ACCEPTANCE OF UPPER LIMB PROSTHESES

Abstract

Introduction: Reasons why patients refuse wearing their upper limb prostheses deserve to be studied.

Method: Amputees were recruited from the clinics as well as from health- and accident insurances and Veterans’ Service Offices. Questions covered the patients’ medical history of amputation, their prosthetic supply and their present living conditions. 454 participants returned the anonymous questionnaire and could be entered into the study.

Amputation was caused by war (287), civil trauma or illness (123) and congenital (44). Age ranged from 3 – 96 years, with mean of 67.8. Distribution regarding sex and side was 411m/43 f and and 211 right/223 left. 20 had bilateral amputation. In 216 patients the dominant side was affected. Level of amputation was: wrist 36, BE 164, elbow 9, AE 201, shoulder 23, forequarter 3, unknown 18.

Prosthetic devices were classified as passive (i.e. cosmetic and passive work prostheses) or active, i.e. electrically- or body-powered prostheses as well as the combination of the two.

In the statistical analysis null hypothesis was that no factor influences the acceptance rate. Significant differences are accepted when p< 0.05.

Results: Electrically-powered prostheses were accepted best. Cosmetic prostheses were accepted well when stigmatization in the context of ethnic origin or religious affiliation may be important.

Acceptance rate was influenced by: Country of origin, religious affiliation, sex, learned occupation, therapist involved in training, return to work, incapacity for work, job held after amputation, own initiative in initiating prosthetic care, loss of friends or partners, level of amputation and the combined parameters AE-amputation and non-dominant side.

No influence was found for education, age at amputation, marital status, side of amputation, recommendation of prosthesis, time until first prosthetic fitting, phantom pain and phantom feeling, return to sports or hobbies, consumption of tobacco, alcohol or sedatives.

Discussion: Looking at all patients, the rates of acceptance of the various prosthetic types equals those found in the relevant literature. However, this study is much more detailed, looking at many different parameters and their combinations and can therefore provide some guidance to the successful prescription of upper limb prostheses. Nowadays electrically-powered prostheses are generally better accepted than all other types and should therefore be provided more often.