Expert consensus identifies priorities for continuous prosthetic health monitoring in diabetic amputees

Diabetic amputees face elevated risks of skin breakdown, infection, and vascular problems, so far, no consensus-driven framework identifies which health domains should be prioritized critically for continuous monitoring in prosthetic environments. This article sought to establish an expert-consensus hierarchy of monitoring priorities to guide the development of future sensor-based prosthetic health-monitoring systems. A three-round Delphi survey was completed by 12 specialists who scored nine predefined health-monitoring domains using a weighted (Severity 40%—Frequency 30%—Preventability 30%) model. Median and interquartile range (IQR) guided round-to-round convergence. Final agreement was measured using Kendall’s W, and inter-rater reliability using ICC (3,1). Bootstrap resampling with 5000 iterations and jackknife sensitivity analysis were used to examine ranking stability. Final expert agreement was Kendall’s W = 0.98, and inter-rater reliability was ICC (3,1) = 0.96. Skin integrity and wound monitoring ranked first, followed by blood flow and vascular health, and temperature monitoring. Humidity and moisture accumulation, sweat and pH levels, and real-time data collection and alerts formed a middle-priority group. Mechanical stability and prosthetic fit, mental and emotional well-being, and battery life and power efficiency were ranked lower but remained relevant supporting domains. Ranking stability was supported by bootstrap and jackknife analyses. This study provides an expert-consensus hierarchy of monitoring priorities for diabetic amputees. The findings may help guide future sensor selection, prosthetic-interface monitoring, and research design. However, the hierarchy should not be interpreted as a clinically validated monitoring protocol, and further patient-centered and real-world validation is required.