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Amputees’ preferences for prosthesis settings are critical not only for their psychological well-being but also for long-term adherence to device adoption and health. Although active lower-limb prostheses can provide enhanced functionality than passive devices, little is known about the mechanism of preferences for settings in active devices. Therefore, a think-aloud study was conducted on three amputees to unravel their preferences for a powered robotic knee prosthesis during user-guided auto-tuning. The inductive thematic analysis revealed that amputee patients were more likely to use their own passive device rather than the intact leg as the reference for the natural walking that they were looking for in the powered device. There were large individual differences in factors influencing naturalness. The mental optimization of preference decisions was mostly based on the noticeableness of the differences between knee profiles. The implications on future design and research in active prostheses were discussed. 

Prostheses help amputees to maintain physical health and quality of life. Prosthesis wearers’ satisfaction and adherence to the prosthesis are closely related to the preferences for prosthesis tuning settings. However, the underlying factors that contribute to the preferences were under-explored. In this study, two able-bodied participants were asked to change the robotic prosthesis settings to their preferred state and the think-aloud technique with a mixed-method approach was used to reveal the contributing factors of preferences. We found that physical perception (e.g., positions of the prosthetic foot, balance, and stability) and subjective feelings (e.g., comfortableness, satisfaction, confidence, and worries) were two major factors. Experiences with the intact leg and other profiles were used as anchors for their preference levels. Preferences may also differ with situational context such as walking speed. The saturation points were reached with no strong approach motivation. The implications for prosthesis design and research were discussed.