Trans-tibial prosthesis fitting and prosthesis satisfaction

Achieving optimal prosthesis fitting and satisfaction is an important goal in treatment of persons with a trans-tibial amputation. However, many prosthesis users are not satisfied with their prosthesis. Factors influencing prosthesis fit have been studied fragmentarily with different operationalizations and a comprehensive overview is lacking. Furthermore, the residual limb and prosthesis is often not systematically checked for fit and prosthesis user’s satisfaction.Use of a silicon liner in trans-tibial prostheses is studied in a literature review and shows some advantages for prosthesis fit and function (Chapter 3) while hand function impairments, illustrated in a case report and studied in a historic cohort, influences prosthesis donning and may result in liner related skin problems (Chapters 2a and 2b). Chapter 4 presents a Delphi survey with expert opinions on biomedical, referring to the residual limb-socket fit, and psychosocial, referring to psychological and social aspects, factors influencing prosthesis fit. Chapter 5 presents results of a systematic review, giving an overview of factors influencing prothesis satisfaction. Chapter 6 presents results of a study using a checklist for systematic checking of the prosthesis during consultation with the certified prosthetist and shows that checklist use identifies more problems and issues of dissatisfaction than mentioned prior to consultation. In the general discussion (Chapter 7) the studies are discussed and implications for clinical practice are given. Assessment of hand function is advised when considering liner use and regular evaluation of the residual limb and prosthesis for fit and satisfaction is recommended. Lastly, recommendations for future research are given