title: Biomedical and psychosocial factors influencing transtibial prosthesis fit: a Delphi survey among health care professionals.
abstract: OBJECTIVE
  We aimed to reach consensus among professionals caring for prosthesis users, on definitions of biomedical and psychosocial factors, to assess their influence on fit of transtibial prosthesis and to identify new factors.
  
  
  METHODS
  A three-round, internet-based, Delphi survey was conducted among experts recruited via the Dutch National Amputee and Prosthesis Work Group. The main outcome measure was consensus among care professionals on statements concerning new and presented biomechanical and psychosocial factors that influence transtibial prosthesis fit.
  
  
  RESULTS
  Fifty-four experts participated in the survey, and consensus was reached on 67% (46/69) of all statements. Consensus on statements relevant for good prosthesis fit was reached in most of the statements concerning psychosocial factors and on statements concerning the biomedical factors "prosthesis support and suspension". Least consensus was reached on statements concerning the biomedical factor "skin problems and pain in the residual limb".
  
  
  CONCLUSIONS
  Biomedical and psychosocial factors influence transtibial prosthesis fit. Consensus was reached among care professionals in a majority of the presented statements concerning these factors. Implications for Rehabilitation Prosthesis fit and comfort is suboptimal in many prosthesis users. Both biomedical and psychosocial factors influence fit. Biomedical and psychosocial factors should be checked during transtibial prosthesis prescription to achieve and maintain an optimal fit. Consensus on many factors influencing prosthesis fit is achieved among care professionals. Consensus was largest regarding prosthesis support and suspension and least regarding skin problems and pain in the residual limb. This consensus contributes to systematic assessment of prosthesis fit.
authors.affiliation: a De Vogellanden, Center for Rehabilitation , Zwolle , the Netherlands .
authors.forename: Erwin C
authors.initials: EC
authors.lastname: Baars
authors.forename: Ernst
authors.initials: E
authors.lastname: Schrier
authors.forename: Jan H
authors.initials: JH
authors.lastname: Geertzen
authors.forename: Pieter U
authors.initials: PU
authors.lastname: Dijkstra
mesh_terms: D000328:Adult; D000674:Amputees / Q000523:psychology* / Q000534:rehabilitation*; D032921:Consensus; D003697:Delphi Technique; D005260:Female; D006281:Health Occupations / Q000706:statistics & numerical data*; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D017755:Prosthesis Fitting / Q000009:adverse effects*; D011795:Surveys and Questionnaires
keywords: Amputee care; biomedical factors; prosthesis fit; psychosocial factors