Activity and Participation, Bimanual Function, and Prosthesis Satisfaction are Strong Predictors of General Well-Being Among Upper Limb Prosthesis Users

Phillip M Stevens; Dwiesha L England; Amy E Todd; Stephen A Mandacina; Shane R Wurdeman

doi:10.1016/j.arrct.2023.100264

Activity and Participation, Bimanual Function, and Prosthesis Satisfaction are Strong Predictors of General Well-Being Among Upper Limb Prosthesis Users

Arch Rehabil Res Clin Transl. 2023 Mar 12;5(2):100264. doi: 10.1016/j.arrct.2023.100264. eCollection 2023 Jun.

Authors

Phillip M Stevens^{1

2}, Dwiesha L England¹, Amy E Todd³, Stephen A Mandacina³, Shane R Wurdeman^{1

4}

Affiliations

¹ Hanger Institute for Clinical Research and Education, Austin, TX.
² Division of Physical Medicine and Rehabilitation, University of Utah Health, Salt Lake City, UT.
³ Upper Extremity Amputation Rehabilitation Program, Hanger Clinic, San Antonio, TX.
⁴ Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE.

Abstract

Objective: To determine the role of multiple factors on general well-being for upper limb prosthesis users.

Design: Retrospective cross-sectional observational design.

Setting: Prosthetic clinics across the United States.

Participants: At the time of analysis, the database consisted of 250 patients with unilateral upper limb amputation seen between July 2016 and July 2021.

Intervention: Not applicable.

Main outcomes measures: Dependent variable: well-being (Prosthesis Evaluation Questionnaire- Well-Being). Independent variables included in analysis: activity and participation (Patient Reported Outcomes Measurement Information System [PROMIS] Ability to Participate in Social Roles and Activities), bimanual function (PROMIS-9 UE), prosthesis satisfaction (Trinity Amputation and Prosthesis Experience Scales-Revised; TAPES-R), PROMIS pain interference, age, gender, average daily hours worn, time since amputation, and amputation level.

Results: A multivariate linear regression model using a forward enter method was applied. The model included 1 dependent variable (well-being) and 9 independent variables. Within the multiple linear regression model, the strongest predictors of well-being were activity and participation (β=0.303, P<.0001), followed by prosthesis satisfaction (β=0.257, P<.0001), pain interference (β=-0.187, P=.001), and bimanual function (β=0.182, P=.004). Age (β=-0.036, P=.458), gender (β=-0.051, P=.295), time since amputation (β=0.031, P=.530), amputation level (β=0.042, P=.385), and hours worn (β=-0.025, P=.632) were not significant predictors of well-being.

Conclusion: Reducing pain interference and improving clinical factors such as prosthesis satisfaction and bimanual function with their associated effects on activity and participation will positively affect the well-being of individuals living with upper limb amputation/congenital deficiency.

Keywords: Amputation; Functional status; Pain; Rehabilitation; Social participation.