The use of residual lower limb –prosthetic socket interface pressure measurements to inform clinical decisions: A systematic review

This systematic review aims to synthesise and consolidate existing knowledge on the relationship between socket interface pressure measurement and outcome measures related to clinical parameters of socket comfort in lower-limb prosthetic sockets. A search of Scopus, Web of Science, MEDLINE, CINAHL, Cochrane database of systematic reviews and IEEE Xplore was performed up to 2nd August 2024. A total of 19 studies were included in the data extraction and quality assessment process. Most studies were moderate to high quality. Extracted data included a variety of sensing systems, predominantly on male subjects with transtibial amputation, measuring normal forces or pressure. Loads were associated with comfort, discomfort, satisfaction, pain onset or pain tolerance, tissue safety and changes to satisfaction over time. There were no studies reporting any of these outcomes for people with impaired sensation or phantom limb pain. Although, there was no consistent identifiable threshold associated with a comfort or discomfort condition for any region or activity between studies, measurements at some bony regions during dynamic or activity associated with higher interface loading allowed differentiation between comfortable and uncomfortable socket conditions across studies. The synthesis of the reported pressure measurements could be a starting point for the iterative process of developing tissue-safe pressure thresholds or ranges for use in long term socket fit monitoring or to assist clinicians and prosthesis users in defining socket fit and comfort.