What Matters Most: A Multi-Stakeholder Study of Outcome Domains in Lower-Limb Prosthesis Use
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Purpose
Lower-limb prosthesis use involves interacting physical, psychosocial, and device-related outcomes that may not be fully represented by conventional clinical assessment. This study aimed to develop and evaluate a stakeholder-informed framework of outcome domains relevant to meaningful everyday prosthesis use.
Materials and Methods
A mixed-methods participatory design comprised synthesis of selected clinically relevant content from five established patient-reported outcome measures; semi-structured interviews and importance and actionability ratings with 18 contributors (12 prosthesis users, four clinicians, and two industrial partners); and integration of synthesis, qualitative, and rating findings. Interview records were analysed using reflexive thematic analysis and ratings descriptively.
Results
The resulting framework comprised four interrelated domains: Mobility, Physical Function, Psychosocial Wellbeing, and Prosthesis Experience. Mobility showed the clearest convergence across stakeholder perspectives. Prosthesis users showed the largest importance–actionability gap for Prosthesis Experience (4.5 vs 3.0), whereas clinicians showed the largest gap for Psychosocial Wellbeing (5.0 vs 3.0). Interviews highlighted day-to-day variability and the influence of confidence, fatigue, comfort, environment, social context, and device usability.
Conclusions
Meaningful outcome assessment in prosthetic rehabilitation should extend beyond mobility alone to consider physical function, psychosocial wellbeing, and prosthesis experience within everyday contexts. The framework provides a stakeholder-informed foundation for multidimensional outcome assessment.
