Predicting Walking Ability and Prosthetic Candidacy Following Lower Extremity Amputation; An Updated Systematic Review and Treatment Pathway

Authors

Scott Love, University of St. Augustine for Health SciencesFollow
Carolyn Dias-Karch, University of St. Augustine for Health SciencesFollow
Bianca Saragusti, University of St. Augustine for Health SciencesFollow
Rebekah Langrek, University of St. Augustine for Health SciencesFollow
Kayla Aponte, University of St. Augustine for Health SciencesFollow
Rebecca Miro, University of South FloridaFollow
Michael Jason Highsmith, U.S. Army Reserves. 319th Minimal Care Detachment. SP CorpsFollow

Document Type

Article

Publication Date

4-13-2023

Publication Title

Acta Scientific Orthopaedics

ISSN

ISSN: 2581-8635

Medical Subject Headings

Amputees; Lower Extremity; Artificial Limbs; Walking; Physical Therapy Modalities; Systematic Review

Abstract

Background: There is not a clear compilation of existing literature that determines walking ability and prosthetic candidacy following lower extremity amputation (LEA). There is no multi-disciplinary instrument or patient centric decision-making protocol accepted that can predict walking ability and prosthetic candidacy nor support a treatment pathway. It is important to determine these factors to better assist clinicians in determining a patient’s MFCL K-level to assist with the delivery of proper prosthetic componentry. Medicare Functional Classification Level (MFCL) K-level is a 0 to 4-point scale of functional level for those with limb loss. The purpose of this systematic literature review is to further develop evidence-based LEA patient centric treatment pathways that determine prosthetic candidacy decisions for LEAs. This evidence will assist the healthcare team in the decision-making process. In a similar systematic review (SR), Kahle., et al. reported into 2016 on the prediction of walking ability following lower limb amputation (LLA).

Methods: This search strategy was designed and similarly implemented from the previous Kahle SR based on predicting walking ability. An electronic literature search was executed from 8/1/2007 to 12/31/2015 using MEDLINE, EMBASE, CINAHL, and Cochrane.

Results: After electronic search and a thorough review and elimination of articles, a total of 104 quality studies were identified. Of these, 78 were systematically reviewed in two previous reviews and eliminated. Twenty-six remained for full evaluation. These updated study conclusions are drawn from a total sample (n) of 46,651 subjects. The size of this updated study has increased the original Kahle., et al. report by including 300% more subjects for a combined total of 61,858 subjects in the two SRs.

Conclusion: In the two combined SRs, cause of amputation (etiology), physical fitness, pre-amputation living status, amputation level, age, cognitive/mood disturbances, social support and comorbidities are included as moderate to strongly supported predictive factors of walking ability and prosthetic candidacy. These factors should be strongly considered in a detailed history and physical examination by the rehabilitation team and documented in the patient healthcare record.

Volume

6

Issue

5

First Page

56

Last Page

71

Comments

© Scott Love, Carolyn Dias-Karch, Bianca Saragusti, Rebekah Langrek, Kayla Aponte, Rebecca Miro, Michael Jason Highsmith

Published to SOAR@USA with the permission of the authors

Recommended Citation

Love S, Dias-Karch C, Saragusti B, Langrek R, Aponte K, Miro R, Highsmith MJ. Predicting Walking Ability and Prosthetic Candidacy Following Lower Extremity Amputation; An Updated Systematic Review and Treatment Pathway. Acta Scientific Orthopaedics. 2023; 6(5):56-71.