Device Adherence and User Satisfaction

Device adherence and user satisfaction describe whether people actually use their prosthesis or orthosis as intended and how content they are with it. They are outcome dimensions in their own right, because a technically successful device that is uncomfortable or unsatisfying may be used little or abandoned.

Definition

Device adherence and user satisfaction refer to the extent to which a user employs a prosthesis or orthosis as intended and their evaluative judgement of the device and associated services.

Scope

This topic covers the concepts of adherence (sustained use and wear time) and satisfaction (appraisal of the device and related services), the factors that influence them such as comfort and fit, and the instruments used to measure them. It is an educational overview of how these outcomes are defined and assessed, not guidance on managing a particular user's device use.

Core questions

• What distinguishes device adherence from user satisfaction?
• Which factors are associated with prosthesis or orthosis abandonment?
• How are satisfaction and comfort with a device measured?
• How do comfort and fit relate to sustained device use?

Key concepts

• Adherence and wear time
• Device abandonment and rejection
• User satisfaction
• Comfort and socket fit
• Satisfaction with services and provision
• Determinants of device use

Mechanisms

Adherence reflects the gap between prescribed and actual device use, expressed through patterns such as daily wear time or, at the extreme, abandonment. Satisfaction is an evaluative judgement covering both the device itself, including comfort, fit, weight, and appearance, and the services around its provision. The two interact: discomfort, poor fit, or unmet expectations lower satisfaction and can reduce use, while a comfortable, well-fitting device that meets the user's goals tends to support sustained use. Because both are subjective, they are quantified through structured self-report instruments, including general assistive-technology satisfaction tools and device-specific scales for comfort and overall experience.

Clinical relevance

Adherence and satisfaction help explain why provision of a device does not guarantee benefit, and why abandonment rates are a recognized concern in the literature. Understanding the comfort, fit, and service factors that these measures capture supports critical reading of outcome studies. The content is reference-oriented and does not constitute advice on an individual's device use or fitting.

Epidemiology

Survey-based evidence indicates that a substantial minority of prescribed devices are abandoned, with upper limb prostheses in particular showing notable rejection across decades of reports, influenced by factors such as comfort, function, and appearance (Biddiss & Chau, 2007).

Evidence & guidelines

Satisfaction with assistive devices is measured by instruments such as the Quebec User Evaluation of Satisfaction with assistive Technology (Demers et al., 1996), and device-specific outcomes include the Prosthetic Socket Fit Comfort Score (Hanspal et al., 2003), the satisfaction module of the Orthotics and Prosthetics Users' Survey (Heinemann et al., 2003), and the satisfaction subscales of the Trinity Amputation and Prosthesis Experience Scales (Gallagher & MacLachlan, 2000).

History

Attention to whether assistive devices are actually used grew as surveys documented that meaningful proportions were abandoned despite successful provision. From the mid-1990s, dedicated satisfaction instruments such as the Quebec User Evaluation of Satisfaction with assistive Technology, and device-specific comfort and experience scales developed around 2000, established adherence and satisfaction as measurable outcomes alongside function.

Debates

What drives device abandonment?

Reported abandonment reflects a mix of comfort, fit, functional benefit, appearance, and service factors, and the relative weight of these determinants, and how best to capture them, remains an open question in the literature.

Seminal works

• demers-1996
• biddiss-2007
• gallagher-2000

Frequently asked questions

What is the difference between adherence and satisfaction with a device?

Adherence is whether and how much a person actually uses the device as intended, while satisfaction is their evaluative judgement of the device and the services around it; low satisfaction can contribute to reduced adherence.

Why is device abandonment an outcome of interest?

Because providing a device does not guarantee it will be used, and survey evidence shows a meaningful share of prostheses, especially upper limb devices, are abandoned, abandonment is tracked as an indicator of unmet need.