What do lower limb amputees think of their cosmesis?

Cairns, Nicola Jeanne and Corney, Jonathan and Murray, Kevin (2011) What do lower limb amputees think of their cosmesis? In: ISPO UK NMS Scientific Meeting and Exhibition, 2011-10-07 - 2011-10-08, W12 Conference Centre.

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Despite the many advances made over the past thirty years in lower limb prosthetic components1, the design of Polyurethane (PU) cosmeses which provide an aesthetic finish has not changed. This is surprising because there are obvious problems with current cosmeses; they are known to lose their original shape as the material degrades and often rupture. Furthermore they are known to influence the function of knee and ankle components. Despite these limitations, the information about cosmesis use is largely anecdotal and the scientific literature has no customer feedback studies routinely used for other consumer products2. Consequently knowledge of the satisfaction of lower limb amputees with their cosmeses and the design factors they consider priority is lacking. The aim of this study was to develop and use a questionnaire to ascertain the satisfaction for a sample population of lower limbs amputees in the U.K. with their cosmeses and to establish what they consider to be important design features for future improvements. The questionnaire (Strathclyde University ethics approval) was developed in consultation with manufacturers, clinicians and amputees. The questions asked for satisfaction and importance of nine features; colour, shape, touch, fit under clothes, cosmesis bending, impact on joints, waterproofing, cleaning, and durability. A combination of categorical, continuous rating, numerical scale and open ended questions was used. The questionnaire was posted to Murray Foundation members (registered charity) and distributed in prosthetic appointments (provided by project partners: Chas A Blatchford Ltd and Pace Rehabilitation Ltd); 296 and 100 postal and appointment questionnaires respectively. The response data was frequency counted to determine the number of respondents in each demographic subcategory. The continuous scale satisfaction scores were converted to a number (0-100); mean values and standard deviations were then calculated. The top three importance ratings were scored and frequency counted. The response rate was 39%. The sample population was 69% male, 67% and 27% were transtibial and transfemoral amputees respectively and 78% were aged between 45 and 70. Mean satisfaction ranged between 44 (cleaning) and 61 (impact on joints); scores of less than 70 are regarded as poor and should be improved2. Higher satisfaction scores were reported by transtibial compared to transfemoral amputees and men compared to women, although statistical significance was not calculated. The feature rated most important (total sample population) was shape matching, followed by unhindered joint movement and natural fit of clothes over the cosmesis. Shape matching remained the most important for all demographic subcategories except for transfemoral amputees, aged 44 or younger and those at the highest activity level; unhindered joint movement was the top priority for these respondents. The results indicate that lower limb amputees are currently dissatisfied with their cosmeses and that design improvements would be welcome. The importance ratings indicate that redesign efforts should focus on improving the cosmesis shape and reducing the influence the cosmesis has on the workings of the prosthetic joints. It may also be useful to conduct statistical analyses on the data to ascertain statistically significant correlations between the demographics and satisfaction level or importance rating.