A questionnaire survey of the effect of different interface types on patient satisfaction and perceived problems among trans-tibial amputees


Van De Weg, F. B.; Van Der Windt, D. A. W. M.

Prosthetics and Orthotics International 29(3): 231-239

2005


Prosthetics
and
Orthotics
International
December
2005;
29(3):
231
—239
0
Taylor
&
Francis
Taylor
&Francis
Group
A
questionnaire
survey
of
the
effect
of
different
interface
types
on
patient
satisfaction
and
perceived
problems
among
trans-tibial
amputees
F.
B.
VAN
DE
WEG
1
&
D.
A.
W.
M.
VAN
DER
WINDT
2
'Rehabilitation
Centre,
Amsterdam,
The
Netherlands
and
2
EMGO
Institute
and
Department
of
General
Practice,
VU
University
Medical
Centre,
The
Netherlands
Abstract
The
objectives
were
to
investigate
the
effect
of
three
different
interface
types
on
consumer
satisfaction
and
perceived
problems
among
trans-tibial
amputees
in
the
Netherlands.
A
postal
questionnaire
(based
on
the
Prosthesis
Evaluation
Questionnaire)
was
sent
to
353
patients.
Responders
were
classified
in
three
groups
of
interface
types:
polyethylene
foam
(PEF)
inserts,
silicone
liners
(SIL),
and
polyurethane
liners
(PUL).
Differences
concerning
satisfaction
and
problems
between
interface
types
were
computed
and
adjusted
for
potential
confounding
by
age,
gender,
reason
for
amputation
and
time
since
first
prosthesis.
A
total
of
220
patients
responded
(62%).
Patients
wearing
liners
reported
a
significantly
poorer
durability
and
higher
maintenance
time
compared
with
patients
using
PEF
inserts.
Sum-scores
for
satisfaction
or
problems
did
not
show
any
significant
differences
between
groups.
Analysis
of
individual
items
showed
a
significant
difference
only
for
satisfaction
with
sitting
and
with
walking
on
uneven
terrain
in
favour
of
PEF
inserts.
In
contrast
to
most
studies,
interface
type
was
included
as
a
possible
determinant
of
customer
use,
satisfaction,
and
perceived
problems.
The
perceived
differences
between
the
three
suspension
types
are
to
a
large
extent
small
and
non-significant.
The
findings
do
not
support
liner
prescription
as
a
matter
of
course
for
all
trans-tibial
amputees.
A
careful
analysis
of
patients'
preferences
should
be
made
to
determine
the
best
course
of
action.
Further
studies,
preferably
prospective,
need
to
be
conducted
to
determine
which
systems
are
most
comfortable
and
offer
least
complaints.
Keywords:
Questionnaire
survey,
interface
types,
patient
satisfaction,
perceived
problems,
trans-tibial
amputees
Introduction
Until
the
early
1990s,
most
patients
with
a
trans-tibial
amputation
were
outfitted
with
a
patellar
tendon
bearing
(PTB)
socket
with
a
soft
insert
of
polyethylene
foam
(PEF).
Silicone
and,
from
the
mid-1990s
onwards,
polyurethane
gel
liners
were
introduced
worldwide
in
an
effort
to
reduce
shear
forces
and
improve
the
quality
of
the
interface.
Silicone
and
gel
liners,
due
to
their
presumed
ability
to
better
control
the
artificial
limb,
are
now
often
prescribed
in
favour
of
PEF
inserts
(Marks
and
Michael
2001).
Liners
supposedly
add
a
measure
of
cushioning,
comfort,
and
pressure
dissipation
(Cochrane
et
al.
2001;
Datta
et
al.
1996;
Correspondence:
F.
B.
van
de
Weg,
Department
of
Rehabilitation,
Rehabilitation
Centre
Amsterdam,
Overtoom
283,
Amsterdam
1054
HW,
The
Netherlands.
E-mail:
weg.f@zaansmc.nl
ISSN
0309-3646
print/ISSN
1746-1553
online
©
2005
ISPO
DOI:
10.1080/03093640500199679
232
F.
B.
van
de
Weg
&
D.
A.
W
M.
van
der
Windt
Fergason
and
Smith
1997;
Hatfield
and
Morrison
2001),
though
several
authors
(Dasgupta
et
al.
1997;
Data
et
al.
1996;
Dillingham
et
al.
2001;
Lake
and
Supan
1997)
have
drawn
attention
to
persistent
stump
problems
with
liners.
Liners
are
now
widely
prescribed,
although
little
empirical
evidence
exists
to
support
their
presumed
surplus
value,
particularly
from
the
point
of
view
of
users.
To
gain
insight
into
consumer
satisfaction
and
perceived
problems
with
three
different
interface
types,
we
conducted
a
questionnaire
survey
among
trans-tibial
amputees
in
the
Netherlands.
Methods
Subjects
A
postal
questionnaire
was
distributed
among
353
outpatients
with
a
trans-tibial
amputation,
who
were
approached
either
through
the
magazine
of
the
Dutch
Society
for
Lower-Limb
Amputees
(n
=
196)
or
through
the
databases
of
two
prosthetics
service
units
(n
=
157).
All
patients
had
received
a
new
prosthesis
between
January
2000
and
January
2002.
There
were
no
restrictions
with
respect
to
socket
characteristics,
age,
gender,
co-morbidity,
date
of
amputation,
or
reason
for
amputation.
Three
interface
types
were
compared:
PEF
inserts,
silicone
liners,
and
polyurethane
liners.
The
sockets
accompanying
the
liners
usually
follow
the
total
surface
bearing
principle
but,
depending
on
the
experience
of
the
prosthetist,
may
incorporate
patellar
tendon
bearing
characteristics
(Fergason
and
Smith
1997).
Questionnaire
The
questionnaire
(see
Appendix)
included
questions
on
demographic
variables
(age,
gender,
marital
status,
level
of
education),
reason
for
amputation,
and
time
since
first
prosthesis.
In
addition,
several
questions
concerned
use,
maintenance,
and
durability
of
the
prosthesis.
Overall
satisfaction
with
the
prosthesis
was
scored
on
a
0-10
point
numerical
rating
scale.
In
addition,
satisfaction
was
measured
on
a
seven-item
scale,
using
four
response
options
ranging
from
'unsatisfied'
(0)
to
'completely
satisfied'
(3).
Items
referred
to
the
fit
of
the
prosthesis,
ability
to
don
and
doff,
sit,
walk,
walk
on
uneven
terrain,
and
walk
up
and
down
stairs,
and
appearance.
Perceived
problems
with
the
prosthesis
were
assessed
with
a
seven-
item
problem
scale,
consisting
of
items
referring
to
sweating,
wounds,
skin
irritation,
unpleasant
smells,
unwanted
sounds,
pain,
and
swelling.
The
five
response
options
ranged
from
'not
at
all
bothered'
(0)
to
'extremely
bothered'
(4).
Selection
of
items
for
the
satisfaction
and
problem
scale
was
based
on
the
Prosthesis
Evaluation
Questionnaire
(Legro
et
al.
1998).
Analysis
Descriptive
statistics
were
used
to
present
population
characteristics
and
results
regarding
use,
maintenance
time,
and
perceived
durability
of
the
prosthesis.
Sum-scores
were
calculated
for
both
seven-item
scales
(0
—21
points
for
satisfaction
and
0-
28
points
for
problems).
A
missing
value
on
the
satisfaction
scale
was
replaced
by
the
mean
score
of
the
subject's
other
items
if
a
minimum
of
five
of
the
seven
items
were
completed
(walking
on
uneven
terrain
and
walking
stairs
were
often
missing
simultaneously),
and
on
the
problems
scale
if
a
minimum
of
six
of
the
seven
items
were
completed.
The
internal
Interface
type
and
patient
satisfaction
233
consistency
of
both
scales
was
satisfactory
(Cronbach's
a
=
0.88
for
satisfaction
and
0.76
for
problems).
Mean
differences
in
sum-scores
on
satisfaction
and
perceived
problems
were
computed
for
subgroups
with
the
following
patient
characteristics:
age
(
.-.,
50
or
>
50
years),
gender
(male
or
female),
partner
(yes
or
no),
currently
working
(yes
or
no),
reason
for
amputation
(vascular
or
other),
and
time
since
amputation
(
.-.,
10
or
>
10
years).
These
differences
were
presented
along
with
95%
confidence
limits.
Mean
differences
in
sum-scores
between
PEF
inserts
and
liner
type
(SIL
or
PUL)
were
computed
and
tested
for
statistical
significance
using
one-way
analysis
of
variance
(ANOVA).
These
differences
were
accordingly
adjusted
for
potential
confounding
by
age,
gender,
reason
for
amputation,
and
time
since
first
prosthesis
using
multivariate
linear
regression
analyses.
Finally,
satisfaction
and
perceived
problems
were
analysed
on
the
level
of
individual
items,
for
which
responses
were
dichotomized.
A
response
was
coded
as
'satisfied'
if
the
participant
had
scored
either
'completely'
(3)
or
'fairly
satisfied'
(2).
For
items
concerning
problems,
a
participant
was
denoted
as
'experiencing
problems'
if
they
had
scored
being
'extremely'
(4)
or
`very
bothered'
(3).
Proportions
were
computed
for
the
total
population,
and
separately
for
PEF
inserts
and
liner
types
(SIL
and
PUL).
All
analyses
were
carried
out
using
SPSS
10.1.
Results
Study
population
(Table
I)
Two
hundred
and
twenty-seven
(227)
questionnaires
were
returned.
Seven
responses
were
too
incomplete
to
utilize;
therefore,
220
responses
were
available
for
analysis
(62%).
Most
respondents
(95%)
were
able
to
indicate
what
type
of
prosthesis
they
were
using
at
the
time
of
investigation.
The
majority
of
persons
were
male
(60%),
had
an
intermediate
or
higher
education
(74.2%),
and
had
no
current
job
(72.6%).
Trauma
was
the
most
common
(42.3%)
Table
I.
Characteristics
of
the
study
population
(n
=
220).
Age:
years,
mean
(SD)
a
62.1
(17.5)
Gender:
male,
n
(%)a
132
(60.3%)
Education:
n
(%)
a
no
or
lower
education
56
(25.8%)
intermediate
education
116
(53.5%)
higher
education
45
(20.7%)
Marital
status,
n
(%)
a
married/living
with
partner
125
(57.6%)
single
89
(41.0%)
child
3
(1.4%)
Work
status:
paid
work,
n
(%)
a
60
(27.4%)
Reason
for
amputation/prosthesis:
n
(%)
vascular
83
(37.7%)
trauma
93
(42.3%)
other
(congenital
deformities,
infection,
etc.)
33
(15.0%)
unclear
11
(5.0%)
Years
since
first
prosthesis:
mean
(SD)
a
16.7
(16.2)
Type
of
liner:
n
(%)
a
PE
foam
insert
62
(28.4%)
silicon
liner
94
(43.1%)
polyurethane
liner
62
(28.4%)
aInfonnation
missing
for
one
to
four
responders.
234
F.
B.
van
de
Weg
&
D.
A.
W
M.
van
der
Windt
reason
for
amputation.
The
most
common
prosthetic
type
was
a
socket
with
a
SIL
liner
(43%).
PEF
inserts
and
PUL
liners
occurred
to
an
equal
extent
(approximately
28%
each).
Use
and
satisfaction
The
majority
(93%)
of
persons
used
the
prosthesis
extensively
(more
than
6
h
per
day).
Daily
wearing
time
was
not
significantly
different
between
groups.
Daily
maintenance
time
was
significantly
longer
for
both
liners
compared
with
PEF.
Durability
was
considered
to
be
significantly
poorer
for
PUL
compared
with
SIL
and
PEF.
The
mean
overall
satisfaction
on
a
0
—10
point
numerical
rating
scale
was
7.0,
ranging
from
6.9
for
PUL
to
7.3
for
PEF.
Differences
in
sum-scores
on
the
satisfaction
scale
between
inserts
and
liner
types
were
also
small
and
not
significant.
Adjustment
for
potential
confounding
by
age,
gender,
reason
for
amputation,
and
time
since
first
prosthesis
further
reduced
these
differences.
Male
gender,
paid
work,
non-vascular
reasons
for
amputation,
and
longer
time
since
first
prosthesis
were
associated
with
significantly
higher
satisfaction
sum-
scores,
although
the
differences
were
small
(<
3
points
on
a
scale
of
0
—21,
Table
III).
Analysis
of
individual
satisfaction
items
showed
a
significant
difference
(P=
0.02)
in
favour
of
PEF
for
walking
on
uneven
terrain
and
sitting.
Differences
regarding
fit
of
prosthesis,
donning
and
doffing,
walking,
stair-climbing,
and
perception
of
looks
were
non-significant
(Table
II).
Problems
with/complaints
about
prosthesis
Younger
age
and
female
gender
were
associated
with
a
higher
problem
sum-score,
although
the
differences
were
very
small
(
<
2
points
on
a
scale
from
0—
28)
and
not
statistically
significant
(Table
III).
Silicone
liners
and
PU
liners
were
associated
with
a
lower
problem
sum-score
compared
with
PE
foam
inserts
(Table
IV).
Mean
differences
(unadjusted
and
adjusted
for
confounding)
were
very
small
(
<
1
point)
and
not
statistically
significant.
None
of
the
individual
items
showed
any
significant
differences
between
the
three
groups.
The
only
sub-
item
approaching
significance
was
sweating,
which
was
a
somewhat
more
common
problem
in
users
of
PEF
inserts
(36%)
compared
with
SIL
and
PUL
(21%
and
24%,
respectively).
Discussion
The
authors
investigated
interface
type
as
a
possible
determinant
of
customer
use
and
satisfaction.
Durability
of
PUL
liners
was
considered
significantly
poorer
and
maintenance
time
significantly
longer
with
both
types
of
liners,
compared
with
PEF.
The
authors
did
not
register
significant
differences
between
interface
types
with
respect
to
perceived
problems.
The
only
sub-item
approaching
significance
(P=
0.08)
was
sweating,
which
was
reported
more
frequently
in
users
of
PEF
inserts
(36%)
compared
with
users
of
SIL
and
PUL
(21%
and
24%,
respectively).
Excessive
sweating
is
often
ascribed
to
liners
but
apparently
is
very
common
with
a
PEF
insert,
too.
Apparently,
liners
are
not
always
perceived
as
'better'
by
users,
yet
this
appears
to
be
the
general
trend
in
the
literature.
Views
from
a
UK
questionnaire
survey
reflecting
personal
experiences
among
doctors
and
prosthetists
(McCurdie
et
al.
1997)
indicated
a
clear
preference
for
liners.
A
recent
Dutch
study
(van
der
Linde
et
al.
2004)
showed
that
rehabilitation
professionals
have
favoured
a
gel
liner
in
the
past
two
years,
despite
a
lack
of
formal
evidence
or
the
presence
of
a
standard
for
the
implementation
of
new
prosthetic
components.
Hatfield
and
Morrison
(2001)
reported
improved
comfort
in
patients
using
Interface
type
and
patient
satisfaction
235
Table
II.
Use
and
satisfaction
with
prosthesis.
All
n
=
220
PEF
n
=
62
SIL
n
=
94
PUL
n
=
62
Wearing
time:
>
6
h/day,
n
(%)
a
199
(92.6%)
58
(96.7%)
82
(88.2%)
58
(95.1%)
P=
.31
Daily
maintenance
time:
35
(16.4%)
4
(6.9%)
17
(18.3%)
14
(22.9%)
P
<
.001
>
10
min,
n
(%)
a
Durability
poor/very
poor:
n
(%)
a
71
(33.8%)
16
(26.7%)
25
(28.1%)
30
(50%)
P=
.013
Satisfied/very
satisfied
with:
n
(%)
b
fit
of
prosthesis
139
(66.5%)
41
(69.4%)
57
(64.0%)
40
(67.8%)
P=
.77
donning
and
doffing
160
(78.0%)
46
(79.3%)
66
(76.7%)
46
(77.9%)
P=
.85
sitting
142
(68.6%)
52
(88.1%)
54
(62.1%)
35
(59.4%)
P=
.02
walking
121
(61.1%)
40
(70.1%)
50
(60.2%)
31
(54.4%)
P=
.12
walking
on
uneven
terrain
76
(39.2%)
27
(45.8%)
27
(24.6%)
22
(39.3%)
P=
.02
stair
climbing
93
(50.3%)
31
(54.4%)
39
(51.4%)
23
(45.1%)
P=
.48
looks
of
prosthesis
133
(66.8%)
39
(67.2%)
56
(67.5%)
37
(66.0%)
P=
.72
Sum-score
satisfaction:
11.4
(4.7)
12.0
(3.9)
11.3
(5.0)
11.0
(5.0)
P=
.50
(0-21),
mean
(SD)`
Overall
satisfaction:
0-10,
mean
(SD)
d
7.0
(1.9)
7.3
(1.6)
7.0
(2.1)
6.9
(1.9)
P=
.44
aInfonnation
missing
for
four
to
nine
responders.
b
Infonnation
missing
for
11
(5%)
to
34
(16%)
responders:
most
often,
the
missing
data
are
related
to
questions
regarding
stair
climbing
or
walking
outdoors
(several
responders
did
not
perform
both
these
activities).
`Sum-score
satisfaction:
higher
scores
indicate
more
satisfaction
with
prosthesis
(score
could
not
be
computed
for
20
(9.1%)
responders).
d
Overall
satisfaction:
information
missing
for
17
(7.7%)
responders.
polyurethane
liners,
although
nine
patients
out
of
56
chose
to
discontinue
PUL
use
due
to
reported
worse
comfort.
Results
are
difficult
to
interpret,
since
the
sample
encompasses
all
(primarily
trauma-related)
amputation
levels,
and
comfort
was
not
measured
formally
(for
example
using
a
visual
analogue
scale).
Moreover,
since
all
patients
had
a
troublesome
prosthetic
history,
the
results
cannot
be
generalized
to
any
extent.
A
recent
study
(Astrom
and
Stenstrom
2004)
reported
that
the
polyurethane
concept
provided
better
socket
comfort
compared
with
the
conventional
system.
It
should
be
noted
that
80%
of
the
selected
patients
had
stump
problems,
and
for
70%
pain
was
a
limiting
factor
in
walking
distance,
which
makes
some
degree
of
selection
bias
likely.
In
addition,
almost
one-third
of
patients
were
lost
to
follow-up
for
various
reasons.
Problems
with
wounds,
skin
irritations,
or
pains
were
reported
by
14.4%
of
the
patients
compared
with
43%
(Dillingham
et
al.
2001),
28%
(Datta
et
al.
1996),
and
38%
(Dasgupta
et
al.
1997)
in
other
studies.
Hachisuka
et
al.
(1998)
found
that
'donning
and
doffing
the
socket',
'perspiration',
'knee
flexion
and
extension',
'odour
from
the
socket',
and
'staining
of
the
socket'
were
regarded
as
good
by
fewer
than
40%
of
the
subjects.
Though
overall
satisfaction
with
the
prosthesis
was
not
significantly
different
for
the
three
groups,
sitting
and
walking
on
uneven
terrain
scored
significantly
poorer
among
liner
users.
A
patient
accustomed
to
sitting
most
of
the
day
may
prefer
a
PTB
socket
of
polyethylene
foam,
since
there
is
no
bunching
or
wrinkling
of
a
liner
at
the
popliteal
fossa.
With
respect
to
walking
on
uneven
terrain,
one
may
postulate
that
a
relatively
'hard'
interface
such
as
the
PEF
offers
more
direct
feedback
and
therefore
more
stability
in
situations
requiring
optimum
security.
Fellow
researchers
(Astrom
and
Stenstrom
2004;
Datta
et
al.
1996;
Dasgupta
et
al.
1997)
did
not
236
F.
B.
van
de
Weg
&
D.
A.
W
M.
van
der
Windt
Table
M.
Determinants
of
satisfaction
or
problems
with
prosthesis.
Satisfaction
sum-score
mean
difference
(95%
CI)
Problem
sum-scoremean
difference
(95%
CI)
Age:
....
50
vs.
>
50
years
1.1
(-0.6
to
2.8)
1.8
(0.1
to
3.5)
a
Gender:
male
vs.
female
2.6
(1.3
to
3.9)
a
-1.8
(-0.3
to
3.4)
a
Partner:
yes
vs.
no
-0.05
(-1.4
to
1.4)
0.8
(-0.7
to
2.4)
Currently
working:
yes
vs.
no
1.6
(0.1
to
3.0)
a
0.8
(-0.9
to
2.4)
Reason
for
amputation:
vascular
vs.
other
reason
-1.7
(-0.3
to
-3.0)
a
-1.5
(-3.1
to
0.05)
Time
since
first
prosthesis:
....
10
years
vs.
>
10
years
-1.9
(-0.6
to
-3.2)
a
-0.9
(-2.5
to
0.6)
Table
IV.
Problems
with/complaints
about
prosthesis.
All
n=
220
PEF
n=
62
SIL
n
=
94
PUL
n=
62
Concerning
stump:
much/very
much,
n
(%)
a
sweating
53
(26.4%)
22
(36.0%)
18
(21.2%)
13
(24.1%)
P=
.08
blisters,
sores,
or
pimples
19
(10.3%)
6
(10.6%)
8
(10.9%)
5
(9.3%)
P=
.76
skin
rash
19
(10.1%)
9
(15.3%)
6
(8.1%)
4
(7.5%)
P=
.67
swelling
16
(8.4%)
9
(15.0%)
4
(5.3%)
3
(4.6%)
P=
.29
pain
46
(22.8%)
11
(18.0%)
20
(23.8%)
14
(25.5%)
P=
.71
Concerning
prothesis:
much/very
much,
n
(%)
a
noises
22
(11.6%)
8
(13.4%)
4
(5.3%)
10
(18.5%)
P=
.34
smells
39
(19.9%)
9
(15.3%)
20
(25.3%)
10
(17.5%)
P=
.25
Sum-score
problems:
0-28,
mean
(SD)"
7.5
(5.3)
8.0
(6.0)
6.9
(5.1)
7.7
(4.6)
P=
.46
aInfonnation
missing
for
18
(9%)
to
34
(16%)
responders.
"Sum-score
on
problems
with
prosthesis:
higher
scores
indicate
more
problems
(score
could
not
be
computed
for
37
(16.8%)
responders).
find
significantly
improved
mobility
with
liner
users
either.
It
is
therefore
somewhat
surprising
that
most
authors
are
clearly
in
favour
of
prostheses
utilizing
liners.
A
possible
explanation
is
that
clinicians
are
naturally
susceptible
to
'technology
driven'
developments
and
tend
to
use
them
swiftly
in
daily
practice.
Some
limitations
of
this
study
that
are
inherent
to
questionnaire
surveys
(Sitzia
1999)
should
be
pointed
out.
The
results
of
the
survey
may
have
been
influenced
by
the
patients'
expectations
and
by
perceived
self-interest
or
gratitude.
Furthermore,
response
rate
was
62%.
This
may
be
considered
to
be
satisfactory
for
a
questionnaire
survey,
but
non-response
bias
cannot
be
ruled
out.
Finally,
the
authors
were
not
able
to
record
the
characteristics
of
non-
responders
and
therefore
do
not
know
whether
our
sample
is
representative
of
the
trans-tibial
amputee
population
in
general.
Conclusion
Evidence
to
support
the
(presumed)
surplus
value
of
liners
is
scant.
The
study's
findings
show
that,
with
respect
to
use,
satisfaction,
and
perceived
problems,
patients
using
different
Intetface
type
and
patient
satisfaction
237
interface
types
do
not
report
significant
differences
to
a
large
extent.
The
authors
therefore
believe
that
liners
should
not
be
prescribed
as
a
matter
of
course
for
all
prosthetic
candidates.
Some
inherent
weaknesses
of
liners
first
remain
to
be
solved.
In
developing
countries
in
particular,
with
high
durability
and
low
cost,
a
prerequisite,
PTB
or
PTB-related
prostheses
might
continue
to
be
the
first
choice.
Most
of
the
literature
originates
from
industrialized
nations,
which
may
explain
any
bias
towards
technological
advances.
Further
studies,
preferably
prospective,
need
to
be
conducted
to
determine
which
systems
are
most
comfortable
and
offer
least
complaints.
References
Astrom
I,
Stenstrom
A.
2004.
Effect
on
gait
and
socket
comfort
in
unilateral
trans-tibial
amputees
after
exchange
to
a
polyurethane
concept.
Prosthet
Orthot
Int
28:28-36.
Cochrane
H,
Orsi
K,
Reilly
P.
2001.
Lower
limb
amputation.
Part
3:
prosthetics—a
10
year
literature
review.
Prosthet
Orthot
Int
25:21—
28.
Dasgupta
AK,
McCluskie
PJA,
Patel
VS,
Robins
L.
1997.
The
performance
of
the
Iceross
prostheses
amongst
transtibial
amputees
with
a
special
reference
to
the
workplace—a
preliminary
study.
Occup
Med
(Lund)
47:228
36.
Datta
D,
Vaidya
SK,
Howitt
J,
Gopalan.
1996.
Outcome
of
fitting
an
Iceross
prosthesis:
views
of
transtibial
amputees.
Prosthet
Orthot
Int
20:
1 1 1
—115.
Dillingham
TR,
Pezzin
LE,
MacKenzie
EJ.
2001.
Use
and
satisfaction
with
prosthetic
devices
among
persons
with
trauma-related
amputations.
Am
J
Phys
Med
Rehabil
80:563-571.
Fergason
J,
Smith
DG.
1997.
Socket
considerations
for
the
patient
with
a
transtibial
amputation.
Clin
Orthop
Rel
Res
361:76—
84.
Hachisuka
K,
Dozono
K,
Ogata
H,
Ohmine
S,
Shitama
H,
Shinkoda
K.
1998.
Total
surface
bearing
below-knee
prosthesis:
advantages,
disadvantages
and
clinical
implications.
Arch
Phys
Med
Rehabil
79:783
789.
Hatfield
AG,
Morrison
JD.
2001.
Polyurethane
gel
liner
usage
in
the
Oxford
Prosthetic
Service.
Prosthet
Orthot
Int
25:41-46.
Lake
C,
Supan
TJ.
1997.
The
incidence
of
dermatological
problems
in
the
silicone
suspension
sleeve
user.
J
Prosthet
Orthot
9:97
—106.
Legro
MW,
Reiber
GD,
Smith
DG,
del
Aguila
M,
Larsen
J,
Boone
D.
1998.
Prosthesis
evaluation
questionnaire
for
persons
with
lower
limb
amputations:
assessing
prosthesis
related
quality
of
life.
Arch
Phys
Med
Rehabil
79:931
938.
Marks
LJ,
Michael
JW.
2001.
Science,
medicine
and
the
future:
artificial
limbs.
Br
Med
J
323:732-735.
McCurdie
I,
Hanspal
R,
Nieveen
R.
1997.
Iceross—a
consensus
view:
a
questionnaire
survey
of
the
use
of
Iceross
in
the
United
Kingdom.
Prosthet
Orthot
Int
21:124-128.
Sitzia
J.
1999.
How
valid
and
reliable
are
patient
satisfaction
data?
An
analysis
of
195
studies.
Int
J
Qual
Health
Care
11:319-328.
van
der
Linde
H,
Hofstad
CJ,
van
Limbeek
J,
Hofstad
CJ,
van
Limbeek
J,
Postema
P.
2004.
Prosthetic
prescription
in
the
Netherlands:
an
interview
with
clinical
experts.
Prosthet
Orthot
Int
28:98
—104.
Appendix:
Questionnaire
This
survey
asks
for
your
views
about
your
current
prosthesis.
In
particular,
we
are
interested
in
your
views
on
the
use
and
comfort
of
the
so-called
'interface'.
The
most
common
forms
of
interface
are
the
liners
and
the
hard-foam
covers.
A
liner
is
a
thick
synthetic
sock
that
is
usually
applied
in
more
or
less
the
same
fashion
as
a
condom.
Foam
covers
are
lightweight,
usually
custom
made
by
your
prosthetist
after
applying
cast.
Foam
covers
are
made
of
less
pliable
material
and
retain
their
form
when
withdrawn
from
the
stump.
If
in
doubt
what
kind
of
interface
material
you
have,
please
consult
the
attached
colour
photographs
or,
if
still
in
doubt,
your
doctor
or
prosthetist.
238
F.
B.
van
de
Weg
&
D.
A.
W
M.
van
der
Windt
A.
General
characteristics.
Check
the
answer
that
best
describes
your
situation
or
fill
in
the
blank
accordingly.
1.
Your
age
is
...
2.
Your
gender
is
...
male
...
female
3.
Marital
status:
...
married
or
living
together
...
single
4.
Education:
...
primary
...
secondary
...
completed
degree
post-secondary
...
university
5.
Current
paid
job
...
yes
...
no
...
pensioned
6.
Years
since
amputation
...
7.
Reason
for
amputation
...
vascular
(diabetes
or
peripheral
disease)
...
accident
tumour
...
do
not
know
8.
Do
you
have
a
liner?
...
yes
...
no
(see
figures
a,
b
and
c).
If
not,
continue
to
question
11
9.
Choose
from
the
pictures
which
liner
type
you
have
(type
A,
B,
or
C)
10.
Is
this
your
first
liner?
11.
Which
interface
type
did
you
have
before?
...
type
A
...
type
B
...
type
C
...
D:
foam
insert
(figure
d)
...
none
12.
How
content
are
you
with
your
current
interface
and
prosthesis
compared
with
the
previous
one?
...
more
content
...
less
content
...
no
difference
...
no
opinion
13.
How
many
hours
do
you
wear
your
prosthesis
daily
(on
average)?
...
h
maximum
...
h
maximum
...
h
maximum
...
h
maximum
...
do
not
wear
my
prosthesis
because
... ...
...
...
14.
How
much
time
does
it
take
on
average
per
day
to
clean
your
liner/insert?
..
.
no
time
.
min
maximum
...
min
maximum
...
more
than
min
15.
How
do
you
rate
the
durability
of
the
liner
or
foam
insert?
...
very
durable
...
durable
...
poorly
durable
...
not
durable
16.
Which
overall
score
between
and
would
you
give
your
current
prosthesis
(
=
very
poor;
=
excellent)?
... ... ...
. .
B.
Use
and
satisfaction.
Please
tick
in
each
of
the
following
columns
the
most
appropriate
answer,
based
on
your
experiences
of
the
past
4
weeks:.
How
satisfied
are
you
with
the
following?
Completely
Fairly
Moderately
satisfied satisfied satisfied
Unsatisfied
Fit
of
prosthesis
(comfort
to
wear)
Ability
to
don
and
doff
prosthesis
Ability
to
sit
with
prosthesis
Ability
to
walk
with
prosthesis
Ability
to
walk
on
uneven
terrain
Ability
to
walk
up
and
down
stairs
Appearance
of
prosthesis
Interface
type
and
patient
satisfaction
239
C.
Prosthesis
related
problems/complaints.
Please
tick
in
each
of
the
following
columns
the
most
appropriate
answer.
How
bothered
were
you
with
any
of
the
following
problems
during
the
last
4
weeks?
Extremely
Very
Somewhat
Hardly
Not
bothered
bothered bothered bothered
at
all
Sweating
Wounds/ingrown
hairs/blisters
Skin
irritations
Painful
stump
Swelling
stump
Unpleasant
smells
of
prosthesis
or
stump
Unwanted
sounds