ASSOCIATION OF PROSTHETIC FIT AND USER SATISFACTION WITH FUNCTIONAL MOBILITY AND QUALITY OF LIFE AMONG LOWER-LIMB PROSTHESIS USERS: A SYSTEMATIC REVIEW

Abstract

Background:

Socket fit and satisfaction with the prosthesis are repeatedly named by lower-limb prosthesis users as their most pressing concerns, yet the strength of their link with functional mobility and quality of life (QoL) has not been synthesized across instruments, designs and regions, including the Middle East and Saudi Arabia.

Objective:

To systematically review the association of prosthetic fit/socket comfort and user satisfaction with functional mobility and QoL among people using lower-limb prostheses.

Methods:

PubMed/MEDLINE was searched with 12 structured strings (database inception to 29 September 2026) following PRISMA 2020. Quantitative studies of lower-limb prosthesis users that reported an association between fit, socket comfort or prosthesis satisfaction and mobility, physical function, participation or QoL were eligible. Data were extracted into a standardized form, methodological quality was appraised with a five-criterion checklist, and findings were synthesized narratively with an effect-direction (harvest) summary and a forest plot of correlation coefficients (95% CIs via Fisher z); no pooled estimate was computed.

Results:

Of 309 unique records, 20 reports (19 studies; ≈3,390 participants plus 19,185 registry outcome records) from 10 countries were included; five studies came from the Middle East (Iran, Türkiye, Jordan). Better socket comfort correlated moderately to strongly with QoL (r = 0.46–0.65) and satisfaction (r = 0.49–0.69), and weakly to strongly with mobility or function (r = 0.32–0.63). Six of ten studies showed a significant positive fit–mobility association, two were mixed and two (including a randomized crossover trial) were null. Device satisfaction was independently associated with lower-extremity functional status (standardized β = 0.55) and, more weakly, with health-related QoL in the largest study (n = 1,736). Socket replacement or redesign was followed by improvements in mobility and well-being in longitudinal cohorts. No Saudi study met the inclusion criteria.

Conclusions:

Socket comfort and prosthesis satisfaction are consistently and positively associated with QoL, and less consistently with objectively measured mobility. Most evidence is cross-sectional, so causality cannot be inferred. Routine measurement of socket comfort and satisfaction, and Saudi-specific longitudinal research using Arabic-validated instruments, are recommended.