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      The modular socket system in a rural setting in Indonesia

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          Abstract

          Background:

          Prosthetic services are inaccessible to people living in rural areas. Systems like the modular socket system have the potential to be fabricated outside of the prosthetic workshop.

          Objectives:

          This study aimed to evaluate the patient’s performance and satisfaction with the use of the modular socket system, and the technical feasibility of its implementation in a rural setting.

          Study design:

          A quantitative longitudinal descriptive study design was followed.

          Methods:

          A total of 15 persons with a lower limb amputation were fitted with the modular socket system and followed over 4–6 months. Performance was measured using a 2-min walk test, 10-m walk test and mobility and function questionnaire. Satisfaction was measured by the Socket Fit Comfort Score, Prosthesis Evaluation Questionnaire and EuroQoL 5 Dimensions 5 Levels. Notes on technical feasibility were taken at the moment of fitting ( t 0), at 1–3 months post fitting ( t 1) and at the end evaluation at 4–6 months post fitting ( t 2).

          Results:

          Performance did not change between t 0 and t 2. The comfort of the socket fit reduced between t 0 and t 2. Satisfaction with prosthesis and general health status stayed constant over time. The average fitting-time for the modular socket system was 6.4 h.

          Conclusion:

          The modular socket system can be considered a useful alternative for use in rural settings.

          Clinical relevance

          The use of the modular socket system is feasible and can improve accessibility to prosthetic technology in rural areas. Experienced prosthetic users were satisfied with the performance and the device. The shorter manufacturing time and use of only hand-held tools makes it an ideal alternative for use in remote and rural settings.

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          Most cited references19

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          Prosthesis evaluation questionnaire for persons with lower limb amputations: assessing prosthesis-related quality of life.

          To develop a self-report questionnaire for persons with lower limb amputations who use a prosthesis. The resulting scales were intended to be suitable to evaluate the prosthesis and life with the prosthesis. The conceptual framework was health-related quality of life. Multiple steps of scale development, terminating with test-retest of the Prosthesis Evaluation Questionnaire (PEQ) by mail. SOURCE OF SAMPLE: Records from two Seattle hospitals. Ninety-two patients with lower limb amputations who varied by age, reason for amputation, years since amputation, and amputation level. The 10 scales used were 4 prosthesis function scales (Usefulness, Residual Limb Health, Appearance, and Sounds), 2 mobility scales (Ambulation and Transfers), 3 psychosocial scales (Perceived Responses, Frustration, and Social Burden), and 1 Well-being scale. Validation measures were the Medical Outcomes Study Short Form-36, the Social Interaction subscale from the Sickness Impact Profile, and the Profile of Mood States-short form. Nine PEQ scales demonstrated high internal consistency. All met test-retest criteria for comparing group results. Validity was described based on methods used to gather original items, distribution of scores, and comparison of scores with criterion variables. The PEQ scales displayed good psychometric properties. Future work will assess responsiveness of PEQ scales to changes in prosthetic components. We conclude that they will be useful in evaluation of prosthetic care.
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            Estimating population-based values for EQ-5D health states in Thailand.

            To derive EuroQol five-dimensional (EQ-5D) health states values from the Thai general population. Forty-eight trained individuals successfully conducted interviews with a representative sample of 1409 respondents in 2007. A total of 12 sets of health states were used with one set allocated to each respondent. A respondent was requested to assign values for 11 states using the ranking and visual analogue scale methods and 10 states using the time trade-off method. The variables from the three existing models were used in model specifications and the best model was chosen on the basis of the extent of logical inconsistency in the estimated scores, predictive performance, parsimony, and sensitivity to changes in health. Eighty-six health states were valued. The mean age of respondents was 44.6 years old. The highly consistent respondents tend to give higher scores for mild states and lower scores for severe states, compared with those given by the highly inconsistent respondents. The best model used variables from the Dolan 1997 study and estimated from the scores given by the respondents with fewer than 11 inconsistencies. The estimated scores are completely consistent, R(2) is 0.448. The second highest score was 0.766 given to state 11112 and the lowest score was -0.454 for state 33333. Values for EQ-5D health states were estimated from the Thai general population. This is the first Thai generic health state value results to be used in evaluating health interventions in Thailand. Copyright © 2011 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.
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              Prosthetic socket fit comfort score.

              To validate a simple numerical scale to record the socket comfort of an artificial limb. This study has adapted the numerical rating scale for pain (Downie et al.(1)) to form a 11 point scale to record the socket comfort score (SCS). Patients were asked to rate the comfort of their socket on a 0 - 10 scale where 0 and 10 represented the most uncomfortable and the most comfortable socket imaginable. Ratings of clinical evidence of poor fit were recorded independently by the physician and the prosthetist. Patients gave new numerical ratings of comfort after any necessary intervention to the socket. Repeatability, criterion related validity, sensitivity to change and use in clinical practice was studied on 44 consecutive patients in the prosthetic rehabilitation clinic. The study showed the reported SCS was consistent and reliable, high correlations being found between three scores obtained from patients by independent recorders. A strong relationship existed between the reported SCS and clinical evidence of poor fit judged by the physician and by the prosthetists' ratings. Significant positive changes in SCS were found after intervention to improve the fit. SCS has shown repeatability, criterion related validity and sensitivity to change. It has clinical utility and wider use is recommended.
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                Author and article information

                Journal
                Prosthet Orthot Int
                Prosthet Orthot Int
                POI
                sppoi
                Prosthetics and Orthotics International
                SAGE Publications (Sage UK: London, England )
                0309-3646
                1746-1553
                20 November 2017
                June 2018
                : 42
                : 3
                : 336-343
                Affiliations
                [1 ]Department of Biomechanical Engineering, University of Twente, Enschede, The Netherlands
                [2 ]Department of Physiotherapy, University of the Western Cape, Bellville, South Africa
                [3 ]Exceed Indonesia, Jakarta, Indonesia
                [4 ]Department of Prosthetic and Orthotic, Polytechnic of Health, Indonesian Ministry of Health, Jakarta, Indonesia
                [5 ]Össur hf, Reykjavik, Iceland
                [6 ]Movendi Foundation, The Netherlands
                Author notes
                [*]Bob Giesberts, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands. Email: r.b.giesberts@ 123456utwente.nl
                Article
                10.1177_0309364617741917
                10.1177/0309364617741917
                5960840
                29153044
                52261bbf-8fab-4e72-a637-d7244887ea15
                © The International Society for Prosthetics and Orthotics 2017

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                : 27 November 2016
                : 16 October 2017
                Categories
                Original Research Reports

                prosthetics,low-income countries,direct lamination,accessibility,community-based rehabilitation

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