上肢假肢弃用因素调查

doi:10.3969/j.issn.1006-9771.2024.12.014

摘要/Abstract

摘要：

目的调查影响上肢假肢被弃用的因素。

方法通过病历查询2016年1月1日至2022年12月31日在广东省工伤康复医院适配上肢假肢的截肢者138例，选择适配后功能独立性评分提高者，采用电话或微信对126例进行问卷调查。依据Trinity截肢和假肢体验量表-修订版、健康调查简表(SF-36)和世界卫生组织生活质量量表简表设计假肢弃用原因问卷，将上肢假肢弃用原因归纳为截肢者因素、假肢适配因素、假肢训练因素以及周围环境和社会政策因素4个方面。

结果假肢总体弃用率为23.0% (29/126)。弃用组与在用组间文化程度、截肢部位和残肢状况有显著性差异(χ² > 6.808, P < 0.05)；假肢类型、假肢是否有功能、安装假肢期望值、假肢舒适性、穿脱方便性、操控灵敏性、假肢重量、外观满意度、假肢技师水平、假肢安装后的满意度和在用假肢满意度有显著性差异(χ² > 13.083, P < 0.05)；假肢装配前的训练程度、安装假肢3个月后对功能性假肢掌握程度、日常生活能力训练、职业康复模拟训练有显著性差异(χ² > 6.520, P < 0.05)；使用假肢参与社会活动意愿、社会人员对其穿戴假肢态度、家人对其使用假肢支持、工作状态、福利政策熟知情况、当前身体状况有显著性差异(χ² > 13.152, P < 0.01)。

结论截肢者因素、假肢适配因素、假肢训练因素以及周围环境和社会政策因素都可能影响截肢者弃用假肢，有必要采取有针对性的措施加以改进。

关键词: 上肢截肢, 上肢假肢, 弃用, 调查

Abstract:

Objective To investigate the factors related to the abandonment of upper limb prostheses.

Methods A total of 138 amputees fitting with upper limb prostheses at Guangdong Work Injury Rehabilitation Hospital from January 1st, 2016 to December 31st, 2022 were reviewed through case data, and those whose Functional Independence Measure scores improved after fitting were selected. A total of 126 amputees were investigated through telephone or WeChat with a questionnaire. The questionnaire was designed based on Trinity Amputation and Prosthesis Experience Scale-Revised, short form of Health Survey (SF-36) and World Health Organization Quality of Life Scale-Brief, and the items that may lead to the abandonment of upper limb prostheses were summarized in four factors: amputee, prosthetic fitting, prosthetic training, and environment and social policy.

Results The overall abandonment rate was 23.0% (29/126). There was significant difference between the the amputee abandonment or using prostheses in educational levels, amputation levels and residual limb condition (χ² > 6.808, P < 0.05); types of prostheses, whether functional prostheses, expectation for prosthesis, comfort of the prostheses, convenience of putting on and taking off, sensitivity of manipulation, weight of the prostheses, satisfaction with the appearance, skill levels of the prosthetist, the satisfaction after prosthesis installation and satisfaction with the prostheses in use (χ² > 13.083, P < 0.05); training levels before prosthesis assembly, the mastery of functional prostheses three months after prosthesis installation, training for activities of daily living, simulated training for vocation (χ² > 6.520, P < 0.05); willingness to participate in social activities with prostheses, attitude of other persons towards their prostheses, support of family members, work status, familiarity with the policies of welfare, and the current physical condition (χ² > 13.152, P < 0.01).

Conclusion Factors of amputee, prosthetic fitting, prosthetic training, and environment and social policy may relate to the abandonment of upper limb prostheses, which are needed to improve in an accurate way.

Key words: upper limb amputation, upper limb prosthesis, abandonment, investigation

中图分类号:

R496

艾旺宪, 刘四文, 刘德明, 韩俊奇, 邓小倩. 上肢假肢弃用因素调查[J]. 《中国康复理论与实践》, 2024, 30(12): 1479-1488.

AI Wangxian, LIU Siwen, LIU Deming, HAN Junqi, DENG Xiaoqian. Factors of abandonment of upper limb prosthesis[J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(12): 1479-1488.

图/表 4

表1

表2

Comparison of prosthetic fitting factors between two groups 单位：n"

变量		弃用组(n = 29)	在用组(n = 97)	χ²值	P值
安装前假肢功能宣教	有，讲解很清楚	25	92	2.557	0.279
	有，但不是很清楚	3	4
	没有，完全不清楚	1	1
假肢的选择	按照自己了解的知识进行选择	6	15	1.411	0.842
	家人或亲属帮忙选择	1	1
	按照假肢师建议进行选择	1	3
	综合以上三个方面进行选择	8	28
	按政策适配，没有进行选择	13	50
假肢类型	假手指	2	31	23.119	0.010
	部分手装饰性假肢	4	26
	半掌肌电假肢	1	0
	腕离断装饰假肢	0	1
	前臂肌电假肢	11	16
	前臂肌电假肢(二自由度)	0	1
	前臂智能仿生手bebionic	3	1
	前臂装饰性假肢	3	8
	上臂肌电假肢	2	8
	上臂装饰性假肢	2	4
	肩离断装饰性假肢	1	1
假肢是否有功能	有肌电控制手部动作功能	18	25	13.083	< 0.001
	有索控式控制手部功能	0	0
	有装饰性功能(无手部功能)	11	72
	其他	0	0
安装假肢期望值	差距很大，不愿使用	21	14	37.593	< 0.001
	有差距，能使用，已经接受	8	79
	无特别差距，一直使用	0	4
假肢费用来源	工伤保险基金	20	78	4.837	0.304
	残联项目基金	1	4
	民政项目基金	0	1
	第三方资金	5	5
	完全自费	3	9
假肢舒适性	良好	7	39	20.464	< 0.001
	一般	13	55
	不适	9	3
假肢穿脱方便性	不方便，导致不愿穿	17	22	13.531	0.001
	有点困难，但穿好后，挺舒适	7	41
	很方便，使用容易	5	34
假肢操控性	良好	1	5	16.127	< 0.001
	一般	18	86
	困难	10	6
假肢重量	太重	18	78	26.952	< 0.001
	一般	10	12
	不重	1	7
外观满意度	满意	3	5	16.466	< 0.001
	一般	19	86
	不满意	7	6
假肢师技能水平	非常认可	6	39	15.880	0.001
	认可	19	58
	一般认可	3	0
	技能需提升	1	0
假肢安装后满意度	非常满意	1	15	22.346	< 0.001
	一般满意	20	80
	不是很满意	5	2
	不满意	3	0
在用假肢满意度	非常满意	0	16	63.583	< 0.001
	一般满意	6	69
	不是很满意(需要修改或更换)	6	10
	不满意	17	2
截肢者期望改善功能	吃饭	18	51
	喝水	16	35
	穿上衣	15	28
	脱裤子	18	23
	洗漱装扮	18	18
	洗澡	21	19
	如厕	21	40
	写字	16	40
	触控使用电子产品	22	76
	按密码	5	23
	其他	14	42

表2

表3

表4

参考文献 40

[1]	HAUPMANN M, HUANG M, SELLY G, et al. Identifying a upper-limb phase-dependent variable under perturbations for powered prosthesis arm control[C]. Sydney:45th Annual International Conference of the IEEE Engineering in Medicine & Biology Society (EMBC), 2023.
[2]	NSUGBE E. Brain-machine and muscle-machine bio-sensing methods for gesture intent acquisition in upper-limb prosthesis control: a review[J]. J Med Eng Technol, 2021, 45(2): 115-128. doi: 10.1080/03091902.2020.1854357 pmid: 33475039
[3]	NAZARI V, ZHENG Y P. Controlling upper limb prostheses using sonomyography (SMG): a review[J]. Sensors (Basel), 2023, 23(4): 1885.
[4]	TRENT L, INTINTOLI M, PRIGGE P, et al. A narrative review: current upper limb prosthetic options and design[J]. Disabil Rehabil Assist Technol, 2020, 15(6): 604-613. doi: 10.1080/17483107.2019.1594403 pmid: 30973275
[5]	GALLONE M, NAISH M D. Scalp-targeted haptic proprioception for upper-limb prosthetics[C]. Rotterdam: International Conference on Rehabilitation Robotics (ICORR), 2022.
[6]	ÖZCAN F, YÜKSEL İ, KAMACI G K, et al. The use of myoelectric prosthesis in a sample of veterans with unilateral upper extremity amputation: prosthesis satisfaction and quality of life[J]. Ir J Med Sci, 2023, 192(2): 839-845.
[7]	BOCHNIEWICZ E M, EMMER G, DROMERICK A W, et al. Measurement of functional use in upper extremity prosthetic devices using wearable sensors and machine learning[J]. Sensors (Basel), 2023, 23(6): 3111.
[8]	胡雅雯, 姜力, 杨斌. 智能上肢假肢感觉反馈研究进展[J]. 机械工程学报, 2023, 59(5): 1-10. doi: 10.3901/JME.2023.05.001
[9]	SALMINGER S, STINO H, PICHLER L H, et al. Current rates of prosthetic usage in upper-limb amputees: Have innovations had an impact on device acceptance?[J]. Disabil Rehabil, 2022, 44(14): 3708-3713.
[10]	秦昌宇, 梁文渊, 毕胜. 成人上肢假肢评价方案[J]. 中国康复医学杂志, 2022, 37(8): 1131-1136.
[11]	BIDDISS E, CHAU T. Upper-limb prosthetics: critical factors in device abandonment[J]. Am J Phys Med Rehabil, 2007, 86(12): 977-987.
[12]	BAKHSH H R, KABLAN N, ALAMMAR W, et al. The Client Satisfaction with Device: a Rasch validation of the Arabic version in patients with upper and lower limb amputation[J]. Health Qual Life Outcomes, 2021, 19(1): 134.
[13]	RESNIK L, BORGIA M, CANCIO J, et al. Dexterity, activity performance, disability, quality of life, and independence in upper limb veteran prosthesis users: a normative study[J]. Disabil Rehabil, 2022, 44(11): 2470-2481.
[14]	BURGER H, MARINCEK C. Upper limb prosthetic use in Slovenia[J]. Prosthet Orthot Int, 1994, 18(1): 25-33. doi: 10.3109/03093649409164667 pmid: 8084746
[15]	STÜRUP J, THYREGOD H C, JENSEN J S, et al. Traumatic amputation of the upper limb: the use of body-powered prostheses and employment consequences[J]. Prosthet Orthot Int, 1988, 12(1): 50-52. pmid: 3399370
[16]	ROESCHLEIN R A, DOMHOLDT E. Factors related to successful upper extremity prosthetic use[J]. Prosthet Orthot Int, 1989, 13(1): 14-18. doi: 10.3109/03093648909079404 pmid: 2717379
[17]	STEVENS P M, ENGLAND D L, TODD A E, et al. Activity and participation, bimanual function, and prosthesis satisfaction are strong predictors of general well-being among upper limb prosthesis users[J]. Arch Rehabil Res Clin Transl, 2023, 5(2): 100264.
[18]	JU N, LEE K H, KIM M O, et al. A user-driven approach to prosthetic upper limb development in Korea[J]. Healthcare (Basel), 2021, 9(7): 839.
[19]	BIDDISS E, BEATON D, CHAU T. Consumer design priorities for upper limb prosthetics[J]. Disabil Rehabil Assist Technol, 2007, 2(6): 346-357. doi: 10.1080/17483100701714733 pmid: 19263565
[20]	RESNIK L, BORGIA M, CLARK M. Function and quality of life of unilateral major upper limb amputees: effect of prosthesis use and type[J]. Arch Phys Med Rehabil, 2020, 101(8): 1396-1406.
[21]	KRISTJANSDOTTIR F, DAHLIN L B, ROSBERG H E, et al. Social participation in persons with upper limb amputation receiving an esthetic prosthesis[J]. J Hand Ther, 2020, 33(4): 520-527. doi: 10.1016/j.jht.2019.03.010 pmid: 31080072
[22]	ATALLAH H, QURESHI A Z, MSECHU Z. Satisfaction of individuals with partial-hand amputations after they were fitted with cosmetic silicone prostheses[J]. Prosthet Orthot Int, 2023, 47(3): 288-292.
[23]	FLINN S R, GOODMAN G. Effective assessments to identify overuse injuries in unaffected limbs of persons with unilateral upper limb amputations[J]. J Hand Ther, 2021, 34(2): 298-308. doi: 10.1016/j.jht.2021.05.006 pmid: 34148738
[24]	SMAIL L C, NEAL C, WILKINS C, et al. Comfort and function remain key factors in upper limb prosthetic abandonment: findings of a scoping review[J]. Disabil Rehabil Assist Technol, 2021, 16(8): 821-830.
[25]	CORDELLA F, CIANCIO A L, SACCHETTI R, et al. Literature review on needs of upper limb prosthesis users[J]. Front Neurosci, 2016, 10: 209.
[26]	CANCIO J M, IKEDA A J, BARNICOTT S L, et al. Upper extremity amputation and prosthetics care across the active duty military and veteran populations[J]. Phys Med Rehabil Clin N Am, 2019, 30(1): 73-87. doi: S1047-9651(18)30832-5 pmid: 30470430
[27]	RESNIK L, BORGIA M, HEINEMANN A W, et al. Prosthesis satisfaction in a national sample of veterans with upper limb amputation[J]. Prosthet Orthot Int, 2020, 44(2): 81-91. doi: 10.1177/0309364619895201 pmid: 31960734
[28]	RESNIK L J, BORGIA M, CLARK M A, et al. Out-of-pocket costs and affordability of upper limb prostheses[J]. Prosthet Orthot Int, 2024, 48(1): 108-114.
[29]	KRISTJANSDOTTIR F, DAHLIN L B, ROSBERG H E, et al. Social participation in persons with upper limb amputation receiving an esthetic prosthesis[J]. J Hand Ther, 2020, 33(4): 520-527. doi: 10.1016/j.jht.2019.03.010 pmid: 31080072
[30]	LUTHI F, PRAZ C, LÉGER B, et al. Cross-cultural adaptation and measurement properties of the French version of the Trinity Amputation and Prosthesis Experience Scales-Revised (TAPES-R)[J]. PLoS One, 2020, 15(2): e0229084.
[31]	AL-IBRAHIMY A S, RABEA I S. Evaluation of general health status in diabetic patients using short form health survey (SF-36)[J]. Curr Diabetes Rev, 2023, 19(9): e081420184858.
[32]	SONG D, LIU D, YANG M, et al. Quality of life in elderly patients with neuro-co-cardiological diseases: Rasch analysis and confirmatory factor analysis of WHOQOL-BREF and SF-36 instruments[J]. Arch Gerontol Geriatr, 2024, 116: 105172.
[33]	HENDERSON E, REHANI M, HEBERT J S. Sex and gender differences in upper extremity prosthesis rejection: a review of literature[J]. Prosthet Orthot Int, 2024, 48(3): 300-314. doi: 10.1097/PXR.0000000000000330 pmid: 38579197
[34]	LAFO J, CORREIA S, BORGIA M, et al. Cognitive characteristics associated with device adoption, skill retention, and early withdrawal from a study of an advanced upper limb prosthesis[J]. Am J Phys Med Rehabil, 2019, 98(10): 879-887.
[35]	GUERRERO E M, MASTRACCI J C, GART M S, et al. Soft tissue management of partial hand amputation[J]. J Hand Surg Am, 2023, 48(6): 612-618.
[36]	ŠOSTERIČ K, BURGER H, VIDMAR G. Adjustment and satisfaction with prosthesis among people after upper limb amputation in Slovenia[J]. Ortop Traumatol Rehabil, 2020, 22(2): 85-93. doi: 10.5604/01.3001.0014.1165 pmid: 32468997
[37]	KERVER N, KARSSIES E, KRABBE P F M, et al. Economic evaluation of upper limb prostheses in the Netherlands including the cost-effectiveness of multi-grip versus standard myoelectric hand prostheses[J]. Disabil Rehabil, 2023, 45(25): 4311-4321.
[38]	EINFELDT A K, REBMANN F, YAO D, et al. What do users and their aiding professionals want from future devices in upper limb prosthetics? A focus group study[J]. PLoS One, 2023, 18(12): e0295516.
[39]	ENGDAHl S M, GONZALEZ M A, LEE C, et al. Perspectives on the comparative benefits of body-powered and myoelectric upper limb prostheses[J]. J Neuroeng Rehabil, 2024, 21(1): 138. doi: 10.1186/s12984-024-01436-4 pmid: 39118106
[40]	MINKS T, CASSISI J E, LIGHTHALL N R, et al. Impact of amputation of the upper limb and prostheses on perceptions of competence, warmth, and functional abilities[J]. Rehabil Psychol, 2024, 69(1): 14-23.

变量		弃用组(n = 29)	在用组(n = 97)	χ²值	P值
性别	男	22	76	0.080	0.777
	女	7	21
年龄	< 18岁	0	0	2.034	0.362
	18~40岁	13	58
	41~60岁	14	34
	> 60岁	2	5
文化程度	小学及以下	2	0	18.218	0.003
	初中	14	29
	高中	7	56
	大专	4	11
	本科	1	0
	硕士及以上	1	1
居住地	城镇	11	56	3.515	0.061
	农村	18	41
截肢部位	手指截肢或部分手截肢	7	57	14.889	0.005
	腕关节离断截肢	0	3
	前臂截肢	17	24
	肘关节离断截肢	0	0
	上臂截肢	4	12
	肩关节以上截肢	1	1
	双侧截肢	0	0
利手/非利手	利手侧	14	52	0.255	0.614
	非利手侧	15	45
截肢原因	外伤	17	74	6.130	0.105
	烧烫伤	7	16
	疾病	1	0
	其他	4	7
残肢状况	软组织比较丰富	2	22	6.808	0.033
	软组织和骨性良好	15	55
	残肢末端骨突明显	12	20
幻肢痛	是	9	21	1.084	0.298
	否	20	76
残肢痛	是	6	18	0.066	0.797
	否	23	79