title: The use of a direct manufacturing prosthetic socket system in a rural community in South Africa: A pilot study and lessons for future research.
abstract: BACKGROUND
  Challenges exist with the provision of appropriate mobility assistive devices in rural areas. The use of the direct manufacturing prosthetic socket system is a possible solution to these challenges.
  
  
  OBJECTIVE
  The objective of this study was to test and explore the clients' perspectives with the application of this device.
  
  
  METHODS
  Within a mixed-methods approach, a longitudinal sequential explanatory design was applied.
  
  
  METHODS
  The Orthotic and Prosthetic User's Survey was administered to explore the use of the direct manufacturing prosthetic socket system in terms of function, health-related quality of life and client satisfaction. A conveniently selected sample of 21 individuals who suffered a unilateral trans-tibial amputation was included. Data were collected at 1, 3 and 6 months post fitting, and two focus group discussions were also administered.
  
  
  RESULTS
  Of the 21 participants recruited, 11 returned for follow up. Although participants reported favourably about the prosthesis, their scores were generally worse than the norms with regard to function and quality of life. Participants highlighted the need for improvement in the cosmetic appearance of the prosthesis.
  
  
  CONCLUSIONS
  The direct manufacturing prosthetic socket system could be considered as an alternative technique of socket manufacturing for individuals living in rural areas due to the shorter manufacture time and promising initial results, but further research on this topic with a bigger sample is recommended. Clinical relevance The direct manufacturing prosthetic socket system may be considered as an alternative to the traditional prosthetic socket manufacturing technique used in South Africa. As this device requires only one visit and therefore decreased travel by the patients to the hospitals, it could be applicable to more amputees who cannot return to hospital post discharge.
authors.affiliation: 1 Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa.
authors.forename: Liezel
authors.initials: L
authors.lastname: Ennion
authors.affiliation: 2 Össur, Reykjavik, Iceland.
authors.forename: Anton
authors.initials: A
authors.lastname: Johannesson
authors.affiliation: 1 Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa.
authors.forename: Anthea
authors.initials: A
authors.lastname: Rhoda
mesh_terms: D000328:Adult; D000368:Aged; D000671:Amputation, Surgical / Q000379:methods; D000674:Amputees / Q000534:rehabilitation*; D001186:Artificial Limbs; D003906:Developing Countries; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D066192:Manufacturing Industry / Q000379:methods*; D008875:Middle Aged; D020380:Needs Assessment; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D010865:Pilot Projects; D011474:Prosthesis Design; D017755:Prosthesis Fitting / Q000379:methods*; D012424:Rural Population; D013019:South Africa; D013977:Tibia / Q000601:surgery
keywords: Direct lamination prosthetic socket; rural setting