Predicting Walking Ability and Prosthetic Candidacy Following Lower Extremity Amputation; Systematic Review, Treatment Pathway and Algorithm

Scott Love, University of St. Augustine for Health Sciences


The purpose of this study is a systematic review (SR) of existing literature to examine characteristics of persons with amputation which predict walking ability and prosthetic candidacy following lower extremity amputation (LEA). The identification, synthesis and summary of this evidence could assist in developing clinical practice guidelines, including a physical rehabilitation treatment pathway and a clinical algorithm. The importance of this project is the establishment to further develop evidence based LEA clinical practice guidelines. This evidence will assist the healthcare team in decision making, specifically considering evidence and patient-centric predictive characteristics.

Background: Currently, there is no multi-disciplinary physical rehabilitation instrument known that can predict walking ability and prosthetic candidacy nor support a treatment pathway and algorithm for the LEA. Also, there is not a patient centric decision making protocol under consideration when determining prosthetic candidacy. Further, the evidence to support these guidelines and protocols has not been aggregated and summarized in a formal systematic approach, such as a comprehensive systematic review. In previous literature the prediction of walking ability has been reported. However, these studies are outdated and not comprehensive, nor do they offer a clinical treatment pathway regarding the prediction of walking ability and prosthetic candidacy following lower LEA. A comprehensive reporting of aggregated and newly synthesized evidence with information from current literature can develop an evidence based patient centric treatment pathway and a prosthetic candidacy algorithm to assist LEAs to receive the correct, initial definitive prosthesis to match their functional abilities.

Methods: This search strategy was designed and similarly implemented considering previous systematic reviews based on a similar topic. It is a more comprehensive update of previously valuable predictive factors of walking ability and prosthetic candidacy. An electronic literature search was executed from 8/1/2007 to 12/31/2015 using MEDLINE, EMBASE, CINAHL, and Cochrane.

Results: This SR performed a more comprehensive search and discovered an additional 26 articles. A total of 104 quality studies were identified through the electronic search. Of these, 78 were systematically reviewed by two former authors, leaving a total of 26 for full evaluation. Conclusions from this updated study are drawn from a total recruited sample of 46,651 subjects. This updated study increases the size of the original Kahle et al. report by including 300% more subjects for a total of 61,858 subjects studied in the two SRs.

Conclusion: In these two combined SRs, cause of amputation (etiology), physical fitness, preamputation living status, amputation level, age, physical fitness, cognitive/mood disturbances, social support and comorbitities are included as moderate to strongly supported predictive factors of walking ability and prosthetic candidacy. These factors are supported in an earlier literature review and should be strongly considered in a complete history and physical examination by multi-disciplinary team. Predictive factors should be part of a patient healthcare record.