Dear O and P List Serve Community,
I would like to thank everyone who participated in my survey regarding upper limb acceptance as well as their patience when I had to as a second question that weighted the factors of acceptance. Here are some of the early results.
The first survey had 59 respondents of which 15% classified themselves as Novices, 41% Intermediates, 29% Experts, and 15% Specialists. The “Golden Period” of fitting as outlined by Malone was 30 days or less. Of the respondents 37% said it was 30 days or less, 54% said that it was 30-60 days, and 8.4% said 60-90 days.
When looking at the 12 factors that indicated acceptance all were rated relatively high from 59-80%. The top five were “Amputation Level” at 80%, “Functional Advantage” at 79%, “Socket and Harness Comfort” at 78%, “Peer at Family Support” at 76%, and “Therapy and Training” at 73%. The issue is that so many were rated highly, then I realized that I had asked the question incorrectly and did not ask that there be greater weighting of the choices.
That necessitated the second question in which 43 people responded. The population of the second survey was similar, but had fewer intermediates, with 23% Novices, 34% Intermediates, 26% Experts, and 16% Specialists. The weighting of the top 4 factors made it easier to see the delineations greater. In this case “Functional Advantage” was highest, followed by “Amputation Level” then it dropped to a second grouping of “Socket & Harness Comfort”, “Patient/Prosthetist Relationship”, “Therapy & Training”, and “Confidence of the Prosthetist”.
Counting just the factors that were rated #1 and #2 and a 80-20 Pareto Analysis (which seeks to find the 20% of factors that have an 80% effect) gave even more weighting to “Amputation Level”, “Functional Advantage”, and “Socket/Harness Comfort” constituting 72% of the factors which is similar to the ratings of Biddiss & Chau (2007) . If “Therapy & Training” were added and “Prosthetist/Patient Relationship “ then the aggregate acceptance factor was increased to 84%.
The other interesting thing was that acceptance by level was more optimistic than the original 50-50 scenario of prosthetic acceptance. By level respondents estimated that 43% of Partial Hands accepted, 65% of Wrist Disarticulation, 79% of Transradial, 54% of Elbow Disaric, 57% of Tranashumeral, and 32% of Shoulder Disarticulation. Although this seems quite high it does match the classical acceptance rates by Berger (1958) which were 75% for Transradial, 61% Transhumeral, and 35% Shoulder Disarticulation.
In the other questions “Patient Input” and “Achievement of Patient” goals were the main methods used to assess function. That “Gadget Tolerance Varies” and “Trial Fits” are beneficial and “Some Frustration is Normal” with respect to gadget tolerance. “Too Few Patients” affects prosthetist confidence with upper limb the most followed by “Too little Time spent with Experts.” With respect to the patient/prosthetist relationship “Taking time to discuss Various Options” and “Patient should make Contributions to Decisions” were rated most highly. With respect to socket and harness comfort “Socket Design takes lot of Practice” and “Alternative Harness Design” were rated most important. With peer support “Parents influence Acceptance” and “Peers ask for more Cosmetic Solutions” were a the most highly rated answers.
Of course all of these answers are from the perspective of the prosthetist and not the patient themselves. In the future I would like to compare the different populations and see if there are any differences. Also I would like to develop a Bayesian prediction based on the four main characteristics of Amputation Level, Functional Expectation, Comfort Tolerance, and Motivation/ Support to provide a baseline Aggregate Acceptance factor.
I hope this was helpful and thanks once again,
Gerry
Gerald Stark, MSEM, CPO/L, FAAOP
Senior Upper Limb Clinical Specialist
Ottobock
14630 28th Avenue N.
Minneapolis, MN 55447
M 612.270.7363
F 763.253.5768
[email protected]
www.ottobockus.com
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