Authors' objectives: HTW searched for evidence on the clinical and cost-effectiveness of using multi-grip myoelectric upper limb prosthetics as opposed to standard prosthetics in people with upper limb difference. This is an updated version of an appraisal. HTW originally published Guidance on this topic in November 2019.

Authors' results and conclusions: The evidence base comparing multi-grip myoelectric upper limb prosthetics to standard prosthetics was limited. Clinical effectiveness evidence came from eleven observational studies of varying design and generally of very low certainty. One economic study was identified, however this provided limited evidence on cost-effectiveness. Outcomes were found to be similar for multi-grip myoelectric prosthetics and standard prosthetics. Most studies showed no statistically significant difference in functional outcomes. Some studies did demonstrate statistically significant improvement in functional outcome measures with multi-grip myoelectric prosthetics, however, a similar number showed a statistically significantly worse performance with multi-grip myoelectric devices. Most studies did not find a statistically significant difference between multi-grip myoelectric and standard prosthetics for health-related quality of life. Prosthesis satisfaction was not significantly different in seven out of ten studies, whilst two showed a statistically significant difference in favour of multi-grip myoelectric prosthetics and one in favour of single-grip myoelectric prosthetics. Evidence on cosmesis outcomes, rejection rates, and complications was limited. Results of the identified economic analysis found that multi-grip myoelectric prosthetics were expected to cost more and be associated with a lower quality of life when compared to single-grip devices. However, this study has potentially serious limitations and the Incremental Cost-Effectiveness Ratio (ICER) was calculated based on retrospective patient-level data rather than economic modelling. Due to the limited evidence base, de novo economic modelling was not feasible.

Authors' recommendations: The evidence on the use of multi-grip myoelectric upper limb prosthetics by people with upper limb difference remains insufficient to support their routine adoption. The benefits of multi-grip myoelectric upper limb prosthetics compared with other types of prosthetics for upper limb difference are uncertain, and their current use should be determined by individual patient requirements. Health Technology Wales recommends the acquisition of data on patient experience and individual patient outcomes for those who have access to these technologies.

Authors' methods: The Evidence Appraisal Report is based on a literature search (strategy available on request) for published clinical and economic evidence on the health technology of interest. It is not a full systematic review but aims to identify the best available evidence on the health technology of interest. Researchers critically evaluate and synthesise this evidence. We include the following clinical evidence in order of priority: systematic reviews; randomised trials; non-randomised trials. We only include evidence for “lower priority” evidence where outcomes are not reported by a “higher priority” source. We also search for economic evaluations or original research that can form the basis of an assessment of costs/cost comparison. We carry out various levels of economic evaluation, according to the evidence that is available to inform this.

Project Status: Completed

Year Published: 2023

URL for published report: https://healthtechnology.wales/reports-guidance/multigrip-upper-limb-prosthetics/

English language abstract: An English language summary is available

Publication Type: Rapid Review

Country: Wales, United Kingdom

Organisation Name: Health Technology Wales

Contact Address: Floor 3, 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ

Contact Name: Susan Myles, PhD

Contact Email: healthtechnology@wales.nhs.uk