INDIVIDUAL PREFERENCES FOR UPPER EXTREMITY PROSTHETICS ALONG A USER-COMPLEXITY FRAMEWORK: A DISCRETE CHOICE EXPERIMENT
Author(s)
Leslie Wilson, BS, MS, RN, PhD1, Ruben R. Vargas III, BA, MPH2, Todd Castleberry, MS, PhD3, Kristin Nalivaika, MS3, Elizabeth Gress, MS4, Michael P. Douglas, MS2, Shane R. Wurdeman, MS, PhD3;
1UCSF, Professor, San Francisco, CA, USA, 2UCSF, San Francisco, CA, USA, 3Hanger Institute for Clinical Research and Education, Austin, TX, USA, 4University of California, San Francisco, San Francisco, CA, USA
1UCSF, Professor, San Francisco, CA, USA, 2UCSF, San Francisco, CA, USA, 3Hanger Institute for Clinical Research and Education, Austin, TX, USA, 4University of California, San Francisco, San Francisco, CA, USA
OBJECTIVES: Upper-limb prosthetic selection lacks structured support to identify and communicate the trade-offs valued most. Preference-based decision aids may improve communication but have not been implemented in routine prosthetic prescription. We aim to implement our previously developed choice-based-conjoint (CBC) PULLTY 8 attribute preference tool in a national sample with upper-limb loss and estimate preference utilities across a user-complexity spectrum of prosthetic technologies.
METHODS: Adults with upper-limb loss recruited nationally from Hanger clinics completed an online survey that included two CBC tools (with and without cost constraints), with 14 randomized full-profile choice tasks, and six fixed paired comparisons corresponding to 4 modeled prosthetic user-complexity categories. Participants also reported demographics, limb loss and prosthetic history, and standardized measures (PROMIS Physical Function and Pain Interference, OPUS Quality-of-Life, Satisfaction, Trust, and Social Support). Preferences were estimated using random parameters logit, latent class analysis, subgroup interaction analyses, and importance scores.
RESULTS: 271 participants (56 years; 70% male; 81% White) mostly had below-elbow loss (60%); currently with body-powered (37%) and electrically-powered devices (36%). The 2nd highest functional technology level (Power-grip with socket electrodes) was most preferred (β=1.38p<0.001) followed by the highest precision devices with surgically implanted electrodes (β=1.12p<0.001). Strongest negative preferences were for low-durability (β=−0.96p<0.001), and heavy prostheses (β=−0.53, p<0.001). Individuals were willing-to-trade lowest durability and highest weights for functional preferences. Highest user-complexity (myoelectric) devices were never preferred over passive, hook/harness, or hybrid devices. Importance scores indicated function contributed 35%, durability 25%, and weight 14% to prosthetic choice. Subgroup analyses showed meaningful heterogeneity, including significant sex differences (women avoiding heavy devices; men avoided high cognitive demand), and differences by experience, satisfaction and other factors.
CONCLUSIONS: Individuals prioritize functional control but weigh these gains against durability and weight/comfort trade-offs. Preference heterogeneity across subgroups supports incorporating individualized preference measurement into prosthetic prescription to improve shared device-user matching.
METHODS: Adults with upper-limb loss recruited nationally from Hanger clinics completed an online survey that included two CBC tools (with and without cost constraints), with 14 randomized full-profile choice tasks, and six fixed paired comparisons corresponding to 4 modeled prosthetic user-complexity categories. Participants also reported demographics, limb loss and prosthetic history, and standardized measures (PROMIS Physical Function and Pain Interference, OPUS Quality-of-Life, Satisfaction, Trust, and Social Support). Preferences were estimated using random parameters logit, latent class analysis, subgroup interaction analyses, and importance scores.
RESULTS: 271 participants (56 years; 70% male; 81% White) mostly had below-elbow loss (60%); currently with body-powered (37%) and electrically-powered devices (36%). The 2nd highest functional technology level (Power-grip with socket electrodes) was most preferred (β=1.38p<0.001) followed by the highest precision devices with surgically implanted electrodes (β=1.12p<0.001). Strongest negative preferences were for low-durability (β=−0.96p<0.001), and heavy prostheses (β=−0.53, p<0.001). Individuals were willing-to-trade lowest durability and highest weights for functional preferences. Highest user-complexity (myoelectric) devices were never preferred over passive, hook/harness, or hybrid devices. Importance scores indicated function contributed 35%, durability 25%, and weight 14% to prosthetic choice. Subgroup analyses showed meaningful heterogeneity, including significant sex differences (women avoiding heavy devices; men avoided high cognitive demand), and differences by experience, satisfaction and other factors.
CONCLUSIONS: Individuals prioritize functional control but weigh these gains against durability and weight/comfort trade-offs. Preference heterogeneity across subgroups supports incorporating individualized preference measurement into prosthetic prescription to improve shared device-user matching.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
PT31
Topic
Patient-Centered Research
Disease
SDC: Injury & Trauma, SDC: Musculoskeletal Disorders (Arthritis, Bone Disorders, Osteoporosis, Other Musculoskeletal)