User-relevant factors determining prosthesis choice in persons with major unilateral upper limb defects: A meta-synthesis of qualitative literature and focus group results

Nienke Kerver, Sacha van Twillert, Bart Maas, Corry K van der Sluis, Nienke Kerver, Sacha van Twillert, Bart Maas, Corry K van der Sluis

Abstract

Objective: Considering 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.

Methods: A 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.

Results: Out 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.

Conclusion: The 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.

Conflict of interest statement

Corry K. van der Sluis was co-author of two of the included studies in the meta-synthesis. To prevent competing interests, those studies were assessed by the other reviewers. The authors have declared that no competing interests exist.

Figures

Fig 1. Preferred Reporting Items for Systematic…
Fig 1. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) flowchart for the selection of studies.
Fig 2. Final framework of factors determining…
Fig 2. Final framework of factors determining prosthesis choice of persons with major unilateral upper limb defects.

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