Prosthesis use in adult acquired major upper-limb amputees: patterns of wear, prosthetic skills and the actual use of prostheses in activities of daily life

Abstract

Purpose: To describe patterns of prosthesis wear and perceived prosthetic usefulness in adult acquired upper-limb amputees (ULAs). To describe prosthetic skills in activities of daily life (ADL) and the actual use of prostheses in the performance of ADL tasks. To estimate the influence of prosthetic skills on actual prosthesis use and the influence of background factors on prosthetic skills and actual prosthesis use. Method: Cross-sectional study analysing population-based questionnaire data (n = 224) and data from interviews and clinical testing in a referred/convenience sample of prosthesis-wearing ULAs (n = 50). Effects were analysed using linear regression. Results: 80.8% wore prostheses. 90.3% reported their most worn prosthesis as useful. Prosthetic usefulness profiles varied with prosthetic type. Despite demonstrating good prosthetic skills, the amputees reported actual prosthesis use in only about half of the ADL tasks performed in everyday life. In unilateral amputees, increased actual use was associated with sufficient prosthetic training and with the use of myoelectric vs cosmetic prostheses, regardless of amputation level. Prosthetic skills did not affect actual prosthesis use. No background factors showed significant effect on prosthetic skills. Conclusions: Most major ULAs wear prostheses. Individualised prosthetic training and fitting of myoelectric rather than passive prostheses may increase actual prosthesis use in ADL.

Implications for Rehabilitation

• Arm prostheses are important functional aids for adult acquired major upper-limb amputees (ULAs).

• Despite being mainly satisfied with their prostheses, reporting their prostheses as useful and showing good prosthetic skills, prosthesis-wearing major ULAs do not use their prostheses for more than about half of the activities of daily life (ADL) tasks carried out in everyday life.

• In unilateral ULAs, individualised and targeted prosthetic training may increase optimal, active prosthesis use in ADL.

• Fitting the amputee with myoelectric rather than passive prostheses may increase prosthesis use in ADL, regardless of amputation level.

Keywords::

• Activities of daily life
• amputees
• prosthesis use
• prosthetic training
• rehabilitation
• upper limb

Declaration of Interest: The authors report no conflicts of interest. Our work was funded in part by Innlandet Hospital Trust and in part by the Norwegian Extra Foundation for Health and Rehabilitation.

Appendices

Appendix 1  Assessment of prosthetic skills in ADL: domains and tasks.

Appendix 2

Assessment of prosthetic skills in ADL tasks: details on performance rating.

Score 0: Task not tested

Task not tested, for any reason (including bilateral tasks for unilateral amputees and to put on a bra for men)

Score 1: Task impossible

Task not possible for the amputee to accomplish

Score 2: Task accomplished with much strain or many awkward motions

Used if the amputee accomplished the task but

• – moved the ipsilateral shoulder more than required and to >90˚ lateral flexion

• – held an item between the head and the shoulder (for instance a cell phone)

• – had abnormal motion in other parts of the body such as lateral flexion of the back, rotation of the trunk, flexion or other use of one or both legs

• used the mouth/teeth

Score 3: Somewhat laboured or few awkward motions

Used if the amputee accomplished the task but

– moved the ipsilateral shoulder more than required but to <90˚ lateral flexion

– had abnormal motion in the ipsilateral arm, but not in other parts of the body

– must sit to accomplish an activity that is normally carried out standing

– used unusually long time

Score 4: Smooth, minimal amount of delays and awkward motions