Methods to assess lower limb prosthetic adaptation: a systematic review

Lower limb amputation is a disabling condition with serious psychological, physical, and functional consequences. The adaptation of a prosthetic device can either mitigate or exacerbate these effects. Although many individuals receive lower limb prostheses, rejection rates remain high. Furthermore, while numerous objective and quantitative methods are available to assess the interface between the residual limb and the prosthetic socket, as well as the device performance, prosthetic fitting largely relies on prosthetists' observation and expertise. Accordingly, this review describes the most commonly employed methods for evaluating prosthetic fitting, emphasizing frequently used combinations of tools, devices, procedures, and tests for characterizing residual limbs and clinical outcomes, which indirectly contribute to prosthetic fitting evaluation.

In July 2023, searches were conducted across the Taylor & Francis, SpringerLink, Sage, ScienceDirect, and Scopus databases, focusing on research papers, case reports, and technical briefs published between 2011 and 2023. Studies were selected by four reviewers, and any discrepancies were resolved through group discussions. The Rayyan tool was employed to ensure that the retrieved publications evaluated residual limb variables involved in prosthetic fitting. The predominant methods for assessing lower-limb prosthetic fitting include mobility evaluation, gait analysis, measurement of physical variables, and stability assessment. Functional tests and self-report questionnaires, which do not require specialized equipment or great expertise, are the most widely utilized techniques.

The results demonstrate that, within clinical practice, mobility evaluation is the primary predictor of prosthetic fitting. Since methodologies for measuring more specific variables are often restricted to laboratory settings, future studies should analyze factors that could enable their implementation in clinical contexts.