Transfemoral Socket Fabrication Method Using Direct Casting: Outcomes Regarding Patient Satisfaction With Device and Services

Abstract

BACKGROUND: Direct Socket for transfemoral (DS-TF) prosthetic user is a novel method of fabricating a laminated interface on to the residual limb but requires different training, production method and service model than what most prosthetists are familiar with. This method and model may improve patient satisfaction by enabling interface fabrication and delivery in one visit.
 OBJECTIVES: Document patient satisfaction regarding DS-TF interface versus the prosthetic users’ previous socket in terms of interface function and the clinic service model.
 METHODOLOGY: In this longitudinal study (from July 2018 to April 2020), the DS-TF was implemented in six prosthetic clinics across the United States. Certified prosthetists (CP) and assistants were trained using a standard protocol. 47 prosthetic users participated, both those in need of a new socket and those without need. Two modules from the Orthotics and Prosthetics Users’ Survey (OPUS), involving questions related to satisfaction with the Device and Services, was used to evaluate each DS-TF user outcome vs. baseline. The only part of the prosthesis that was replaced was the interface, except in 2 cases.
 FINDINGS: Each DS-TF interface was fabricated, fit and delivered in a single clinic visit. At 6-months follow-up, 38 users reported an average of 29.8% increase in satisfaction with their new interface compared with original, and a 14.8% increase in satisfaction with the services they received from the clinic in providing of the new prosthesis vs. their original prosthesis. The main outcome increases were between baseline (initial fitting) and 6-week follow-up and remained consistent after 6 months. This improvement was consistent irrespective if the user needed a new socket for clinical reasons or not.
 CONCLUSION: This study shows that after a standardized training and implementation, the DS-TF fabrication process including a new interface improves the user’s satisfaction with their prosthetic device and services.
 Layman's Abstract
 The connection between an amputee’s remaining limb and their prosthesis is called the interface and is the most critical part in a prosthetic system for the user satisfaction, comfort and mobility. Interfaces commonly consist of two parts; a flexible “liner” rolled onto the limb, which then goes into a hard socket custom-made by the prosthetist. The assembled interface then provides a secure connection between the users remaining limb and the prosthesis. Historically the prosthetist’s fabrication and fitting procedure required many hours of time and multiple visits to the prosthetic clinic before the interface was delivered to the user. Direct Socket for above knee prosthetic users is a new method of fabricating laminated sockets directly on the residual limb that enables fabrication and delivery in a single visit. However, Direct Socket require different training and methods than what most prosthetists are familiar with. This new procedure was implemented in six different prosthetic clinics across the United States. Seven CP’s were trained, each in their clinic and the method was tested on 38 users for a period of 6 months. The users filled in questionnaires about their experience and satisfaction using their existing socket, as well as their satisfaction of using their new socket. Overall, the Direct Socket prosthetic users reported after the 6-months follow-up significantly greater (29.8%) satisfaction with their new socket compared to their previous socket. They also reported 14.8% increase in satisfaction with the services they obtained from the clinic when receiving the new socket, compared to their satisfaction with receiving their original socket.
 Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/34672/26933
 How To Cite: Marable W.R, Smith C, Sigurjónsson B.Þ, Atlason I.F, Johannesson G.A. Transfemoral socket fabrication method using direct casting: outcomes regarding patient satisfaction with device and services. Canadian Prosthetics & Orthotics Journal. 2020;Volume 3, Issue 2, No.6. https://doi.org/10.33137/cpoj.v3i2.34672
 Corresponding Author: G. Anton Johannesson, PhDTeamOlmed, Kistagången 12, 164 40 Kista, Stockholm, Sweden.E-mail: ajohannesson@teamolmed.seORCID: https://orcid.org/0000-0001-8729-458X

Clinical Outcome of Transfemoral Direct Socket Interface (Part 2)

“…A description of their prosthesis can be found in the previous study. 27 Subjects represent the full spectrum of K-Levels 1 through 4:…”

“…In total, 47 subjects were enrolled into this study. The previous article was derived from the same cohort 27…”

“…The flexible silicone brim encompasses and compresses the proximal thigh muscles when contracted, thereby stabilizing the hip at initial contact, loading response, mid-stance, and terminal-stance while creating axial and transverse stabilization. 27 During swing phase, the brim only follows the hip movement. Most outcome measures (PLUS-M™, 37 CLASS, 38 ABC, 39 TUG, 40 and AMPPRO 41 ) were collected using the Prosthetic Rehabilitation Outcomes Application (PROApp) iPad application.…”

“…23 The unique DS-TF interface design has led to greater user satisfaction regarding interface function, comfort, and overall improvement in the fabrication and delivery experience compared to traditional methods. [25][26][27] A deeper analysis of the outcome requires more specific tools. 12 Dissonance between the user and the prosthetic interface design can negatively impact comfort level and strongly correlates with lower functional outcomes.…”

The Use of Smartphone Photogrammetry to Digitise Transtibial Sockets: Optimisation of Method and Quantitative Evaluation of Suitability

“…Within limb centres one of the critical advantages of digital socket production is the ability to utilise centralised fabrication facilities, avoiding much of the advanced machining costs whilst reducing workshop man hours, and potentially decreasing delivery times to patients [8][9][10][11][12]. There are techniques that use direct limb casting to laminate the socket onto the user, allowing for socket delivery within one session [13]. Whilst these methods have increased satisfaction for transfemoral amputees, the authors are not aware of any literature on reliably successful use with transtibial amputees.…”