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Prosthetic Limb User Experiences With Crossover Feet

A Pilot Focus Group Study to Explore Outcomes That Matter

McDonald, Cody L., MPH, CPO; Cheever, Sarah M., BS; Morgan, Sara J., PhD, CPO; Hafner, Brian J., PhD

JPO: Journal of Prosthetics and Orthotics: April 2019 - Volume 31 - Issue 2 - p 121–132
doi: 10.1097/JPO.0000000000000240

Introduction Many different prosthetic feet are available to meet the diverse needs of people with lower-limb amputation. Current methods used to assess comparative effectiveness of prosthetic feet may not align with outcomes that are most important to people with lower-limb amputation. User participation in qualitative research is one approach to guide selection of outcome measures for clinical practice and quantitative research studies. This pilot study examined outcomes of importance to people who have used both energy storing and crossover prosthetic feet.

Materials and Methods An in-person focus group of people with lower-limb amputation was conducted. Inclusion criteria were as follows: 18 years of age or older, lower-limb amputation, previous use of an energy storing foot and crossover foot, and a minimum of 1 year prosthesis use.

Results Five participants with lower-limb amputation (4 males/1 female), aged 41 to 59 years (mean, 45.6 ± 7.7 years), participated in the focus group. Three participants had unilateral transtibial amputations; one had bilateral transtibial amputations; and another had bilateral involvement with a transtibial and partial-foot amputation. All participants reported daily use of a prosthesis (mean, 15.2 ± 1.1 hours). Three categories of themes arose from this focus group: direct outcomes, external influences, and indirect outcomes. Direct outcomes included balance and stability, endurance and sustained gait quality, and naturalness. External influences included peer and prosthetist interactions. Indirect outcomes included increased confidence and expanded mobility. Outcome measures available to assess identified constructs were suggested.

Conclusions Engagement of prosthesis users through qualitative research methods can inform the choice of outcome measures used to assess clinical outcomes or evaluate the effectiveness of prosthetic devices.

CODY L. MCDONALD, MPH, CPO; SARAH M. CHEEVER, BS; SARA J. MORGAN, PhD, CPO; and BRIAN J. HAFNER, PhD, are affiliated with Department of Rehabilitation Medicine, University of Washington, Seattle, Washington.

Disclosure: The authors declare no conflict of interest.

Funding/Support: This work was supported by the University of Washington Department of Rehabilitation Medicine (under a Walter C. and Anita C. Stolov Award) and the Office of the Assistant Secretary of Defense for Health Affairs through the Orthotics and Prosthetics Outcomes Research Program (under award no. W81XWH-15-1-0458).

Disclaimer: Opinions, interpretations, conclusions, and recommendations are those of the authors and are not necessarily endorsed by the University of Washington or the US Department of Defense.

Correspondence to: Brian J. Hafner, PhD, Department of Rehabilitation Medicine, University of Washington, 1959 NE Pacific St, Box 356490, Seattle, WA 98195; email:

© 2019 by the American Academy of Orthotists and Prosthetists.