Evaluation of the Northwestern University Subischial Socket for Persons with Transfemoral Amputation and Lower Mobility Levels
Abstract
Rationale: Prosthetic sockets that are currently used by persons with above-the-knee amputation (AKA) fit intimately with the thigh and pelvis, limiting hip motion and causing discomfort. Socket comfort while standing and sitting is of great importance to persons with lower limb amputation. Yet discomfort while sitting has been reported in 44% of persons with AKA. In those with AKA who are more sedentary, clinical observation indicates that socket discomfort in sitting results in less prosthesis wear time and less mobility with the prosthesis. Based on these observations, we propose that improving socket comfort in persons with AKA who have lower mobility will increase the time spent wearing the socket, which will in turn increase mobility, and in turn again improve satisfaction with the prosthesis and overall quality of life. A new prosthetic socket design, the sub-ischial socket, which eliminates contact with the pelvis, has been developed with the intent of improving comfort and hip motion in people with AKA. In particular, sitting comfort has been highlighted as an advantage of this new socket design by early users. Therefore, the objective of this proposed project is to assess use and benefits of the sub-ischial socket for persons with AKA and lower mobility levels. We will evaluate whether the sub-ischial socket is more comfortable (Aim 1, hypothesis 1), improves prosthesis wear time, mobility, participation in society (Aim 2, hypotheses 2-5), satisfaction with device, skin-related quality-of-life, and health-related quality-of-life (Aim 3, hypotheses 6-8) compared to the current standard-of-care socket design in persons with AKA and lower mobility levels. Applicability and Impact: This project will help patients with AKA who have low levels of mobility by evaluating if a new prosthetic socket design is more comfortable than the current standard-of-care socket design. If the socket is more comfortable, it may lead to other benefits such as increased mobility and better overall quality of life. However, it is possible that the socket may not achieve these goals and patients risk trying a socket that does not help their mobility. Adjusting to a new prosthetic socket takes time, as do changes to behavior such as mobility and participation in society. Hence, the study will monitor patients wearing the new socket for 6 months in order to allow time for patient-related outcomes to be achieved. Military Benefits: We expect the proposed project to improve prosthetic care that maximizes function in persons with AKA and lower mobility levels. The evidence produced by this research will support immediate clinical application of the socket technique given that it is readily available for use by prosthetists. Our previous Department of Defense-funded research evaluated the sub-ischial socket in AKAs with higher mobility levels. Exploring effects of the sub-ischial socket on persons with AKA and lower mobility levels is a logical extension of our previous work as it would close the gap with respect to use of this socket in Service Members with lower mobility levels due to polytrauma and Veterans with AKA with lower mobility levels due to age and other health issues. Active Service Members who begin use of sub-ischial sockets while young with higher mobility levels will also benefit from this research in the future as they age and mobility levels decrease.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Dec 28, 2022
- Source ID
- W81XWH2210362
Entities
People
- Stefania Fatone
Organizations
- United States Army
- University of Washington