To the Editor: The article published in Volume 29, Number 3, 2017, titled “Assessment of Functionality of Multifunction Prosthetic Hands”1 is concerning to us, given our significant clinical experience in fitting all the hands tested in this article. Although the aim of the study to provide information on the functional capability of various prosthetic hands to assist decision makers is a noble endeavor, we are concerned that this study may cause more confusion than assistance. In our experience providing upper-limb prosthetic services directly to end users, both acquired and congenital, we find that the clinical implications and concerns are far more complex than which device can open/close faster; they include and encompass a more holistic approach, involving users performing “real-life” tasks, unlike the measurements of this well-intended study. First, we would like to address the use of the SHAP (Southampton Hand Assessment Procedure) as the only outcome measure utilized to demonstrate functional capability. One challenge in upper-limb prosthetic care is the lack of available, clinically relevant outcome measures combined with the lack of consensus on how to use them.2 For these reasons, common practices to assess upper-limb prosthetic solutions highlight the need to use multiple outcomes and when not possible,3 at the very least, to soften the results by acknowledging that further investigations would be needed. None of these rules of thumb are acknowledged in this article, the results being presented as strong evidence despite these limitations. Furthermore, the SHAP bases scores on time to complete tasks, limiting the approach to a single measure of performance. This does not take into account compensatory motions needed to complete that task, which may impact risk for overuse syndromes as highlighted below. It also does not consider the user’s ability to complete their goals with the prosthesis and their satisfaction with how they complete those tasks. Second, this study was completed with a single-subject, able-bodied design where the author of the article was the only subject.4 Although the author has a strong background with myoelectric technology, given his description of how he entered and exited the grips with the various technology, we are concerned this may have impacted the results. We believe that clinical articles, when assessing the functionality of prosthetic solutions, should include at least one subject fitting the indication related to the use of the solutions tested. Candidly, we are surprised that this study passed peer review and was published by your journal, given the bias of this type of design. The analytical bias, sample bias, and observer bias would make it difficult to interpret the results of this study. Third, the author does point out some of the areas for consideration beyond the scope of his study including the potential kinematic differences between multiarticulating hands and standard single-grip prosthetic hands. However, this critical claim as the benefit of the advanced technology is not measured in any way. This makes it difficult to accept the author’s strong conclusion that “clinically, the implications are clear.” How could the implications be clear if the main benefit of the advanced technology was not tested? In addition, the technology used in this article is already representative of previous generations of the i-limb and bebionic products. The latest i-limb quantum is 30% faster than the i-limb Pulse tested in this article. The thumb positioning and other points raised about the technology are no longer relevant as per our clinical experience and the feedback provided by patients fitted with the next product generation. In our practice, we focus on a holistic plan of care including prosthetic fitting as well as the indispensable role of occupational therapy training, which we regard as critical for upper-limb clients. We take into account the user’s goals when prescribing appropriate technology and work as a team to ensure end user goals are accomplished. The author does agree that it depends on the individual as to what technology will best suit the user’s needs, and we feel that may be the better conclusion to this study. Debra Latour, OTD, MEd, OTR/LThomas Passero, CP Handspring Rehabilitation LLC and Prosthetic & Orthotic Associates, Inc Middletown, NY