Comparisons of (cost-)effectiveness of manual, hybrid, and digital shape capture and shape design techniques for transtibial and transfemoral prosthetic sockets: A scoping review

This scoping review provides an overview of studies comparing the (cost-)effectiveness of shape capture and socket design techniques for transtibial and transfemoral prostheses. The review compares manual, hybrid, and digital methods, identifies the measurement tools used, and assesses their methodological quality. Effectiveness refers to clinical and functional outcomes such as socket fit, comfort, and user function, whereas cost-effectiveness reflects the balance between resource use and these outcomes. Following Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines, 5 databases (PubMed, Embase, Web of Science, CINAHL, and Cochrane) were systematically searched. Studies involving humans with transtibial or transfemoral prostheses that compared at least 2 of the 3 methods and reported (cost-)effectiveness outcomes were included. Of 556 articles screened, 20 met the inclusion criteria (497 participants). Sixteen studies evaluated transtibial prostheses and 4 transfemoral prostheses. Manual and hybrid methods were compared in 14 studies, and digital and manual methods in 6, whereas none compared hybrid and digital methods. Eighteen studies were rated as low quality, 2 as moderate, and none as high. Effectiveness constructs mainly covered the International Classification of Functioning, Disability and Health domains "Body functions & Body structures" and "Activities and participation," but many were not clearly defined within this framework. Reported outcomes most often addressed production time, number of socket attempts, and socket fit or comfort. Overall, evidence remains limited and inconsistent, with a clear lack of direct comparisons between digital and hybrid techniques. Tentatively, hybrid and digital approaches may improve efficiency and comfort compared with manual methods, but robust, standardized research is needed to confirm these effects.