A pilot randomised within-subject trial in 14 unilateral transfemoral prosthesis users compared a low-profile, femoral-adducted Asian Transfemoral Socket with each participant's usual socket after six weeks of ATS use. Twelve participants attained cross-legged sitting and six additional participants attained side-sitting with ATS, alongside comfort and quality-of-life signals. Six-minute walking distance, four-square-step balance and daily steps did not differ significantly; the small sample could not exclude clinically important harm.
Key findings
- Twelve of 14 participants attained cross-legged sitting with ATS, with p
- Six additional participants attained side-sitting with ATS compared with their usual socket, p=0.031.
- Comfort and quality-of-life effects were large, but only two of four SCS ratings and two of three PEQ scales were significant; not every patient-reported domain improved.
- Mobility outcomes were not significantly different: 6MWT +0.4 m (95% CI -3.5 to 11.3), 4SST -0.21 s (-0.44 to 0.21), and daily steps -23 (-449 to 521).
- The authors explicitly state that clinically important harm cannot be excluded and that cost, fabrication time, training, maintenance and service delivery were not evaluated.
Why this matters globally
Floor-sitting supports meals, rituals, work and family life across many Asian societies yet is often absent from prosthetic outcome frameworks developed in Western settings. ATS addresses it through socket geometry rather than costly add-ons, making the concept relevant to resource-limited services. Scale-up requires multicentre evidence on safety, durability, fit across body shapes, skin and fall outcomes, lifetime cost and reproducible fabrication.
Thai researcher contribution
Siriraj and Mahidol prosthetics researchers framed the study around a culturally meaningful activity for Asian users and, with a US movement-science collaborator, assessed sitting, comfort, quality of life, walking, balance and daily activity. The work broadens prosthetic design beyond walking performance toward participation that matters in users' lives.
Limitations to consider
This 14-person, single-Thai-centre pilot used ATS for only six weeks, leaving low power and no long-term durability or complication evidence. Within-person comparison reduces between-user variation, but the abstract does not state assessor masking or a washout for order effects. Community ambulators may not represent less-mobile users, and cost, fabrication, training, maintenance and service delivery were not studied.