Survey of transfemoral amputee experience and priorities for the user-centered design of powered robotic transfemoral prostheses.
Chiara Fanciullacci, Zach McKinney, Vito Monaco and 14 others
PMID 34863213WHAT IT FOUND
Transfemoral amputees using microprocessor knees reported higher autonomy, satisfaction, and daily prosthesis use than those with mechanical knees.
Both groups prioritized stability and comfort over running capability. Cost sensitivity did not correlate with income, but rather with the level of insurance reimbursement.
Key findings
01Users of microprocessor-controlled knees (MPKs) reported significantly greater daily prosthesis usage and perceived autonomy in activities of daily living compared to users of non-microprocessor knees (NMPKs).
02Across both groups, the highest priorities for an ideal prosthesis were stability, reliability, and comfort, while running was among the least prioritized functions.
03Cost sensitivity among users was not significantly correlated with their income, but was significantly correlated with the type of financial assistance or payer they had.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study is cross-sectional and observational, so it cannot prove that microprocessor knees cause higher autonomy or satisfaction; healthier or more active patients may simply be selected for these devices (selection bias). The sample was heavily skewed towards traumatic amputations (78.9%) and males, which does not reflect the general transfemoral amputee population where dysvascular causes are more common. Data relies on self-reported autonomy and satisfaction, which can be subjective and influenced by the patient's pre-amputation lifestyle and expectations. The study was conducted in a single country (Italy) with a specific healthcare reimbursement system, which may limit generalizability to other clinical contexts. A significant portion of participants declined to specify their income, and the recruitment site was a specialized rehabilitation center, potentially biasing the sample toward more engaged patients.
Declared interests
The study was funded by Istituto Nazionale per l'Assicurazione Contro Gli Infortuni sul Lavoro (INAIL), which is the Italian national insurance institute against workplace accidents and also operates the primary recruitment site (Centro Protesi INAIL).
The easy way to misread this
Do not conclude that microprocessor knees independently improve patient outcomes. The higher autonomy and satisfaction reported by MPK users may reflect the fact that they were generally younger, had traumatic (rather than dysvascular) amputations, and were selected for the device based on better baseline health, rather than the device itself causing the improvement.