User-relevant factors determining prosthesis choice in persons with major unilateral upper limb defects: A meta-synthesis of qualitative literature and focus group results.

OBJECTIVE: Considering the high rejection rates of upper limb prostheses, it is important to determine which prosthesis fits best the needs of each user. The introduction of the multi-grip prostheses hands (MHP), which have functional advantages but are also more expensive, has made prosthesis selection even harder. Therefore, we aimed to identify user opinions on factors determining prosthesis choice of persons with major unilateral upper limb defects in order to facilitate a more optimal fit between user and prosthesis. METHODS: A qualitative meta-synthesis using a 'best-fit framework' approach was performed by searching five databases (PROSPERO registration number: CRD42019126973). Studies were considered eligible if they contained qualitative content about adults with major unilateral upper limb defects experienced in using commercially available upper limb prostheses and focused on upper limb prosthesis users' opinions. Results of the meta-synthesis were validated with end-users (n = 11) in a focus group. RESULTS: Out of 6247 articles, 19 studies were included. An overview of six main themes ('physical', 'activities and participation', 'mental', 'social', 'rehabilitation, cost and prosthetist services' and 'prosthesis related factors') containing 86 subthemes that could affect prosthesis choice was created. Of these subthemes, 19 were added by the focus group. Important subthemes were 'work/school', 'functionality' and 'reactions from public'. Opinions of MHP-users were scarce. MHPs were experienced as more dexterous and life-like but also as less robust and difficult to control. CONCLUSION: The huge number of factors that could determine upper limb prosthesis choice explains that preferences vary greatly. The created overview can be of great value to identify preferences and facilitate user-involvement in the selection process. Ultimately, this may contribute to a more successful match between user and prosthesis, resulting in a decrease of abandonment and increase of cost-effectiveness.

The efficacy of microphone directionality in improving speech recognition in noise for three commercial cochlear-implant systems.

Objectives: To investigate the effect of fixed and adaptive microphone directionality on speech reception threshold (SRT) in noise when compared to omnidirectional mode in unilateral cochlear-implant (CI) use for three different CI systems.Methods: Twenty-four CI recipients with bilateral severe-to-profound hearing loss participated in the study. Eight recipients of each CI system were enrolled, and their SRT in noise was measured when the speech and noise signals were co-located in the front to serve as a baseline. The acute effect of different microphone directionalities on SRT in noise was measured with the noise emanating at 90° in the horizontal plane from the side of the CI sound processor (S0NCI).Results: When compared to the baseline condition, the individual data revealed fairly similar patterns within each CI system. In the S0NCI condition, the average improvement in SRT in noise for fixed and adaptive directionalities over the omnidirectional mode was statistically significant and ranged from 1.2 to 6.0 dB SNR and from 3.7 to 12.7 dB SNR depending on the CI system, respectively.Discussion: Directional microphones significantly improve SRT in noise for all three CI systems. However, relatively large differences were observed in the directional microphone efficacy between CI systems.

No difference in joint awareness after mobile- and fixed-bearing total knee arthroplasty: 3-year follow-up of a randomized controlled trial.

PURPOSE: To compare the patients ability to forget the artificial knee joint in everyday life who were randomized to be operated for mobile- or fixed-bearing total knee arthroplasty (TKA). METHODS: This single-center randomized controlled trial evaluated the 3-year follow-up of the cemented mobile- and fixed-bearing TKA from the same brand in a series of 41 patients. Clinical examination was during the pre-, 6-week, 6-month, 1-, 2- and 3-year follow-up containing multiple patient-reported outcome measures (PROMs) including the 12-item Forgotten Joint Score (FJS-12) at 3 years. Effect size was calculated for each PROM at 3-year follow-up to quantify the size of the difference between both bearings. RESULTS: At 3-year follow-up, general linear mixed model analysis showed that there were no significant or clinically relevant differences between the two groups for all outcome measures. Calculated effect sizes were small (<0.3) for all the PROMs except for the FJS-12; these were moderate (0.5). CONCLUSION: The results of this study demonstrate that joint awareness was slightly lower in patients operated with the MB TKA with comparable improved clinical outcome and PROMs at 3-year follow-up. Measuring joint awareness with the FJS-12 is useful and provides more stringent information at 3-year follow-up compared to other PROMs and should be the PROM of choice at each follow-up after TKA. LEVEL OF EVIDENCE: Level I, randomized controlled trial.

[Ocular prosthetics. Fitting, daily use and complications]. / Augenprothetische Versorgung. Anpassung, Handhabung und Komplikationen.

BACKGROUND: Ocular prosthetics make a decisive contribution to the functional, esthetic and psychosomatic rehabilitation of patients after ocular extirpation. OBJECTIVES: This article provides an overview of the fitting, daily care and complications of ocular prosthetics. METHODS: The study comprised a PubMed literature review and own clinical results. RESULTS: Ocular prosthetics made from cryolite glass or perspex can be manufactured and fitted 5-8 weeks after removal of the eye. During this period a conformer is placed within the conjunctival sac in order to prevent scar formation and shrinking of the socket. Artificial eyes can be worn continuously, only interrupted by a short but regular cleaning procedure. Artificial tears and lid hygiene improve the comfort of wearing. Glass prostheses have to be renewed every 1-2 years, while perspex prostheses need to be polished once a year. Complications, such as giant papillary conjunctivitis or blepharoconjunctivitis sicca are facilitated by poor fit, increased age and inappropriate care of the prosthetic device. In the case of socket shrinkage or anophthalmic socket syndrome, surgical interventions are needed to re-enable the use of an artificial eye. CONCLUSION: Adequate fitting, daily care of ocular prosthetics and therapeutic management of associated complications are mandatory for a durable functional, esthetic and psychosomatic rehabilitation after ocular extirpation.

The effects of suction and pin/lock suspension systems on transtibial amputees' gait performance.

BACKGROUND: The suction sockets that are commonly prescribed for transtibial amputees are believed to provide a better suspension than the pin/lock systems. Nevertheless, their effect on amputees' gait performance has not yet been fully investigated. The main intention of this study was to understand the potential effects of the Seal-in (suction) and the Dermo (pin/lock) suspension systems on amputees' gait performance. METHODOLOGY/PRINCIPAL FINDINGS: Ten unilateral transtibial amputees participated in this prospective study, and two prostheses were fabricated for each of them. A three-dimensional motion analysis system was used to evaluate the temporal-spatial, kinematics and kinetics variables during normal walking. We also asked the participants to complete some part of Prosthesis Evaluation Questionnaire (PEQ) regarding their satisfaction and problems with both systems. The results revealed that there was more symmetry in temporal-spatial parameters between the prosthetic and sound limbs using the suction system. However, the difference between two systems was not significant (p<0.05). Evaluation of kinetic data and the subjects' feedback showed that the participants had more confidence using the suction socket and the sockets were more fit for walking. Nevertheless, the participants had more complaints with this system due to the difficulty in donning and doffing. CONCLUSION: It can be concluded that even though the suction socket could create better suspension, fit, and gait performance, overall satisfaction was higher with the pin/lock system due to easy donning and doffing of the prosthesis. TRIAL REGISTRATION: irct.ir IRCT2014012816395N1.

Style preference survey: a report on the psychometric properties and a cross-validation experiment.

BACKGROUND: Several self-report measures exist that target different aspects of outcomes for hearing aid use. Currently, no comprehensive questionnaire specifically assesses factors that may be important for differentiating outcomes pertaining to hearing aid style. PURPOSE: The goal of this work was to develop the Style Preference Survey (SPS), a questionnaire aimed at outcomes associated with hearing aid style differences. Two experiments were conducted. After initial item development, Experiment 1 was conducted to refine the items and to determine its psychometric properties. Experiment 2 was designed to cross-validate the findings from the initial experiment. RESEARCH DESIGN: An observational design was used in both experiments. STUDY SAMPLE: Participants who wore traditional, custom-fitted (TC) or open-canal (OC) style hearing aids from 3 mo to 3 yr completed the initial experiment. One-hundred and eighty-four binaural hearing aid users (120 of whom wore TC hearing aids and 64 of whom wore OC hearing aids) participated. A new sample of TC and OC users (n = 185) participated in the cross-validation experiment. DATA COLLECTION AND ANALYSIS: Currently available self-report measures were reviewed to identify items that might differentiate between hearing aid styles, particularly preference for OC versus TC hearing aid styles. A total of 15 items were selected and modified from available self-report measures. An additional 55 items were developed through consensus of six audiologists for the initial version of the SPS. In the first experiment, the initial SPS version was mailed to 550 veterans who met the inclusion criteria. A total of 184 completed the SPS. Approximately three weeks later, a subset of participants (n = 83) completed the SPS a second time. Basic analyses were conducted to evaluate the psychometric properties of the SPS including subscale structure, internal consistency, test-retest reliability, and responsiveness. Based on the results of Experiment 1, the SPS was revised. A cross-validation experiment was then conducted using the revised version of the SPS to confirm the subscale structure, internal consistency, and responsiveness of the questionnaire in a new sample of participants. RESULTS: The final factor analysis led to the ultimate version of the SPS, which had a total of 35 items encompassing five subscales: (1) Feedback, (2) Occlusion/Own Voice Effects, (3) Localization, (4) Fit, Comfort, and Cosmetics, and (5) Ease of Use. The internal consistency of the total SPS (Cronbach's α = .92) and of the subscales (each Cronbach's α > .75) was high. Intraclass correlations (ICCs) showed that the test-retest reliability of the total SPS (ICC = .93) and of the subscales (each ICC > .80) also was high. TC hearing aid users had significantly poorer outcomes than OC hearing aid users on 4 of the 5 subscales, suggesting that the SPS largely is responsive to factors related to style-specific differences. CONCLUSIONS: The results suggest that the SPS has good psychometric properties and is a valid and reliable measure of outcomes related to style-specific, hearing aid preference.

Experiences in the provision, fitting and supply of external breast prostheses: findings from a national survey.

A good-quality external breast prosthesis and prosthesis-fitting service is integral to recovery post-mastectomy. However, this area of care has minimal information or research available. The aim of this study was to investigate women's experience of the provision, fitting, supply and use of breast prostheses in Ireland. Three national surveys were undertaken with women (n = 527), breast care nurses (BCNs) (n = 32) and retail prosthesis fitters (n = 12). The findings identified the importance of the prosthesis for shape, appearance to self, appearance to others, sense of well-being, self-confidence and femininity. Dissatisfaction with weight, comfort and movement of the prosthesis was identified. Cost and travel distance were found to influence the replacement of the prosthesis. Dissatisfaction emerged with the display and choice of products, and brochure availability at the prosthesis fitting. Women preferred to be fitted for the first silicone prosthesis by a BCN in a hospital setting whereas for the replacement prosthesis they preferred a trained fitter at a specialized prosthesis supplier. BCNs and retail fitters identified the need for service guidelines and increased availability of professional development opportunities in prosthesis-fitting. These findings contributed to the development of standards of care for breast prosthesis-fitting services to benefit women and to provide guidelines for those providing the service.

Evaluation of three penile prosthesis pump designs in a blinded survey of practitioners.

Erectile dysfunction continues to be a problem that can be successfully treated either through medical or surgical management. A cohort of self-identified experts in teaching the operation of penile implants completed a series of questions and tasks associated with three implant pump designs. This study examines the responses and impressions of these expert teachers in regard to three penile prosthesis pump designs. The goal of this project was to establish if one prosthesis pump was superior in the user's ability to correctly identify components in a blinded, scrotal simulation study.

Biological space adaptation to implant dimensions.

PURPOSE: Implant osseointegration has been well described, but coronal osseous healing continues to be investigated because of its impact on esthetic results and long-term maintenance. Although numerous implant diameters and designs exist, little is known about the role of these parameters on surrounding bone. Therefore, this study aimed at elucidating the influence of implant dimensions on crestal bone morphology. MATERIALS AND METHODS: Sixty Biomet/3i implants (20 standard, 20 wide, and 20 expanded platform [XP]) were randomly placed in posterior quadrants of 5 mongrel dogs. After healing, exposure of the implants to the oral cavity, and euthanasia of the animals, samples were harvested. Histomorphometric measurements were performed to determine the bone cuff height, width, and angle, and analysis of variance was applied to compare groups. RESULTS: Formation of a periimplant cuff was noticed in all implant sites. Mean cuff height was 0.8 mm, 1 mm, and 1.4 mm for standard, wide, and XP implants, respectively. Mean cuff width was 1.9 mm, 2.1 mm, and 2.8 mm for standard, wide, and XP implants, respectively. These differences were statistically significant between wide and XP implants (P = .035), as well as between standard and XP implants (P = .001). Angle did not differ significantly between implants of different platform widths. CONCLUSIONS: Craterization after placement of healing abutments and a healing period was observed around all implants. Width and height of the cuff varied significantly with implant diameter and platform design, but the angle formed with the implant did not vary significantly.

Patients' perspective on controversial issues in total knee arthroplasty.

We investigated the level of patient knowledge and preferences over the currently controversial issues in TKA. One hundred patients who had decided to undergo TKA for advanced osteoarthritis were asked to complete a questionnaire inquiring their knowledge and preferences over three controversial issues: (1) computer assisted surgery (CAS), (2) minimal invasive surgery (MIS), and (3) ceramic femoral component. The patient preferences over the three issues were questioned again after they had been informed of advantages and disadvantages of each option using an explanatory document. Most (more than 75%) of the patients did not have sufficient knowledge and their knowledge was based on non-professional sources (more than 85%). Before the information was given, most (more than 80%) of the patients preferred a new option. After the information was provided, more patients preferred a standard option in the issues of CAS (60%) and MIS (88%). This study prompts health care providers to become more active in providing accurate information and to consider patients perspective in making decisions which will influence the benefits and risk of the patients.

Experience with the SOUNDTEC implantable hearing aid.

OBJECTIVE: To assess the efficacy, morbidity, and patient satisfaction of the SOUNDTEC semi-implantable hearing aid. STUDY DESIGN: Retrospective case review. SETTING: Two tertiary referral centers (the Silverstein Institute and the Atkins Institute). PATIENTS: Sixty-four (four bilateral placements) patients with bilateral moderately severe sensorineural hearing loss: 47 patients had previously worn hearing aids. INTERVENTIONS: After separating the incudostapedial joint, a magnet encased in a titanium canister with a ring was introduced onto the stapes neck. Gelfoam or adipose tissue was used to stabilize the magnet. After 3 months, the external processor was fitted. MAIN OUTCOME MEASURES: At 1 month, audiometric testing was performed and functional gain was assessed. Patient acceptance and implant performance were measured by a visual analogue questionnaire. RESULTS: The device produced an average functional gain of 26 dB. Fifty-five percent of patients complained of magnet movement; this was eliminated in 80% of Silverstein Institute patients when the external processor was worn and fat was used to stabilize the magnet. CONCLUSION: The SOUNDTEC direct device is well tolerated in the majority of patients, with a significant increase in functional gain. Magnet instability and noise were the most frequent complaints and improved with processor placement and anchoring the magnet with fat. This electromagnetic semi-implantable hearing aid confers greater functional gain over conventional hearing aids and reduces occlusion effect and feedback.

The "hearing aid effect" 2005: a rigorous test of the visibility of new hearing aid styles.

PURPOSE: The visibility of open ear (OE) styles of hearing instruments was rigorously investigated for their potential to reduce the stigma of wearing hearing aids. METHOD: Three groups of 50 young adults (150 total) rated the visibility of 6 hearing aid styles-OE, invisible completely-in-the-canal (CIC), mini in-the-canal (m-ITC), half- and full-shell in-the-ear (ITE), and behind-the-ear (BTE)-worn by a peer model with revealing hairstyle, photographed from 2 ft and at 3 different angles (45 degrees, 90 degrees, and 135 degrees). RESULTS: CIC was rated significantly most "invisible" at 45 degrees and 90 degrees, OE and m-ITC were next at those angles, and OE and BTE were least invisible at 135 degrees. CONCLUSIONS: The findings have implications for counseling potential users who are reluctant to try hearing aids for cosmetic reasons.

A comparison of the user-friendliness of hydroxyapatite and titanium ossicular prostheses.

Both hydroxyapatite (Ha) and titanium (Ti) are well-accepted alloplastic materials for ossicular prostheses. Many different designs of Ha and Ti prostheses are presently available. Fourteen surgeons of different seniority and surgical experience were asked to 'test-drive' four different types of ossicular prostheses in cadaveric temporal bones to investigate the user-friendliness of these protheses. The Goldenberg design Ha incus prosthesis and the Dusseldorf design Bell Ti prosthesis were used as partial ossicular replacement prostheses (PORP). The Richards design Ha incus-stapes prosthesis and the Dusseldorf design Aerial Ti prosthesis were used as a total ossicular replacement prostheses (TORP). Nine out of 14 surgeons found the Ha PORP to be more user-friendly because of the notch design in the head. The Ti prosthesis was found to be more difficult to manipulate because it was too light. Half of the surgeons preferred the Ti TORP because of the open design of the top-plate. The Ha TORP was thought to be too top-heavy and to have a tendency to fall over.

Prosthetic complications of extraoral implants.

The use of tissue-integrated fixtures for the retention of an extraoral prosthesis has simplified the placement, removal, and cleaning of the prosthesis by the patient. Tissue evaluation, structural designs, and retention mechanisms, combined with patient compliance and the ability to perform hygiene around retentive substructures, has produced an array of new problems. Clinical and technical problems are presented with techniques used in their resolution.