Restoring Culturally Essential Floor-Sitting in Transfemoral Prosthesis Users: A Six-Week Pilot Randomized Within-Subject Trial

Natthawan Sutthison; Moe Nang Myat Myat; Yasmin  Nutchamlong; Marisa  Amattayakul; Mathurin Rairat; Woratee Dacharux; Gary Guerra; Kazuhiko  Sasaki

doi:10.33192/smj.v78i10.283845

Authors

Natthawan Sutthison Sirindhorn School of Prosthetics and Orthotics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Nang Myat Myat Moe Sirindhorn School of Prosthetics and Orthotics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Yasmin Nutchamlong Sirindhorn School of Prosthetics and Orthotics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Marisa Amattayakul Sirindhorn School of Prosthetics and Orthotics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Mathurin Rairat Sirindhorn School of Prosthetics and Orthotics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Woratee Dacharux Department of Anatomy, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Gary Guerra Department of Exercise and Sport Science, St. Mary’s University, San Antonio, Texas, USA.
Kazuhiko Sasaki Sirindhorn School of Prosthetics and Orthotics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

DOI:

https://doi.org/10.33192/smj.v78i10.283845

Keywords:

transfemoral prosthesis, socket design, floor-sitting, quality of life, resource-limited setting

Abstract

Objective: Floor-sitting, including cross-legged and side-sitting, is culturally essential in many Asian societies but is often prevented by conventional transfemoral sockets. The Asian Transfemoral Socket (ATS) is a low-profile, femoraladducted design that aims to restore floor-sitting through socket geometry rather than costly add-on components.

Materials and Methods: In a pilot randomized within-subject trial, 14 community walkers with unilateral transfemoral amputation were assessed with the ATS after six weeks of use and with their own socket, in randomized order. The primary outcome was floor-sitting attainment (cross-legged and side-sitting); secondary outcomes were socket comfort (SCS), prosthesis-related quality of life (PEQ), walking capacity (6MWT), dynamic balance (4SST), and daily step count. Outcomes were analyzed using Wilcoxon signed-rank and McNemar tests, with rank-biserial correlations as effect sizes.

Results: Cross-legged was attained by 12 participants with the ATS (p < 0.001) and side-sitting by 6 additional participants (p = 0.031). The ATS showed large effect sizes on comfort and quality of life, significant on two of four SCS ratings and two of three PEQ scales, whereas walking, balance, and activity did not differ (6MWT r = 0.09; 4SST r = 0.29; steps r = -0.05).

Conclusion: The ATS was associated with better floor-sitting and patient-reported outcomes. No statistically supported mobility difference was detected (paired median differences: 6MWT +0.4 m [95% CI -3.5 to 11.3], 4SST -0.21 s [-0.44 to 0.21], steps/day -23 [-449 to 521]); clinically important harm cannot be excluded. Cost, fabrication time, training, maintenance, and service delivery were not evaluated; findings are limited to this Thai center.

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