Introducing an adjustable upper limb prosthesis into a Ugandan clinical service: impacts on free living behaviour and prosthetic use

Access to prosthetic services in Uganda is poor, negatively impacting people with upper limb difference in function, community participation, and employment. Technologies to improve the efficiency and effectiveness of services are needed, but there is very little evidence of potential solutions. Off-the-shelf, adjustable prosthetic sockets, which can be fitted in minimal time without the complexities associated with traditional socket manufacturing, show promise. We tested the feasibility of introducing the Koalaa ALX, a prosthesis for people with trans-radial limb difference, and a peer-to-peer support system into a Ugandan clinical service. Prosthesis-worn and thigh-worn monitors successfully captured concurrent patterns of wear and free-living physical behaviours (including periods at home and away) at baseline, post-fitting, and six months post-fitting. End-of-study interviews captured participants' experiences. Four of the eight participants had no previous experience using a prosthesis (new users). The ALX could be easily deployed and supported. All participants wore their ALX, with an increase in wear time among new users at six months. Prosthesis donning and doffing events were associated with behavioural changes (e.g., changes in stepping duration). The interviews revealed good levels of satisfaction, though concerns about access to repairs, cleaning, heat discomfort, and long-term support were noted.