## 4 Discussion
### Prosthetic Supply, Assistive Devices, and Mobility
Maybe this could be explained by the finding that advanced mobility skills including outdoor walking could still be reached using a reliable, safe prosthesis and required assistive. As for additional therapies, all were regarded as helpful; 74% of the study cohort received physiotherapy but only 33% participated in rehabilitation sport. However, the presence and characteristics of a specific prosthetic rehabilitation protocol were not assessed in this study, which might be a further important factor influencing the overall (functional) outcome [4; 5; 7]. Even if our data consisted of discrete variables, we decided to use linear regression lines, without forecasting character but aiming for better visualization of the degree of correlation. Generally, there are many possible scores that can be used to measure QoL, with high variations due to complex interactions of physical function and psychological comorbidities [6; 7; 32]. It is important to note that even though 44% stated to be severely limited in the QoL, the majority of participants (96%) felt largely or even completely adapted to the new life situation after amputation. There are multiple questionnaires with different approaches to assess satisfaction with the prosthetic devices [33; 34; 35]. The herein used QUEST 2.0 questionnaire evaluates the degree of satisfaction with assistive technology devices from the user's perspective [11]. Overall satisfaction is the result of multidimensional, dynamic constructs. The subjective evaluation of a limb replacement, including the emotional perception, seems to be influenced by factors like appearance, properties, fit, use, and interaction with the residual limb, as well as pre-existing emotional predispositions of the amputee. Therefore the satisfaction with the prosthesis can be described as a bio-psycho-social construct, contributing to the overall quality of care [31; 32; 35; 36; 37; 38; 39; 40; 41]. Furthermore, amputees' satisfaction is the offset of their continuous experience and their expectations of healthcare services, including experienced management of the healthcare budget [31; 32; 33; 34; 35; 36; 37; 38]. Interestingly, amputees were generally more satisfied with the services than with the prosthetic devices. The German guidelines for rehabilitation after major lower-limb amputation defines minimum goals 14 days after the prosthetic fitting, such as independent ability of donning the prosthesis, pain-free fitting, and safe and independent mobilization with an assistive device [41]. This is congruent to other investigations using the QUEST and highlighting comfort, effectiveness, and ease of use [42]. We agree that those goals allow for satisfaction, mobility, and safety and are fundamental for the acceptance of the physical impairment, but also for the long-term rehabilitation, including adaptation at a satisfying QoL. Worse outcomes in overall mobility have been associated not only with a worse QoL, but with preceded cognitive concerns and overall activity [43]. One of the main objectives in rehabilitation is regaining mobility, in which satisfaction with the prosthetic device is a major factor as it enables mobility [33]. From the previous literature, we know that the higher the mobility of amputees, for example, due to participation in mobility programs [44] or even due to more advanced prostheses [45], the higher the satisfaction in the QUEST questionnaire is stated to be. It has been shown, furthermore, that independence is very valued and expressed by activities, commonly regarded as mundane, such as being able to go for a walk or driving a car [15]. The design of this study placed the focus on substantial mobility and patients' evaluation of their assistive-device-related quality of care, which is why our QoL questionnaire was adapted to the ability of mundane but elementary activities (go for a walk, driving a car), kind and frequency of support by caregivers, and overall self-rated degree of adaption to the new life situation [31; 32; 33; 34; 35; 36; 37; 38].