Abstract
ObjectiveConsidering the high rejection rates of upper limb prostheses, it is important to determine which prosthesis fits best the needs of each user. The introduction of the multi-grip prostheses hands (MHP), which have functional advantages but are also more expensive, has made prosthesis selection even harder. Therefore, we aimed to identify user opinions on factors determining prosthesis choice of persons with major unilateral upper limb defects in order to facilitate a more optimal fit between user and prosthesis.MethodsA qualitative meta-synthesis using a ‘best-fit framework’ approach was performed by searching five databases (PROSPERO registration number: CRD42019126973). Studies were considered eligible if they contained qualitative content about adults with major unilateral upper limb defects experienced in using commercially available upper limb prostheses and focused on upper limb prosthesis users’ opinions. Results of the meta-synthesis were validated with end-users (n = 11) in a focus group.ResultsOut of 6247 articles, 19 studies were included. An overview of six main themes (‘physical’, ‘activities and participation’, ‘mental’, ‘social’, ‘rehabilitation, cost and prosthetist services’ and ‘prosthesis related factors’) containing 86 subthemes that could affect prosthesis choice was created. Of these subthemes, 19 were added by the focus group. Important subthemes were ‘work/school’, ‘functionality’ and ‘reactions from public’. Opinions of MHP-users were scarce. MHPs were experienced as more dexterous and life-like but also as less robust and difficult to control.ConclusionThe huge number of factors that could determine upper limb prosthesis choice explains that preferences vary greatly. The created overview can be of great value to identify preferences and facilitate user-involvement in the selection process. Ultimately, this may contribute to a more successful match between user and prosthesis, resulting in a decrease of abandonment and increase of cost-effectiveness.
Highlights
The absence of an upper limb, due to either an amputation or a congenital defect, can have a huge impact on a person’s life and can cause a decrease in life satisfaction [1]
The huge number of factors that could determine upper limb prosthesis choice explains that preferences vary greatly
If a clinician asks a potential prosthesis user which factors they think might be of importance, it is highly unlikely that they will mention all factors that really matter, because the potential user does not know that these factors can matter
Summary
The absence of an upper limb, due to either an amputation or a congenital defect, can have a huge impact on a person’s life and can cause a decrease in life satisfaction [1]. The population with upper limb defects (ULD) is small compared to that with lower limb defects, people with ULD are typically young and have normal life expectancy [2,3]. They are potentially long-term prosthesis users and consumers of prosthesis-related health care, resulting in high costs [4,5,6]. In the Netherlands, the yearly average cost per upper limb prosthetic user increased from €3070 in 2012 to €4130 in 2016 [7]. Considering that the rejection rates for upper limb prosthesis are estimated as high as 35%, it is important to determine which prosthesis best fits the needs and wishes of each user [8]
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