A new review maps what matters most to users and urges clinics to bring patient preferences into every step of care.

Even as upper‑limb prosthetic technology races ahead, up to 60% of people who receive an arm prosthesis either stop using it or use it very little—a rate that hasn’t budged much in a decade. Reasons include weight, comfort, day‑to‑day function, cost, and inconvenience, the review reports.  

Researchers screened more than a thousand papers and included 67 studies to chart the “patient journey” in upper‑limb prosthetic care. They grouped today’s evidence into five themes: (1) how outcomes are measured, (2) how often patient preferences are studied, (3) comparisons among device types, (4) the rehab and prescription process, and (5) factors that truly drive decisions. The authors found only six formal studies that measured patient preferences—and just four used the strongest trade‑off (“discrete choice”) methods.

What matters most to users. When people weigh options (no device, cosmetic, body‑powered, myoelectric, or hybrid systems), the consistently important attributes are functionality, appearance, grip capability, durability, weight, and cost. A practical checklist emerging from the literature also highlights battery life and control, ease of don/doff, training time, maintenance, reliability, pain/skin issues, body image, independence and daily‑living tasks, and sensory “embodiment.”

Money still moves decisions. In the few studies that tracked dollars, 37% of users were financially strained by prosthesis costs and 48% said cost was a major reason not to adopt a device—with big differences in funding access.  

A framework to match person and device. The authors propose a “user‑complexity spectrum”—aligning device complexity (and required training) with a person’s goals, routines, and support—so the “best” prosthesis is the one a person can use comfortably, consistently, and safely. They also note distinct needs (for example, women often weigh both function and cosmesis) and call for preference‑aware prescribing.  

What this means for patients and families

When you meet your prosthetist or rehab team, bring these questions:

• Function & comfort: Which everyday tasks will this device help most? How heavy is it and how does it feel after hours of wear?  
• Training & upkeep: How much practice and follow‑up will I need? What breaks most often and how is it repaired?  
• Cost & coverage: What will I pay over time (device, training, replacement, repairs), and what does insurance cover?  
• Options & trade‑offs: How do body‑powered and myoelectric options compare for my priorities (speed, grip variety, noise, appearance)?  

Bottom line: There’s no one “best” arm prosthesis—there’s a best fit for you. The review urges clinics to use shared decision‑making, with clear talk about trade‑offs, costs, and real‑world use, and to study user preferences far more rigorously so fewer people end up abandoning devices.  

Source: Wilson L., Gutin M., Banh T., et al. “Outcomes and Preferences for Decision‑Making for Upper Limb Prosthetic Care: The Patient Journey — A Scoping Literature Review.” Archives of Rehabilitation Research & Clinical Translation (2025;7:100460).