Patient satisfaction following lower-limb amputation

Abstract

Background: Patient satisfaction is an important measurement in healthcare for administrators, clinicians and patients. Objectives: This study investigated the role of gait deviation in patient satisfaction following lower-limb amputation and prosthesis prescription. Study design: A cross-sectional study was done. Methods: Twenty community-based unilateral lower-limb amputees, 12 transtibial and 8 transfemoral, were recruited from support groups. Participants completed the prosthesis evaluation questionnaire (PEQ) with embedded satisfactionrelated questions, the timed-up-and-go test and the six-minute walk test, and also underwent quantitative three-dimensional analysis. Kinematic deviation was summarized using the gait profile score (GPS). Results: Satisfaction levels were generally high (median 80 + /100). Sociodemographic variables did not correlate significantly with any of the satisfaction measures (À0.35 r 0.54). Satisfaction correlated strongly with the PEQ scales, particularly ambulation, prosthetic utility, frustration, perceived response and social burden (r ! 0.70). By contrast, the relationships between satisfaction and performance-based outcome measures were not significant (À0.45 r 0.43), and the GPS did not correlate with any satisfaction measures (À0.23 r 0.15). Conclusions: In this study of high functioning amputees, gait deviation was unimportant to the amputee, while selfreported functional ability and attitudes toward the prosthesis were the strongest correlates of satisfaction following lower-limb amputation. Clinical relevanceFor the high functioning individuals with lower-limb amputation in this study, gait deviation was not a significant correlate of patient satisfaction. Results suggest that improving self-perceived functional ability and attitudes toward the prosthesis, rather than minimizing gait deviation, will improve patient satisfaction.

Long-term activity in and among persons with transfemoral amputation

“…Use of a prosthesis may promote independence in activities that incorporate the lower limb (e.g., postural transitions, locomotion), but prominent deficits remain. Standing balance [12], level-ground walking [13][14][15][16][17][18], stair ascent and descent [19][20][21], hill ascent and descent [22], negotiation of uneven terrain [14], standing from and sitting in a chair [23], and obstacle avoidance [24] have been reported to be significantly impaired in persons with TFA compared to nondisabled control subjects. Documented limitations typically relate to the capacity of prosthetic users to engage in specified activities compared with those without amputation in controlled laboratory environments.…”

Prosthesis preference is related to stride-to-stride fluctuations at the prosthetic ankle

“…Patients consistently prefer energystorage-and-return (ESAR) prosthetic feet [6][7][8], but the typical biomechanical metrics used to assess gait do not always demonstrate superiority of ESAR. Furthermore, Kark and Simmons showed a lack of relationship between gait deviations and prosthesis satisfaction, implying the role of gait is not unambiguously coupled to prosthesis satisfaction [9]. Numerous biomechanics measures covering all areas of kinematics and kinetics as well as electromyography and energy expenditure have been explored in gait of individuals with lower-limb amputation [6].…”

“…While this technique is informative, it fails to account for the inherent relationship between strides that calculations such as the largest Lyapunov exponent (LyE) will capture. Measures, such as those utilized by Kark and Simmons [9], presume that every step is completely independent of the previous steps and has no influence on any ensuing steps. However, studies have confirmed the presence of strong relationships between continuous strides during gait [10][11][12].…”

Review of the Socket Design and Interface Pressure Measurement for Transtibial Prosthesis

“…Dillingham et al [7] conducted a survey and noticed that most of the participants ( n = 146) were not satisfied with their prostheses due to skin problems and pain. Another study [29] also revealed dissatisfaction with prostheses. Moreover, more than 70% of participants in a study were more satisfied with the pin/lock suspension system than the Pelite liner [30].…”