Self-Management Problem-Solving Tools for Lower-Limb Prosthesis Wearers: Mobile App Usability and Acceptability Study

Abstract

Introduction The ability to self-manage and problem solve effectively is an important component of managing chronic conditions. For individuals with limb loss, problem solving the fit of their prosthetic socket is crucial to being able to functionally ambulate with a prosthetic leg. This study evaluates and compares two innovative problem-solving tools designed to empower prosthesis wearers in self-managing their socket fit. Materials and Methods Fourteen paper-based problem-solving decision trees were integrated into a mobile health app displayed on an iPad. Thirty prosthesis wearers performed a total of six trials split between the two conditions (paper-based and mobile app).Technical effectiveness, efficiency, and acceptability were assessed during and after participants used each tool to problem solve real-life scenarios. Technical effectiveness was a measure of the number of errors, whereas efficiency was a measure of the amount of time needed to complete each trial. Acceptability was measured using Likert-like questionnaires and semistructured interviews. Results Results demonstrated significantly better efficiency (paper-based = 124.22 seconds on average, app = 108.76 seconds; P = 0.0076) and technical effectiveness (paper-based = 0.66 errors on average, app = 0.2 errors; P < 0.001) for the app. Age and education were correlated with the outcomes. Conclusions The mobile app demonstrated significantly better outcomes as compared with the paper-based decision trees. Both the mobile app and paper-based tool had high acceptability; however, the mobile app was found to be significantly easier to use and less confusing than the paper-based version of the decision trees. Further study is required to assess the efficacy of the decision trees to manage a prosthetic fit issue in an individual who is currently having difficult managing a prosthetic socket fit issue.

Usability of Self-Management for Amputee Rehabilitation using Technology (SMART): An online self-management program for users with lower limb loss

“…28 For example, individuals with LLL experienced fewer navigation issues and less overall issues when using a problem-solving app for self-management of prosthetic socket fit compared with a paper-based condition. 29…”

“…28 For example, individuals with LLL experienced fewer navigation issues and less overall issues when using a problem-solving app for self-management of prosthetic socket fit compared with a paper-based condition. 29 Table 2. Changes applied into SMART to address the usability issues regarding navigation, presentation, and content.…”

Development and validation of the Self-Management Assessment for the Residuum and prosThesis system designed for persons with limb loss (SMART)

“…This includes performing routine skin selfassessments, recognizing when to seek help, and problem-solving socket fit issues. 1 Failure to properly self-manage can result in self-managementrelated complications (SMRC) that can vary from skin irritation to the possibility of reamputation. [2][3][4][5][6][7][8] This process of self-managing is crucial in the prevention of SMRC's related to limb loss, including integumentary, musculoskeletal, and functional impairments.…”

“…Persons with lower limb loss (PwLLL) require the ability to self-manage if they are to be successful in adapting to life after loss of limb. 1 Self-management in the case of PwLLL can be defined as the knowledge and skills required to care for the residual limb (RL), prosthesis (PR), and the interface between both. This includes performing routine skin self-assessments, recognizing when to seek help, and problem-solving socket fit issues.…”

Self-Management in Persons With Limb Loss: A Systematic Review

“…10 Selfmanagement also involves problem-solving the fit of the prosthesis, which may include modification of sock-ply, sequencing components for donning, and maintaining awareness of how the fit changes throughout the day. 11 Finally, decision-making is concerned with recognizing when an issue presents, such as skin breakdown, and properly contacting the correct medical professional for assistance. 12 If self-management is not embodied and embraced by persons with limb loss they may be at an increased risk of injury, including but not limited to skin breakdown, wound formation, musculoskeletal issues, or falls.…”