Activity, socket fit, comfort and community participation in lower limb prosthesis users: a Cambodian cohort study

BACKGROUND: After amputation, many people become less active, feel lonely and lose independence. Understanding the factors associated with low physical activity levels and participation could contribute to defining key interventions which can support prosthesis users so they can live a more active and socially included lifestyle. This longitudinal observational study aims to assess relationships between physical activity, community participation, prosthetic fit, comfort and user satisfaction using actimetry, 3D scans and questionnaires in a Cambodian cohort of established lower limb prosthesis users. METHODS: Twenty participants (5F:15M, nine transfemoral, eleven transtibial, 24–60 years old and 3–43 years since amputation) were recruited. They completed a questionnaire which included their demographics, community participation, prosthesis satisfaction and comfort at the start of the study, and between three and six months later. Their prosthetic sockets and residual limbs were 3D scanned at the start and end of the study. Accelerometers were embedded under the cosmesis on the shank of the prosthesis, to collect ten weeks of activity data. RESULTS: Participants averaged 4470 steps/day (743–7315 steps/day), and wore their prosthesis for most waking hours, averaging 13.4 h/day (4.5–17.6 h/day). Self-reported measures of activity and hours of wear correlated with these accelerometer data (Spearman’s rho r(s) = 0.59, and r(s) = 0.71, respectively). Participants who were more active wore their prosthesis for more hours/day (Pearson r = 0.73) and were more satisfied with socket fit (r(s) = 0.49). A longer residual limb correlated with better community participation (r(s) = 0.56) and comfort (r(s) = 0.56). Self-reported community participation did not correlate with a person’s activity level (r(s) = 0.13), or their prosthesis comfort (r(s) = 0.19), and there was only weak correlation between how important the activity was to an individual, and how often they participated in it (r(s) = 0.37). A simple 0–10 scale of overall comfort did not provide enough detail to understand the types and severity of discomfort experienced. CONCLUSION: Associations between perceived and measured activity levels correlated with socket satisfaction in this cohort of people with established lower limb amputations. The small sample size means these correlations should be interpreted with caution, but they indicate variables worthy of further study to understand barriers to community engagement and physical activity for prosthesis users in Cambodia, and potentially in other settings.