Patient reported outcomes improve following lower limb prosthesis and socket replacement

TL;DR

Replacing lower limb prostheses and sockets significantly improves patients' mobility, quality of life, and satisfaction.

Contribution

This study provides empirical evidence on the benefits of socket and prosthesis replacements for lower limb amputees.

Findings

Quality of life, satisfaction, and mobility improved significantly across all groups following socket or prosthesis replacement.

Hours worn increased after socket replacement but not after prosthesis replacement.

Older age and conditions like diabetes or vascular disease negatively impacted mobility.

Abstract

Prosthetic sockets are fundamental in stabilizing the residual limb and providing a secure attachment for the prosthesis, therefore aiding in achieving a more natural and efficient walking motion. Patients who are fit with a prosthesis report increased mobility which correlates to increased quality of life and satisfaction. While timely receipt of an initial prosthesis following amputation improves patient outcomes, the impact of the socket or prosthesis being replaced is less documented. The purpose of this analysis was to assess the change in outcomes resulting from socket and prosthesis replacements.

This study included patients within a national database from a national privately owned provider of prosthetic care. Inclusion criteria consisted of adults with a unilateral, lower limb amputation that received either a replacement socket or prosthesis. Data were collected during routine clinical care with questionnaires about quality of life and satisfaction (Prosthesis Evaluation Questionnaire-Well Being), and mobility (Prosthesis Limb Users Survey of Mobility). Statistical analyses consisted of Student’s t-tests and estimated marginal means to determine significant changes within each group. Hours worn was collected as a secondary variable.

A total of 19,185 longitudinal outcomes were included in the final analysis and divided into four groups based on amputation level and socket or prosthesis replacement status (above knee socket replacement n = 2,515, below knee socket replacement n = 7,746, above knee replacement prosthesis n = 1,717, and below knee replacement prosthesis n = 7,207). Quality of life, satisfaction, and mobility improved significantly across all groups (p < 0.01), with hours worn increasing after socket replacement in both groups (p < 0.01) but not in the prosthesis replacement groups. Individuals with vascular disease or diabetes had reduced mobility compared to other etiologies. Older age negatively impacted mobility.

On average, patients with lower limb amputation receiving an above-knee or below-knee socket replacement or prosthesis replacement can expect an improvement in their mobility and well-being.

The findings highlight the clinical relevance of prosthetic socket and prosthesis replacements by demonstrating significant improvements in quality of life, satisfaction, and mobility for patients with lower limb amputations. This evidence supports the importance of socket and prosthesis replacements in enhancing patient outcomes and informs evidence-based clinical practices. By addressing gaps in the literature, this research provides valuable insights that can guide prosthetists and physicians in optimizing care. Overall, these results underscore the long-term benefits of replacements, advocating for prioritizing resources and support for prosthetic care to improve health outcomes and quality of life for individuals with an amputation.

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