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JOURNAL, VOLUME 1, ISSUE 2, 2018; ABSTRACT, ORAL PRESENTATION AT THE AOPA’S 101ST NATIONAL ASSEMBLY, SEPT. 26-29, VANCOUVER, CANADA, 2018.    DOI: 
https://doi.org/10.33137/cpoj.v1i2.32045                                                                         

 

1 

 
OPEN  ACCESS 

 

AOPA’S 101 ST NATIONAL ASSEMBLY ABSTRACTS, SEPTEMBER 26-29, VANCOUVER, CANADA, 2018 
 

ABSTRACT (ORAL PRESENTATION) 

FACTOR ANALYSIS OF UPPER LIMB PROSTHETIC ACCEPTANCE FROM 

RETROSPECTIVE PROSTHETIC CLINICIAN SURVEY  

Gerald E. Stark 

School of Biological Sciences, Georgia Institute of Technology, Georgia, USA. 

Email: gerald.e.stark@gmail.com 

DOI: https://doi.org/10.33137/cpoj.v1i2.32045  

 

INTRODUCTION 

Upper limb prosthetic acceptance seems to be relatively 

unchanged from 1958 where it was measured to be 75% 

for transradial, 61% for transhumeral, and 35% for 

shoulder disarticulation levels. A practitioner survey 

from 2013 by the author found this to be largely 

unchanged at 79.6%, 57.8%, and 32.8% respectively. An 

upper limb meta-analysis showed that the most 

significant factors affecting prosthetic rejection using a 

median rating were function, comfort, ease of use, 

weight, heat, lack of sensory feedback, inconvenience, 

lifestyle, dissatisfaction with technology, irritation, and 

availability of services. An earlier survey by the author 

condensed these factors of rejection to amputation level, 

functional advantage, and comfort, and included 

confidence of the prosthetist, availability of therapy, and 

support of the patient context. Also it was speculated that 

the value of factors influencing rejection of prostheses 

may not be simply the converse of those accepting the 

prosthesis but different scales.  

METHODS 

A retrospective case survey was created using a third-

party web-based survey provider that was posted from 

3/15/17 to 4/1/17 using postings on the OANDP ListServ 

to recruit participants. Prosthetists were asked to recall 

up to their last three upper limb fittings. There were 75 

respondents with 209 retrospective cases. Based on the 

number of UL fitting, participants were participants 

classified: 12 specialists, 20 experts, 27 intermediates, 

and 16 novices. The participants were asked to assess 

various retrospective factors including prosthetic level, 

type of control, patient gadget tolerance, patient 

functional expectation, comfort tolerance, patient value 

of cosmesis, confidence of prosthetist, availability of 

therapy, experience level of therapist, daily wear time, 

patient description of prosthesis, and patient assessment 

of cosmetic quality. By level the distribution was 24 

finger/transcarpal, 17 wrist disarticulation, 110 

transradial, 4 elbow disarticulation, 47 transhumeral, 6 

shoulder disarticulation, and 1 interscapular thoracic 

reflecting a common distribution. Body power control 

predominated with 84 and external power as 72 with 

passive at 27, and hybrid control at 26.  

RESULTS 

The clinician self-assessments predominantly showed 

highly favorable, and perhaps skewed, outcomes with 

respect to functional expectation, gadget tolerance, 

prosthetic confidence, contextual support, patient wear 

time, patient proficiency, cosmetic acceptance, and 

description of the prosthesis. Areas of more normalized 

distribution appeared to be upper limb experience for 

therapists, patient experience, and prosthetic description. 

Using Pearson’s coefficient, there were statistically 

significant relationships at p (one-tailed)<.01 level 

between the patient acceptance level and patient 

experience, gadget tolerance, functional expectation, 

comfort tolerance, prosthetist confidence, and patient 

cosmetic description and a negative p<.05 relationship 

with experience of the therapist. The relationships were 

true of the number of hours worn. A very strongly 

predictive relationship of R2 Linear = .564 F(10,197) = 

25.513 with all of the factors listed above. However a 

systematic multi-variable reduction found a strong 

significance, R2Linear =.556, F(3,204) = 85.302,  with 

the patient acceptance level, gadget tolerance, patient 

experience, which may not have practical clinical 

relevance.  

DISCUSSION 

The skewed distribution of prosthetist self-assessment 

for functional expectation, gadget tolerance, comfort, 

prosthetic confidence, contextual support, and patient 

proficiency, wear time, and prosthetic description of this 

retrospective may be indicative of a group halo or 

optimism bias. Also this calls into question the validity 

and reliability of the sample and relevance to the 

application. However, the negative relationship between 

the expertise of therapist and proficiency of the patient 

may indicate that the therapist may mitigate this bias and 

mailto:gerald.e.stark@gmail.com
https://doi.org/10.33137/cpoj.v1i2.32045


 

 

Stark G E.  FACTOR ANALYSIS OF UPPER LIMB PROSTHETIC ACCEPTANCE FROM RETROSPECTIVE PROSTHETIC CLINICIAN SURVEY. CANADIAN PROSTHETICS & ORTHOTICS 
JOURNAL, VOLUME 1, ISSUE 2, 2018; ABSTRACT, ORAL PRESENTATION AT THE AOPA’S 101ST NATIONAL ASSEMBLY, SEPT. 26-29, VANCOUVER, CANADA, 2018.    DOI: 
https://doi.org/10.33137/cpoj.v1i2.32045                                                                         

 

2 

 
OPEN  ACCESS 

 

AOPA’S 101 ST NATIONAL ASSEMBLY ABSTRACTS, SEPTEMBER 26-29, VANCOUVER, CANADA, 2018 
 

ABSTRACT (ORAL PRESENTATION) 

influence a clearer understanding of functional outcome. 

The strong statistically predictive relationship between 

the 10 identified factors suggests these may provide an 

indicator of acceptance. However additional direct 

patient understanding seems to be needed to draw a 

narrower focus as to the most significant factors for 

clinical use. 

CONCLUSION 

More research needs to be done directly done with upper 

limb prosthetic users with respect to acceptance rather 

than the convenience sample of prosthetists. As a group, 

clinicians seem to present a higher assessment of their 

abilities due to an optimism bias. External evaluation by 

a therapist seems crucial to understanding true patient 

functional performance However, this current work may 

help to establish which factors seem to have the greatest 

relationship for acceptance for subsequent research.  

REFERENCES 

Berger, N. Studies of the upper extremity amputee II. The 

population (1953-55) Artificial Limbs. 1958; 5 (1), p. 57-72.  

Biddess, E., Chau, T. (2007). Upper limb prosthetics: Critical 

factors in device abandonment. Am J Phys Med Rehabil. 2007; 

86, p. 977-987. DOI:10.1097/PHM.0b013e3181587f6c 

Stark, G. Factor analysis of upper extremity prosthetic patient 

acceptance. Paper presented at the American Orthotic and 

Prosthetic Association National Meeting, Las Vegas, Nevada, 

2014. 

Burrough, S., Brook, J. Patterns of acceptance and rejection of 

upper limb prostheses. Orthotics and Prosthetics, 1985, 39(2), 

p. 40-47. 

 

https://doi.org/10.1097/PHM.0b013e3181587f6c

