@2024 Afarand., IRAN

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ISSN: 2008-2630    Iranian Journal of War & Public Health 2018;10(2):75-83

Background
The customers of each company are quantitative and qualitative determinants of the company's products and the main factors of their life and sustainability. Therefore, the necessity of satisfying and continuous improvement of the quality and quantity of goods and services is of interest to managers [1].
Previous Studies
... [2]. [3]. Assessing user satisfaction is a kind of quality assessment of the quality and quantity of goods and services. Pathological research and patient satisfaction measurement are essential in increasing the quality of goods, as well as bringing services closer to their true demands [4]. Based on the results of some studies, an amputee suffers from pain while using the prosthesis. Obviously, their satisfaction is effective in improving the quality of the prosthesis [3]. ... [4]. [5]. Part of the components of satisfaction is related to the consumer and others to the institutions and organizations that provide it. Based on the primary principles of customer service, the customer is the first advisor to continually improve the corporate status of the company, in the sense that customer retention is more important and difficult than attracting the customer [6]. The less is the distance between the needs of individuals and their level of supply and reality, the greater the consent of the individuals would be, because psychologically, feeling of relaxation and secure are created in them [7]. ... [8-11].
Aim(s)
The purpose of this study was to evaluate the satisfaction of users with prosthesis and prosthetic services.
Research type
This descriptive study was conducted using a survey method.
Research society, place and time
In this research, users who came to the Method Company in Tehran, including those who received and used the services of the prosthesis, in 13 months from the beginning of January 1, 2015 to the end of January 2016, entered the study.
Sampling method and number
388 users were selected by census method.
Used devices&materials
To evaluate the satisfaction of users with prosthesis and its services, the standard questionnaire of OPUS (Orthotics Prosthetics Users Survey) and telephone interview technique were used. The OPUS consists of five evaluation modules: Lower Extremity Functional Status Survey (LEFS), Upper Extremity Functional Status Survey (UEFS), Satisfaction with Devices (CSD), Satisfaction with Services (CSS), and Health Related Quality of Life Index (HRQoL) [12]. ... [13]. The average between 1 to 2, between 2 to 3, between 3 to 4 and between 4 and 5 show high dissatisfaction, low dissatisfaction, low satisfaction and high satisfaction respectively. At the end of the OPUS questionnaire, the need for repair of the prosthesis was asked from users. Satisfaction of the device was evaluated with the components of size, weight, ease of use, ease of wearing the device, goodness, durability, not damaging, painless and affordable repair and replacement of the device. Satisfaction of the service was evaluated with the components of the appointment, the respect and honor of the employees, the waiting time, Providing information to staff, providing an opportunity to express user concerns, responsiveness of the therapist, providing training on using the device, interaction with therapist and users to resolve problems, interacting staff with therapists and doctors, and employee participation with the user. Also, using focus group method as a qualitative method, with the presence of managers, experts and related users, questions were raised and the results of the discussions and comments were elaborated. In addition, a questionnaire was designed and completed containing background information including the veteran`s code for users, demographic information, user contact information, year of amputation, year of receiving the first prosthesis, current prosthesis receiving year, daytime use, amputee limb, place of amputation and cause of amputation. Data were analyzed by SPSS 23 software and analyzed by Pearson correlation, ANOVA, independent t-test, and Scheffe post hoc test.
Findings by Text
97.9% of the statistical population was male. The minimum age for users was 6 years and the maximum age was 83 years. The mean age of the users was 49.14 ± 8.44 years and the mean was 49 years. Approximately 97% of users were residents of the city that 48.1% of them were residents of Tehran and 51.9% were residents of other provinces of Iran. Bushehr, North Khorasan, Sistan and Baluchestan, Kohgiluyeh and Boyer Ahmad each had 0.3% of the least number of visits compared to other provinces. About 60% of the users were covered by employment law and were paid by the Foundation of Martyrs and Veterans Affairs. 67.4% of the users were in employment age (15-64 years old) and 32.6% were retired (Table 1). The amputation of the four participants was before 1980, due to illness and accident. About three quarters of users were amputated in the 1980-1988 period during the war. Also, 21.4% of the users were amputated after the end of the war due to trauma. 96.9% of amputations were caused by war and most of them were caused by land mines explosion in lower extremities. In the right leg, 66.2% of the users were amputee under the knee and in the left leg 62.8% of the patients were amputee in the same area. 19% of users had more than one cutoff limb. The injured had their first prosthesis during the same period of the war between 1980 and 1988 and purchased the current prosthesis after 1988 until the study. About 22% of users were simultaneously using old and new prosthesis (Tables 2 and 3). 242 persons believed that their prosthesis was well fit, while 129 believed that their prosthesis was not well fit. Based on information on the device's satisfaction section, the average of all items was between 2 and 4. The average of 8 items included "Fitness", "being controllable", "comfort", "easiness", "good look", "durability", "not worn out the clothes" and "no pain" were in the range of 3 to 4 (Table 4) . Also, regarding scratching and burning on the skin when using the prosthesis and the ability to pay for purchase, maintenance, repair and replacement costs were between 2 and 3. In the service satisfaction section, the average of all items was between 3 and 5. Among them, the politeness and proper respect by the staff with the highest level of satisfaction was 4.74 ± 0.44. Only about the degree of satisfaction with the training provided to users and the interaction of users with the clinic staff in deciding on the treatment and the device, the mean values were between 3 and 4 (Table 4). In general, 45.5% of users expressed their satisfaction with prosthesis. The satisfaction of the device in the lower extremity was 45.7% slightly higher than the satisfaction of users in the upper extremity. Also, 66.2% had satisfaction with the services, so that the users' satisfaction in the upper limb was slightly higher than the lower extremity (Table 5). Finally, 43.0% of the respondents returned to the company after they received their device for molding, repair and replacement. According to some users, the main problem of the prosthesis was the molding defect. Therefore, after delivery of the prosthesis, users were occasionally forced to visit the clinic and remold the device. The repair of the socket or replacement of the socket was one of the most important reasons for referring to the company. In general, replacement of the prosthesis usually takes place after a long time. There was no significant relationship between age with satisfaction of the device (p = 0.51) and satisfaction with the service (p = 0.95). There was no significant difference between device satisfaction and services between three age groups less than 40 years, 40-59, 60 years old and more. There was no significant difference between instrument satisfaction between the five educational groups (p = 0.59). However, satisfaction of services between the five groups showed no significant difference (p = 0.0001). In the supplementary survey, the satisfaction of services between users under the diploma (first group) was higher than that of the ones with diploma (second group). The satisfaction of the device between the two groups of users with upper and lower limb amputation was also not significantly different (Table 6). The necessity of applying quantitative and qualitative combinational methods was determined using the focus group method after the design of the disadvantages of quantitative and qualitative methods.
Main comparison to the similar studies
... [14-25]. In Magnusson et al. Research, 75% dissatisfaction was reported, which was more than 44.3% dissatisfaction reported in the present study, as well as 62% dissatisfaction reported in Hagberg research. In a study by Sherman on a sample of 43 with traumatic amputations, it was shown that the whole group had problems with their prosthesis, with 91% believed that the prosthesis was painful [26]. In research by Bosmans et al. [27], the satisfaction rate of the device was 78%. In the study of Routhier et al. [28], the rate of satisfaction with device was 80% and in research by Nielsen et al. [10], this rate was 71.4%, which reported higher rate of satisfaction compared to the findings of this study. … [29]. .... [30-33].
Suggestions
Companies are encouraged to register and store complete information about their customers during the acceptance of the clients for receiving goods and services in order to provide more information for the researchers.
Limitations
The irregular and incomplete registration of the names and information of the attendees to the company and the lack of a breakdown of the reasons for the visit were of the research constraints.
Conclusions
Satisfaction of users with prosthetic services is more than their satisfaction with prosthesis. Users are not satisfied with the device (prosthesis), while their satisfaction is relatively high with services that relate to human resource performance, interaction, communication and customer-oriented principles.
Acknowledgments
In this respect, the authors would like to express their gratitude to the cadres for their commitment to the implementation of this plan.
Conflict of interest
Non-declared
Ethical Permissions
This research was approved and confirmed in the Ethics Committee of the Institute of Engineering and Medical Sciences for Veterans.
Funding Sources
This study was sponsored by the Institute of Engineering and Medical Sciences for Veterans.

TABLES and CHARTS

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