Beyond the Device: Why Provider-Side Factors Determine Upper-Limb Prosthesis Acceptance

Abandonment of upper-limb prostheses has remained stubbornly common for more than two decades, despite substantial refinement of prosthetic hardware. A recent survey from a leading bionic-reconstruction group found that technological advancement did not significantly change acceptance rates; instead, structured prosthetic training and active patient participation in decision-making emerged as the factors most likely to improve device use. Read together with earlier work identifying fitting time-frame and client involvement as critical variables, these data relocate the problem of abandonment from the device to the process of rehabilitation. This editorial argues that the decisive variables in prosthesis acceptance are provider-side: the timing, structure, and shared-decision quality of the rehabilitation a patient receives. Drawing on the concept of learned non-use from stroke rehabilitation, I propose-as an interpretive framework rather than a demonstrated mechanism-that clinicians themselves may develop a parallel clinician learned non-engagement (LNE), a conditioned reduction of active engagement shaped by the same behavioral contingencies that drive patient non-use. If the field's central obstacle is no longer the hardware, then attention, measurement, and resources should shift toward the human processes that determine whether a well-engineered hand is ever truly adopted. Practically, this argues for building rehabilitation timing and provider engagement into care pathways as routinely measured outcomes, and for prioritizing prospective study of these process variables.