Comparisons of (cost-)effectiveness of manual, hybrid, and digital shape capture and shape design techniques for transtibial and transfemoral prosthetic sockets: A scoping review.

The review included only 20 studies and 497 patients, most studies evaluated transtibial sockets, and pediatric patients were excluded, so the findings are limited for children and transfemoral users. No study directly compared hybrid and digital methods, so their relative value is unknown. Eighteen of the 20 included studies were rated low quality, and most were observational or quasi-experimental without standardized comparators. The main quality problems were lack of randomization, lack of blinding, small sample sizes, and poor control of confounders. Outcome definitions varied widely, and many studies used subjective patient-reported measures rather than objective pressure, gait, or limb-volume measures. Cost was often proxied by time or number of socket attempts, not formal economic evaluation. 24% of studies did not specify the shape capture technique, 20% omitted socket design details, and duration was not reported in 4 reports. Quality assessment and ICF classification were done by one reviewer, ICF linking rules were not applied directly, and gray literature was excluded.

Do not conclude that digital or hybrid socket methods are proven better. The review found no direct hybrid-versus-digital comparisons, most studies were low quality, and efficiency findings were inconsistent, so firm conclusions about cost-effectiveness or comfort cannot be made.