Abstract
When fitting prosthetic feet, prosthetists fuse information from their visual assessment of patient gait with the patient’s communicated perceptions and preferences. In this study, we sought to simultaneously and independently assess patient and prosthetist preference for prosthetic foot stiffness using a custom variable-stiffness prosthesis. In the first part of the experiment, seven subjects with below-knee amputation walked on the variable-stiffness prosthetic foot set to a randomized stiffness, while several prosthetist subjects simultaneously observed their gait. After each trial, the amputee subjects and prosthetist subjects indicated the change to stiffness that they would prefer (increase or decrease). This paradigm allowed us to simultaneously measure amputee subject and prosthetist subject preferences, and provided a reliability index indicating the consistency of their preferences. In the second part of the experiment, amputee subjects were instructed to communicate verbally with one prosthetist subject to arrive at a mutually preferred stiffness. On average, prosthetist subjects preferred a 26% higher stiffness than amputee subjects (p < 0.001), though this depended on the amputee subject (p < 0.001). Prosthetist subjects were also considerably less consistent than amputee subjects in their preferences (CV of 5.6% for amputee subjects, CV of 23% for prosthetist subjects; p = 0.014). Mutual preference seemed to be dictated by the specific patient-prosthetist dynamic, and no clear trends emerged.
Highlights
When fitting prosthetic feet, prosthetists fuse information from their visual assessment of patient gait with the patient’s communicated perceptions and preferences
We focus on developing a more rigorous understanding of how people with below-knee amputation (BKA) and certified prosthetists (CP) develop and communicate preferences for prosthetic foot stiffness
Seven certified prosthetist (CP) subjects were recruited from the Shirley Ryan AbilityLab via word-of-mouth, and seven high-activity (K3-K4) subjects with below-knee amputation (BKA) were recruited through the facility’s prosthetics and orthotics clinic
Summary
Prosthetists fuse information from their visual assessment of patient gait with the patient’s communicated perceptions and preferences. In the first part of the experiment, seven subjects with below-knee amputation walked on the variable-stiffness prosthetic foot set to a randomized stiffness, while several prosthetist subjects simultaneously observed their gait. It is difficult to design experiments free from subject biases, such as acquiescence bias and the placebo effect, and subjective rating scales are often coarse, unvalidated, and not analyzed using conventional statistical m etrics[5] In this investigation, we focus on developing a more rigorous understanding of how people with below-knee amputation (BKA) and certified prosthetists (CP) develop and communicate preferences for prosthetic foot stiffness. This feedback may not be in the form of the intended variable, but instead in the form of the sensation, and it is the prosthetist’s responsibility to map that sensation into an appropriate change (e.g. a patient is unlikely to request decreased dorsiflexion stiffness, but they may complain of feeling like they are “walking uphill”[7])
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