A Survey of Prosthetists' Perspectives on Adjustable-Volume Lower-Limb Prosthetic Sockets

ABSTRACT Introduction Adjustable-volume prosthetic sockets have been available for many years to address residual limb volume changes, although little research has been conducted regarding their efficacy. As such, prosthetists are guided by patient preference, personal experience, and professional perception. The purpose of this study was to explore clinician perceptions and experiences fitting adjustable-volume prosthetic sockets. Materials and Methods An anonymous online survey was distributed to certified prosthetists. The survey contained questions about prosthetists' demographics, whether they had previously fit an adjustable-volume prosthetic socket, whether these fittings were successful, and what challenges they experienced. Those who had not previously fit adjustable sockets were asked what barriers had prevented them from doing so. Results A total of 221 certified prosthetists completed the survey. Of the 195 eligible respondents, 82% had experience in fitting adjustable prosthetic sockets. The most commonly fit socket styles were the RevoFit (n = 123), Socket-less (n = 67), and Infinite (n = 66) sockets. Prosthetists had varied success with the different socket styles, with the RevoFit being the most successful, and the Infinite and Socket-less sockets the least successful. Respondents most frequently noted increased bulk (93% of respondents; n = 181), complicated fabrication (72%; n = 141), and poor cosmesis (65%; n = 127) as challenges faced when fitting adjustable-volume sockets. Some respondents felt these sockets were a useful clinical tool; however, common themes regarding clinical perception of adjustable sockets included issues with cost/reimbursement and appropriateness for only a subset of the population of individuals with amputation only. Other respondents felt that adjustable sockets were either not adequate for clinical use or required improvements before their use would be beneficial. Conclusions There is no majority opinion regarding the benefits and challenges of adjustable sockets among prosthetists. In general, prosthetists feel that adjustable sockets can be used as one of the various tools to accommodate complicated lower-limb fittings. Additional work is needed to provide clinicians with a best practice guideline for providing adjustability within lower-limb sockets. Clinical Relevance The study showed that prosthetists feel that adjustable sockets can be one of the tools used for complicated lower-limb fittings. Additional work is needed to develop a best practice guideline for providing adjustability in lower-limb sockets.