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A Structured Rehabilitation Protocol for Improved Multifunctional Prosthetic Control: A Case Study
Published on: November 6, 2015
User-Complexity and Decision-Making in Upper Limb Prosthetic Device Selection: Discrete Choice Measurement Tool
Ruben Vargas1, Todd Castleberry2, Kristin Nalivaika2
1Department of Clinical Pharmacy, University of California San Francisco, San Francisco, CA.
Objective:
To develop and pilot-test a choice-based conjoint (CBC) tool using discrete choice methodology to assess risk-benefit trade-offs in prosthetic device selection among individuals with upper limb amputation or difference (ULA/D) and explore how user-complexity influences prosthetic preferences.
Design:
A survey-based study using a CBC tool with a full-profile, balanced-overlap experimental design. The tool presented participants with different combinations of prosthetic attributes to evaluate selection preferences.
Setting:
Research setting involving remote interviews and online survey participation.
Participants:
Six individuals with ULA/D and 8 content experts participated in qualitative one-on-one interviews to inform prosthetic attribute selection and refinement. A total of 54 individuals, recruited from Hanger Clinic, with ULA/D completed the CBC tool for pilot testing.
Interventions:
N/A.
Main Outcome Measures:
The main outcomes include the development of the CBC tool and the analysis of prosthetic attribute selection frequencies, including variations by user-complexity level and shifts in preferences when cost was introduced as an attribute. User-complexity is the conceptual framework underlying our CBC preference choice tool and is defined as the user's individual capability to function and adapt to different levels of technological device complexities.
Results:
Eight key attributes were identified: 3 benefits (functional usefulness, life goals, and noticeability) and 5 risks (weight/comfort, durability/repairs, concentration/energy required, body connection, and training). A secondary version of the CBC tool, included in the same survey, incorporated cost as a ninth attribute. Among participants (N=54), the highest preference for functional usefulness of device was for precision control via implanted electrodes (62.1%). Highly durable devices with minimal repairs (56.0%) were preferred over delicate options (41.3%). In paired device choice comparisons, preferences varied across user-complexity levels, with participants choosing moderate-complexity devices (hook/shoulder harness) 70% of the time over low-complexity (passive) devices (30%), and 56% of the time over moderate/high-complexity devices (hybrid harness/myoelectric), and 63% of the time over high-complexity (fully myoelectric) options.
Conclusions:
The CBC tool captured user preferences, allowing individuals to weigh risk-benefit trade-offs in prosthesis selection. Preliminary findings aligned with expected patterns, highlighting the tool's potential application in guiding personalized prosthetic decision-making based on user-complexity levels.
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