Longitudinal improvements in comfort, mobility, and quality of life with adjustable‐volume prosthetic sockets
Dwiesha L. England, Phillip M. Stevens, Aolani M. Wheeler, Bretta L. Fylstra, Kathleen M. Caroll, Emilly A. Steffensen, Todd J. Castleberry, Shane R. WurdemanAbstract
Background
The prosthetic socket is central to the comfort, function, and satisfaction for lower‐limb prosthesis users. Traditional fixed‐geometry sockets offer limited adjustability and sometimes fail to accommodate daily changes in residual limb volume or shape, leading to poor load distribution, discomfort, skin issues, and reduced quality of life. Adjustable volume sockets (AVS) have been introduced as a potential solution.
Objective
To evaluate the impact of AVS on socket comfort, quality of life, general satisfaction, satisfaction with walking ability, and prosthetic mobility in a large clinical population.
Design and Setting
A retrospective longitudinal study was conducted across multiple U.S. prosthetic clinics, reviewing data from 2023 to 2025.
Participants
Adults with lower‐limb amputation ( n = 444).
Intervention
Adjustable‐volume socket.
Main Outcomes Measures
Socket Comfort Score (SCS), quality of life, satisfaction, satisfaction with walking ability, and Prosthetic Limb Users Survey of Mobility (PLUS‐M).
Results
Significant improvements were observed across all outcomes instruments. Mean SCS increased from 5.59 to 7.16 ( p < .001, Cohen's d = .64). Quality of life, general satisfaction, and satisfaction with walking ability all improved significantly ( p < .001), with small‐to‐medium effect sizes. PLUS‐M T‐scores increased from 44.8 to 46.9 ( p < .001). Change score correlations demonstrated that improvements in SCS were positively associated with increases in all secondary outcomes including higher mobility ( r = .32, p < .001), improved quality of life ( r = .48, p < .001), and greater satisfaction ( r = .49, p < .001). Greater improvements in SCS were also correlated with longer prosthesis wear times ( r = .13, p = .003).
Conclusion
Use of AVS was associated with clinically meaningful improvements in comfort, satisfaction, and functional mobility among prosthesis users.