Session III - Polytrauma

Fri., 10/11/02 Polytrauma, Paper #17, 4:09 PM

Prosthetic Device Satisfaction among Patients with Lower Extremity Amputation Due To Trauma

Juliana K. Cyril, MPH, PhD; Ellen J. MacKenzie, PhD; Douglas G. Smith, MD; Michael J. Bosse, MD; The LEAP Study Investigators; Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, USA

Purpose: Satisfaction with a prosthetic device may have an important and continuous effect on long-term outcomes, such as quality of life and return to usual activities. However, despite the increased availability and technological sophistication of prosthetic devices, patients and health care organizations have little on which to judge their quality and cost-effectiveness. The purpose of this study was to assess satisfaction with the prosthetic device among patients who had a lower extremity amputation due to trauma and, specifically, to determine whether those with high-tech devices express greater levels of satisfaction than those with medium- or low-tech devices.

Methods: Our data come from a multi-center, prospective study of 601 lower extremity trauma patients ages 16 through 69. Study participants included 135 patients who had had a unilateral transfemoral or transtibial amputation within the first 3 months after injury and who reported owning a prosthetic device within 12 months after injury. Respondents rated their satisfaction on a scale from 1 (not at all satisfied) to 5 (completely satisfied) in the following six dimensions: comfort, appearance, walking with the device, weight, ease of use, and satisfaction with prosthetic services. To determine the technological sophistication of each device, an expert panel consisting of two prosthetists and one surgeon independently rated each device as being either low-, medium- or high-tech. We examined patients' satisfaction with their devices at 12 and 24 months after injury. We used regression models to examine the satisfaction correlates, including the impact of device sophistication on patients' level of satisfaction.

Results: Over 70% of patients were moderately to completely satisfied with their device. Individuals with high-tech devices reported higher mean satisfaction scores. Multivariate regression analysis of 12-month data showed that those who used a high-tech device (P <0.05), who had at least a high school education (P<0.05), and who had a higher self-efficacy score (P <0.10) were more satisfied. Patients who had an atypical flap (P <0.10) and who reported skin irritation (P <0.05) were less satisfied. At 24 months, patients who were living at more than 125% of the poverty level (P <0.05), who were the head of their household (P <0.10), and who reported better prosthetic functional status (P <0.05) reported increased satisfaction. Patients who were female (P <0.05), who reported skin irritation (P <0.05), and who reported phantom pain (P <0.05) were less satisfied.

Discussion/Conclusion: Users of high-tech devices tended to report greater satisfaction. Although the technological sophistication of the device may influence satisfaction levels, our analysis shows that socioeconomic status, device-related problems, and limb characteristics were strongly associated with satisfaction. These findings show the need for further investigation of satisfaction with prosthetic devices and its impact on other patient outcomes such as quality of life and the ability to return to normal activities.