Cross-sectional International Multicenter Study on Quality of Life and Reasons for Abandonment of Upper Limb Prostheses

Abstract

Background: This multicenter study aimed to examine the reasons for prosthesis rejection and assess the quality of life (QOL) among patients with upper limb deficiency.

Methods: Three rehabilitation centers in Japan and 1 academic medical center in the United States participated. Patients between the age of 12 and 75 years with unilateral or bilateral upper limb absence from the level of wrist to shoulder disarticulation were included. Two questionnaires were used, an original questionnaire on prosthesis use and the EQ-5D, which were completed by both the participant and a live-in proxy.

Results: Of the 367 patients with upper limb loss invited, 174 patients participated in this study. Eighty percent of the study population were male patients. The most common amputation level was transradial. Trauma was the most common cause of limb loss. The prosthesis rejection rate was 9% (n = 16). The most common reason for abandonment was a lack of prosthesis functionality. Ten of 16 prosthesis nonusers (63%) and 59 prosthesis users (38%) were unemployed or students. The mean EQ-5D utility score was significantly higher in prosthesis users than in nonusers (0.762 versus 0.628, P < 0.01). Live-in proxies significantly overestimated QOL in male patients (0.77 versus 0.807, P=0.01).

Conclusions: The current prosthesis rejection rate is low. QOL was significantly higher in prosthesis users than in nonusers. More prosthesis users were employed compared with nonusers. Care should be taken not to overestimate the QOL of male patients with upper limb loss as their proxies often did.

Fig. 1.

Reported stump problems. The most common symptom of the stump was tingling (51%, n = 88), followed by phantom pain (45%, n = 79), pain in the stump (24%, n = 41), itching (13%, n = 22), skin problems (6%, n = 10), and others (6%, n = 11). Twenty percent of patients (n=34) responded that they had no stump problem. Chubu, Chubu Rosai Hospital; Hyogo, Hyogo Rehabilitation Center Central Hospital; NRCD, National Rehabilitation Center for Persons with Disabilities; UM, University of Michigan.

Fig. 2.

Main prosthetic type used. The greatest number of prosthesis users employed a myoelectric prosthesis (n = 75). There were also 50 body-powered prosthesis users and 33 cosmetic prosthetic users. Chubu, Chubu Rosai Hospital; Hyogo, Hyogo Rehabilitation Center Central Hospital; NRCD, National Rehabilitation Center for Persons with Disabilities; UM, University of Michigan.

Fig. 3.

Days per week that patients used a prosthesis. One hundred eight patients (70%) used their prosthesis every day. Chubu, Chubu Rosai Hospital; Hyogo, Hyogo Rehabilitation Center Central Hospital; NRCD, National Rehabilitation Center for Persons with Disabilities; UM, University of Michigan.

Fig. 4.

Time per day that patients used a prosthesis. One hundred patients (67%) wore their prosthesis more than 8 h/d. Chubu, Chubu Rosai Hospital; Hyogo, Hyogo Rehabilitation Center Central Hospital; NRCD, National Rehabilitation Center for Persons with Disabilities; UM, University of Michigan.

Fig. 5.

Activities for which patients used a prosthesis. Patients used their prosthesis for leisure or outings (n = 104), job (n = 97), driving (n = 73), cooking and eating (n = 49), sports (n = 18), writing (n = 15), and other activities (n = 27). Chubu, Chubu Rosai Hospital; Hyogo, Hyogo Rehabilitation Center Central Hospital; NRCD, National Rehabilitation Center for Persons with Disabilities; UM, University of Michigan.

Fig. 6.

Satisfaction with the prosthesis. Twelve patients (8%) reported being very satisfied with their prosthesis, 76 patients (51%) were satisfied, and 38 patients (25%) were neutral. Twenty-three patients (15%) were dissatisfied, and 1 patient was very dissatisfied with their prosthesis. Chubu, Chubu Rosai Hospital; Hyogo, Hyogo Rehabilitation Center Central Hospital; NRCD, National Rehabilitation Center for Persons with Disabilities; UM, University of Michigan.

Fig. 7.

EQ-5D utility score according to the level of limb absence. EQ-5D utility score did not significantly differ according to the level of upper limb deficiency.