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Physical Function Outcomes in Patients with Lower-Limb Amputations Due to Trauma: A Systematic Review JPO033-2A
Journal of Prosthetics and Orthotics: Volume 33, Issue 2
Keyword(s)
JPO033-2A
Introduction: Lower-limb amputation (LLA) due to trauma is a life-changing medical event that challenges daily physical functioning. The aim of this systematic review was to summarize the physical function outcomes in patients with major traumatic LLA.
Methods: A literature search was conducted using MEDLINE, EMBASE, CINAHL, and PsycINFO. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed for the review methodology. Observational studies on physical function outcomes post major traumatic LLA, with sample sizes of at least 10 adults in an outpatient setting and published in English were included. The Downs and Black scale was used to assess methodological quality and articles were assigned a level of evidence.
Conclusions: Given the changes in mobility and physical health, multidisciplinary care teams are essential to manage traumatic LLA individuals' rehabilitation programs and health. Higher-quality research is needed to support evidence-based clinical recommendations. (J Prosthet Orthot. 2021;33:88–95)
Methods: A literature search was conducted using MEDLINE, EMBASE, CINAHL, and PsycINFO. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed for the review methodology. Observational studies on physical function outcomes post major traumatic LLA, with sample sizes of at least 10 adults in an outpatient setting and published in English were included. The Downs and Black scale was used to assess methodological quality and articles were assigned a level of evidence.
Results: The initial search retrieved 4626 articles, and 69 met the inclusion criteria. On average, papers had poor methodological quality. The traumatic LLA population was found to have numerous mobility challenges and reduced physical fitness, with unilateral transtibial amputation resulting in the best outcomes. There was a lack of literature on female populations, civilians, and patients from low- and middle-income countries.
Conclusions: Given the changes in mobility and physical health, multidisciplinary care teams are essential to manage traumatic LLA individuals' rehabilitation programs and health. Higher-quality research is needed to support evidence-based clinical recommendations. (J Prosthet Orthot. 2021;33:88–95)
Credit Information
2.0 Credits (Scientific)
Author(s)
Yuvreet Kaur, BSc; Stephanie R. Cimino, MSc; Mikhaela Albarico, BA; Amanda L. Mayo, MD, MHSc; Sara J.T. Guilcher, PT, PhD; Lawrence R. Robinson, MD, FABPMR; Ed Hanada, MD, MSc; Sander L. Hitzig, PhD
Description
Lower-limb amputation (LLA) due to trauma is a life-changing medical event that can lead to physical and psycho-social decline and loss of life expectancy. Hemipelvectomy, hip disarticulation, transfemoral amputation, knee disarticulation, transtibial amputation and ankle disarticulation are considered major LLAs. Minor LLAs include partial foot and toe amputations. LLA has been negatively associated with outcomes such as physical strength, gait, mobility, quality of life, and mental health. Physical function outcomes can be influenced by preoperative functional status, comorbidities, the level of amputation, and social support. Physical function is associated with other health-related outcomes such as hospitalization, nursing home admissions, falls, loss of independence, and death. Given the negative health impacts of traumatic LLA on physical function, it is critical to understand how people with LLA function physically in the community and the factors influencing those outcomes so that they can be best supported by health care professionals.