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L. Abou1, A. Fliflet1, Y. Du2, L.A. Rice1
1University of Illinois at Urbana-Champaign, Kinesiology and Community Health, Urbana, United States, 2Northwestern University, Physical Therapy, Chicago, United States
Background: Lower limb amputees present with significant gait and balance limitations while performing their daily living activities. In addition to the conventional prosthetic rehabilitation including traditional static, dynamic balance, and gait training, several other physical therapy (PT) interventions have been used to improve gait and balance functions in this population. However, no recent study has systematically reviewed the effectiveness of the PT interventions on gait and balance in lower limbs amputees.
Purpose: To determine the effectiveness of PT interventions to improve gait and balance in unilateral lower limb amputees compared to conventional prosthetic rehabilitation.
Methods: A systematic search for randomized controlled trials (RCTs) that analyzed the effectiveness of PT interventions in lower limb amputees was conducted through the following databases: PubMed, Web of Science, Scopus, SportDiscuss, and CINAHL. The databases were searched from inception to August 2020. Two independent reviewers screened titles and abstracts of the articles retrieved from the databases. Next, two reviewers independently reviewed the full text articles for inclusion in the review and extracted the data of interest. A meta-analysis was not conducted because of the heterogeneity between the RCTs included in the review. Finally, the reviewers independently evaluated the methodological quality of the included studies using the Cochrane Risk of Bias tool.
Results: From a total of 2123 articles identified, twelve RCTs with a total of 512 participants were included in this review. One hundred twenty-nine participants (25%) presented with trans-femoral amputation, 188 (37%) with trans-tibial amputation and 1 (0.2%) knee disarticulation. In addition, data was not provided on level of amputation from 194 (37.8%) participants. Participants age ranged from 18 to 91 years old. The most commonly used gait measurements were 2-Minutes Walking Test (2MWT), the Locomotor Capabilities Index (LCI), and gait parameters including cadence and walking speed. The most commonly used balance measurements include the Activities-Specific Balance Confidence (ABC) scale, the Timed Up and Go (TUG), and one leg standing test. Overall, the included studies presented with low risk of bias. The included studies report that conventional prosthetic rehabilitation and other PT interventions including neuromuscular electrical stimulation (NMES), proprioceptive neuromuscular facilitation (PNF), supervised circuit-style group exercise, and home-based exercise showed significant improvements on gait parameters, 2 MWT, LCI, and balance measures after interventions. However, most studies report no significant difference between both conventional prosthetic rehabilitation and other PT interventions on gait and balance measures.
Conclusion(s): This study showed that conventional prosthetic rehabilitation is as effective as other PT interventions including NMES, PNF, supervised circuit-style group exercise, and home-based exercise in improving gait and balance outcome measures in unilateral lower limb amputees. However, more RCTs using the existing intervention protocols to reduce the heterogeneity among the studies are warranted. This will improve replications of the intervention protocols in clinical settings and allow a more robust analysis such as a meta-analysis to consolidate the findings of this review.
Implications: Among a variety of available PT interventions, clinicians may choose the most appropriate intervention including conventional prosthetic rehabilitation to improve gait and balance in unilateral lower limb amputees.
Funding, acknowledgements: No funding was received for this study
Keywords: Amputation, Gait, Postural balance
Topic: Musculoskeletal: lower limb
Did this work require ethics approval? No
Institution: University of Illinois at Urbana-Champaign
Committee: UIUC-IRB
Reason: This work is a systematic review and does not involve directly any human data collection.
All authors, affiliations and abstracts have been published as submitted.
