and clinical outcomes also remain largely unexplored within lower-limb prosthetics but are likely to be a critical factor in understanding and establishing positive PROs [193]. Given these considerations, it may be important for future outcome measures to address issues of satisfaction by incorporating the concept of patient expectation.…”

Section: Preference and Satisfactionmentioning

confidence: 99%

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Outcomes associated with the use of microprocessor-controlled prosthetic knees among individuals with unilateral transfemoral limb loss: A systematic review

Sawers¹,

Hafner²

2013

JRRD

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Abstract-Microprocessor-controlled prosthetic knees (MPKs) have been developed as an alternative to non-microprocessorcontrolled knees (NMPKs) to address challenges facing individuals with lower-limb loss. A body of scientific literature comparing MPKs and NMPKs exists but has yet to be critically appraised. Therefore, we conducted a systematic review to examine outcomes associated with the use of these interventions among individuals with transfemoral limb loss. A search of biomedical databases identified 241 publications, of which 27 met the inclusion and exclusion criteria and were reviewed for methodological quality and content. We developed 28 empirical evidence statements (EESs) in 9 outcome categories (metabolic energy expenditure, activity, cognitive demand, gait mechanics, environmental obstacle negotiation, safety, preference and satisfaction, economics, and health and quality of life) based on findings in the literature. The level of evidence supporting these EESs varied due to quantity, quality, and consistency of the results. EESs supported by a moderate level of evidence that noted significant differences between MPKs and NMPKs were derived in five of the nine outcome categories. The results from this review suggest that evidence exists to inform clinical practice and that additional research is needed to confirm existing evidence and better understand outcomes associated with the use of NMPKs and MPKs.Key words: amputation, artificial limb, function, gait, knee, microprocessor, outcome, preference, rehabilitation, safety. Abbreviations: AAOP = American Academy of Orthotists andProsthetists, ABC = Activities-specific Balance Confidence, CWS = controlled walking speed, DLW = doubly labeled water, EBP = evidence-based practice, EES = empirical evidence statement, EV = external validity, GRF = ground reaction force, HAI = Hill Assessment Index, HRQL = health-related quality of life, IV = internal validity, LLL = lower-limb loss, MFCL = Medicare Functional Classification Level, MP = microprocessor, MPC = microprocessor control, MPK = microprocessor-controlled prosthetic knee, MRPP = Montreal Rehabilitation Performance Profile, NMPK = non-microprocessor-controlled prosthetic knee, O 2 = oxygen, O&P = orthotic and prosthetic, PAEE = physical activity-related energy expenditure, PCBS = Prosthetic Cognitive Burden Scale, PCI = physiological cost index, PEQ = Prosthesis Evaluation Questionnaire, PEQ-A = PEQ Addendum, PRO = patient-reported outcome, QALY = quality adjusted life year, QOL = quality of life, RPE = rating of perceived exertion, SAI = Stair Assessment Index, SF-36 = 36-Item Short-Form Health Survey, SOT = sensory organization test, SSWS = selfselected walking speed, SSC = State of the Science Conference, TDEE = total daily energy expenditure, TFLL = transfemoral limb loss.

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Section: Preference and Satisfactionmentioning

confidence: 99%

Section: Preference and Satisfactionmentioning

confidence: 99%

Outcomes associated with the use of microprocessor-controlled prosthetic knees among individuals with unilateral transfemoral limb loss: A systematic review

Sawers¹,

Hafner²

2013

JRRD

View full text Add to dashboard Cite

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“…However, the actual impact of these technologies on patients' lives has been documented in only two case reports [10][11]. The question remains whether advanced devices may be more suited for some people with amputation and less for others based on underlying patient characteristics [12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Impact of Michelangelo prosthetic hand: Findings from a crossover longitudinal study

et al. 2015

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Abstract-This work explores the functional and psychosocial impact of the multigrip Michelangelo (M) prosthetic hand. Transradial myoelectric prosthesis users (6 men, median age: 47 y) participated in a crossover longitudinal study. A multifactorial assessment protocol was applied before the application of M and after 3 mo (functional assessment) and 6 mo (psychosocial assessment) of home use. Functional assessment included both practical tests (i.e., Southampton Hand Assessment Procedure [SHAP], Box and Blocks Test [BBT], and Minnesota Manual Dexterity Test [MMDT]) and self-report functional scales. Psychosocial assessment consisted of a clinical interview and a battery of self-report questionnaires concerning current anxious-depressive symptoms and healthrelated quality of life, body image concerns, adjustment and satisfaction with prosthesis, social support, coping style, and personality. Increased manual dexterity was observed after 3 mo based on improvements in the SHAP, BBT, and MMDT. Two important themes emerged from the clinical interviews at the 6 mo follow-up: (1) the enhanced functionality and (2) the "like a real hand" aspect of the M, which further increased prosthesis integration to the Self. A few patients expressed concerns about M dimension, noise, and weight. The M appeared to restore hand function and natural appearance. The present findings provide preliminary evidence, and additional studies are needed.

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“…Several researchers have actually focused on the patients' perspective on prosthetics including the role of advancements in prosthetics. [42][43][44] They expressed their concern that patients' preference into the decision process lacks intention. They plead for standardized methods in which to measure patient preferences within prosthetic prescription.…”

Section: K-levelmentioning

confidence: 99%

“…In this technology-driven time frame in prosthetic rehabilitation, clinicians should be well aware of the patients' psychosocial issues and patients' emotions and feelings towards technological devices. 43 These researchers [42][43][44] thus impute an important role for clinicians in rehabilitation to balance the functional opportunities offered by technology with a holistic view on the patient. We argue that researchers themselves can also fulfil an important role in this balancing process.…”

Section: K-levelmentioning

confidence: 99%

Reconsidering evidence-based practice in prosthetic rehabilitation

Twillert

Geertzen

Hemminga

et al. 2013

Prosthetics &Amp; Orthotics International

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Background: A divide is experienced between producers and users of evidence in prosthetic rehabilitation. Objective: To discuss the complexity inherent in establishing evidence-based practice in a prosthetic rehabilitation team illustrated by the case of prosthetic prescription for elderly dysvascular transfemoral amputee patients. Study Design: A qualitative research design was used, in which data from multiple sources was triangulated to extract themes for discussion. Methods: This discussion paper draws on empirical material gathered by individual and focus-group interviews with members of a prosthetic rehabilitation team, information on technological advancements presented on websites of orthopaedic industry, guidelines and literature study. Results: A prosthetic rehabilitation team needs to deal with lack of evidence, contradictory results, various classification systems, diverging interests of different stakeholders and many modifying factors, and all of this in a continuous technological changing environment. Integrating research designs with different strengths but not sharing the same biases may help researchers to deal with the multimorbidity and multifaceted disability of the target group. Articulating clinical knowledge, patients’ needs and values in a systematic way provides depth, detail, nuance and context for evidence-based practice issues in prosthetic rehabilitation. Conclusions: Reconsidering the relationship between evidence, technology and rehabilitation practice is an imperative shared enterprise for clinicians and researchers. Scientific, clinical and patient-related knowledge are seen as important knowledge practices that should inform and strengthen each other. Clinical relevance This discussion paper puts the academic clinical debate on evidence-based practice in prosthetics and orthotics in another light. By demonstrating the complexities surrounding evidence-based practice, it is argued and illustrated how both researchers and clinicians can contribute to optimal patient care in which evidence, technology and rehabilitation practice are integrated.

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Identifying the Values and Preferences of Prosthetic Users

Cited by 41 publications

References 28 publications

Outcomes associated with the use of microprocessor-controlled prosthetic knees among individuals with unilateral transfemoral limb loss: A systematic review

Outcomes associated with the use of microprocessor-controlled prosthetic knees among individuals with unilateral transfemoral limb loss: A systematic review

Impact of Michelangelo prosthetic hand: Findings from a crossover longitudinal study

Reconsidering evidence-based practice in prosthetic rehabilitation

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