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Disability and Rehabilitation 2012The purpose of this review of the scientific literature was to investigate the incidence and prevalence of hemiplegia with lower limb amputation, and to identify... (Review)
Review
PURPOSE
The purpose of this review of the scientific literature was to investigate the incidence and prevalence of hemiplegia with lower limb amputation, and to identify outcomes following the dual disability of hemiplegia and amputation.
METHODS
Electronic searching of the literature identified major studies examining the effects of hemiplegia on rehabilitation following amputation. Data were extracted and levels of evidence assigned for each subtopic area.
RESULTS
The summary conclusions are Level 4 evidence. The prevalence of amputation and hemiplegia is 8-18% and amputation and hemiplegia occur most often in the same leg. Once individuals with hemiplegia and lower limb amputation are selected for prosthetic rehabilitation, rate of successful functional ambulation is greater than 58%. In general there is a lower rate of prosthetic success and independence with hemiplegia than without. Predictive factors associated with success include less severe hemiplegia, laterality of hemiplegia (ipsilateral and right side), transtibial level of amputation and absence of impaired mental function. There is wide variation in length of hospital stay, but a specialty multidisciplinary team reduces length of stay.
CONCLUSIONS
Patients with dual disability of hemiplegia and amputation generally benefit from a prosthetic rehabilitation program. Further study on predictive factors for outcome would be beneficial.
IMPLICATIONS FOR REHABILITATION
• The prevalence of hemiplegia with lower limb amputation ranges from 8 to 18%, most frequently affecting the same leg. • The majority of patients attain successful functional levels of ambulation with prosthetic rehabilitation, although lower rates than nonhemiplegic patients. • Predictive factors associated with greater success include less severe hemiplegia, ipsilateral hemiplegia, transtibial level of amputation and absence of impaired mental function.
Topics: Activities of Daily Living; Amputation, Surgical; Amputees; Artificial Limbs; Comorbidity; Hemiplegia; Humans; Incidence; Leg; Length of Stay; Predictive Value of Tests; Prevalence; Recovery of Function; Treatment Outcome
PubMed: 22424496
DOI: 10.3109/09638288.2012.665131 -
Ethiopian Journal of Health Sciences Sep 2023Most amputees suffered from lack of rehabilitation services and went on streets as glorified beggars. However, there is a paucity of information about determinant causes... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Most amputees suffered from lack of rehabilitation services and went on streets as glorified beggars. However, there is a paucity of information about determinant causes of amputation in Ethiopia. Therefore, this systematic review and meta-analysis was conducted to estimate pooled prevalence of limb amputation and its determinant causes in Ethiopian population.
METHODS
Worldwide databases such as PubMed/MedLine, Web of Science, CINAHL, Embase, Scopus, and Science Direct were searched to retrieve pertinent articles. Grey literatures were also looked in local and national repositories. Microsoft excel was used to extract data which were exported to stata version 14.0 for analysis. Cochrane Q and I tests were used to assess heterogeneity. Egger's and Begg's tests were employed to assess reporting biases. Random effect meta-analysis model was applied to estimate pooled prevalence.
RESULTS
Twenty-one qualified studies with 18,900 study participants were reviewed. Pooled prevalence of limb amputation was 31.69%. Lower extremity amputation (LEA) accounted for 14.41%, and upper extremity amputation (UEA) took 10.53% (6.50, 14.53). Above knee amputations (2.50 %) were common orthopedic operations whereas ray amputations (0.03%) were the least orthopedic procedures of LEA. Above elbow amputations (2.46%) were common from UEA while shoulder disarticulations (0.02%) were the least orthopedic surgical procedures. The major causes of limb amputations were trauma (11.05%), diabetic foot ulcer (9.93 %), traditional bone setters (24.10%) and burn (10.63%).
CONCLUSIONS
Lower extremity amputations were common orthopedic surgical procedures. Major determinant causes were trauma, diabetic foot ulcer, traditional bone setters and burn.
Topics: Humans; Ethiopia; Amputation, Surgical; Lower Extremity; Prevalence; Amputees; Upper Extremity
PubMed: 38784515
DOI: 10.4314/ejhs.v33i5.19 -
Prosthetics and Orthotics International Oct 2016Cycling with any form of limb amputation has progressed from an activity of leisure or rehabilitation to elite level competition as part of the Paralympic Games... (Review)
Review
BACKGROUND
Cycling with any form of limb amputation has progressed from an activity of leisure or rehabilitation to elite level competition as part of the Paralympic Games programme.
OBJECTIVE
While it is often proposed that research into sport with an amputation can be extremely limited, this study intended to identify the volume, type and historical strategy in this area.
STUDY DESIGN
This study comprises a documented systematic literature review of cycling undertaken with any form of limb amputation.
METHOD
This study used four online search engines to identify relevant peer-reviewed literature. These included SPORTDiscus, CINAHL, Scopus and MEDLINE. Google Scholar was also used as a secondary source. The initial results were then subjected to a set of pre-defined inclusion criteria. The resulting publications were then analysed for content and thematic commonality.
RESULTS
The review identified 20 articles which met pre-defined inclusion criteria. The identified peer-reviewed publications were dated from the period 2004 to 2014.
CONCLUSIONS
Three clear themes emerged from the historical research. There was both a paucity of peer-reviewed literature with respect to cycling with an amputation and the design of adaptive or assistive technology to replace limb loss. However, publications have been rising substantially over the last 5 years.
CLINICAL RELEVANCE
This review study established the historical strategy and content of cycling with an amputation and identified the existing research themes. This will assist in summarising the current level of knowledge and help signpost such work in the future.
Topics: Amputation, Surgical; Artificial Limbs; Bicycling; Humans
PubMed: 26527756
DOI: 10.1177/0309364615610659 -
Pain Practice : the Official Journal of... Nov 2023Limb amputation can cause residual limb pain (RLP) and/or phantom limb pain (PLP). Although targeted muscle reinnervation (TMR) was initially introduced to facilitate... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Limb amputation can cause residual limb pain (RLP) and/or phantom limb pain (PLP). Although targeted muscle reinnervation (TMR) was initially introduced to facilitate the control of prosthetic limbs, it has been noted that these patients experience less pain and improved prosthetic functional outcomes. As a result, the use of TMR in managing neuroma-related RLP is increasing. The aim of this review is to assess the quality and strength of the evidence supporting the effectiveness of TMR in managing amputation-related pain.
METHODS
Five different databases, including MEDLINE (PubMed), Scopus, Web of Science, Cochrane Library, and Embase, were searched from inception to March 2022. The protocol for this systematic review has been registered in the PROSPERO database (CRD42020218242). To be included, studies needed to compare pre- and postoperative pain outcomes or different techniques for adult patients who underwent TMR following amputation. Eligible studies also needed to use patient-reported outcome measures (PROMS) and be clinical trials or observational studies published in English. Excluded studies were case reports, case series, reviews, proof of concept studies, and conference proceedings. A meta-analysis was performed on studies that had similar intervention and control groups to examine treatment effects using a random-effects model. Studies were weighted using the inverse variance method, and a statistically significant p-value was considered to be less than or equal to 0.05.
RESULTS
This review included five studies for qualitative analysis and four studies for quantitative analysis. Reviewed studies enrolled a total of 127 patients. The TMR group was compared with standard treatment at 12 months follow-up. The TMR group showed significantly better PLP as assessed by the numerical rating score RLP, and PLP assessed using Patient-Reported Outcomes Measurement Information System (PROMIS) also showed significantly lower pain intensity in the TMR group.
CONCLUSION
There is limited evidence of good quality favoring TMR in reducing postamputation PLP and RLP pain compared with standard care. Randomized clinical trials are encouraged to compare the efficacy of different surgical techniques.
Topics: Adult; Humans; Amputation, Surgical; Phantom Limb; Neurosurgical Procedures; Extremities; Muscles
PubMed: 37357830
DOI: 10.1111/papr.13262 -
Archives of Physical Medicine and... Sep 2023To synthesize evidence for (1) the effectiveness of exercise-based rehabilitation interventions in the community and/or at home after transfemoral and transtibial... (Review)
Review
OBJECTIVES
To synthesize evidence for (1) the effectiveness of exercise-based rehabilitation interventions in the community and/or at home after transfemoral and transtibial amputation on pain, physical function, and quality of life and (2) the extent of inequities (unfair, avoidable differences in health) in access to identified interventions.
DATA SOURCES
Embase, MEDLINE, PEDro, Cinahl, Global Health, PsycINFO, OpenGrey, and ClinicalTrials.gov were systematically searched from inception to August 12, 2021, for published, unpublished, and registered ongoing randomized controlled trials.
STUDY SELECTION
Three review authors completed screening and quality appraisal in Covidence using the Cochrane Risk of Bias Tool. Included were randomized controlled trials of exercise-based rehabilitation interventions based in the community or at home for adults with transfemoral or transtibial amputation that assessed effectiveness on pain, physical function, or quality of life.
DATA EXTRACTION
Effectiveness data were extracted to templates defined a priori and the PROGRESS-Plus framework was used for equity factors.
DATA SYNTHESIS
Eight completed trials of low to moderate quality, 2 trial protocols, and 3 registered ongoing trials (351 participants across trials) were identified. Interventions included cognitive behavioral therapy, education, and video games, combined with exercise. There was heterogeneity in the mode of exercise as well as outcome measures employed. Intervention effects on pain, physical function, and quality of life were inconsistent. Intervention intensity, time of delivery, and degree of supervision influenced reported effectiveness. Overall, 423 potential participants were inequitably excluded from identified trials (65%), limiting the generalizability of interventions to the underlying population.
CONCLUSIONS
Interventions that were tailored, supervised, of higher intensity, and not in the immediate postacute phase showed greater promise for improving specific physical function outcomes. Future trials should explore these effects further and employ more inclusive eligibility to optimize any future implementation.
Topics: Adult; Humans; Quality of Life; Exercise Therapy; Pain; Amputation, Surgical; Lower Extremity; Randomized Controlled Trials as Topic
PubMed: 36893877
DOI: 10.1016/j.apmr.2023.02.009 -
Foot & Ankle International Mar 2018In the decision-making process toward an amputation of the lower extremity, knowledge about patient-related outcomes after amputation and rehabilitation is important. We... (Comparative Study)
Comparative Study
BACKGROUND
In the decision-making process toward an amputation of the lower extremity, knowledge about patient-related outcomes after amputation and rehabilitation is important. We have not found a systematic review that provides this knowledge for Syme amputation. The aim of this study was to present an overview of outcomes after a Syme amputation grouped according to the International Classification of Functioning, Disability and Health (ICF) model, focusing on body structures and functions, activities, and participation.
METHODS
A systematic literature search was performed. Included studies went through 2 selection procedures by 2 independent assessors. Included were all studies concerning Syme amputation with patient-related outcomes.
RESULTS
Thirty-six studies were included for data extraction, concerning 1056 patients (238 children and 818 adults). Heel pad migration was reported in 49 of 176 (28%), skin problems in 23 of 128 (18%), and bone problems in 42 of 145 (29%) children. No reamputations were reported. All children were fitted with a prosthesis, and 62 of 90 (69%) children participated in sports. Skin problems were reported in 35 of 195 (18%), ulceration or infection in 120 of 512 (23%), residual limb pain in 46 of 181 (25%), and reamputations in 180 of 919 (20%) adults. In total, 247 of 363 (68%) adults were fitted with a prosthesis. Walking aids were used by 45 of 135 (33%) adults. Employment status was unchanged in 147 of 209 (72%) adults.
CONCLUSION
In children, no reamputations were necessary and few complications were reported, with good participation in daily life in the majority of children. In adults, more complications and reamputations were reported; nevertheless, most adult amputees became successful prosthesis users.
LEVEL OF EVIDENCE
Therapeutic Level III, systematic review containing retrospective cohort studies.
Topics: Adult; Age Factors; Amputation, Surgical; Ankle Joint; Artificial Limbs; Child; Cohort Studies; Disability Evaluation; Disarticulation; Female; Follow-Up Studies; Foot; Humans; Male; Prosthesis Fitting; Retrospective Studies; Treatment Outcome; Wound Healing
PubMed: 29320640
DOI: 10.1177/1071100717745313 -
Disability and Rehabilitation 2009To systematically examine the state of research on sexuality and amputees. (Review)
Review
PURPOSE
To systematically examine the state of research on sexuality and amputees.
METHODS
A total of five publication databases were searched: Pubmed, Cinahl, Embase, Psychinfo and Recall.
RESULTS
A total of 11 eligible studies was found. The studies were characterised by a diversity of study populations, sampling methods, gender and age distributions, assessment methods, and outcomes measures. The use of the terminology regarding sexuality was ambiguous. All studies found an impact of the amputation of a limb on some part of sexual functioning (or concerns about) to some degree.
CONCLUSIONS
Studies on sexuality and amputees are very diverse and terminology is ambiguous. Amputation of a limb has an impact on sexual functioning. Amputees complain that there is little support from professionals. The authors recommend the use of the ICF terminology. Suggestions for future research are given.
Topics: Amputation, Surgical; Amputees; Female; Humans; Male; Quality of Life; Sexuality
PubMed: 19117187
DOI: 10.1080/09638280802240589 -
Vascular and Endovascular Surgery Feb 2017Drug-eluting balloon (DEB) and drug-eluting stent (DES) have been proposed for the treatment of infrapopliteal artery disease. We performed a systematic review and... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Drug-eluting balloon (DEB) and drug-eluting stent (DES) have been proposed for the treatment of infrapopliteal artery disease. We performed a systematic review and meta-analysis of the current available studies investigating outcomes of DEB and DES in the treatment of infrapopliteal artery disease.
METHODS
Multiple databases were systematically searched to identify studies investigating the outcomes of DEB and DES in the treatment of patients with infrapopliteal artery disease. The quality of studies was assessed by Cochrane Collaboration method. The demographic data, risk factors, outcomes, and antiplatelet strategy were extracted.
RESULTS
Nine studies were identified with 707 and 606 patients in DEB/DES and standard percutaneous balloon angioplasty (PTA)/bare metal stenting (BMS) group, respectively. The risk of target lesion revascularization (TLR; odds ratio [OR] = 0.38, 95% confidence interval [CI]: 0.23-0.63, P < .01), restenosis rate (OR = 0.30, 95% CI: 0.18-0.50, P < .01), and amputation rate (OR = 0.49, 95% CI: 0.29-0.83, P < .01) significantly decreased in the DES group. The overall survival (OR = 0.86, 95% CI: 0.56-1.32, P = .50) was similar in DES and standard PTA/BMS group; TLR (OR = 0.59, 95% CI: 0.32-1.09, P = .09), restenosis rate (OR = 0.49, 95% CI: 0.11-2.14, P = .35), amputation rate (OR = 1.32, 95% CI: 0.51-3.40, P = .57), and overall survival (OR = 1.40, 95% CI: 0.72-2.71, P = .32) were similar in DEB and standard PTA group.
CONCLUSION
The present meta-analysis suggests that compared with standard PTA/BMS, DES may decrease the risk of clinically driven TLR, restenosis rate, and amputation rate without any impact on mortality. However, DEB has no obvious advantage in the treatment of infrapopliteal disease. Due to the limitations of our study, more randomized controlled trials, especially those for DEB, are necessary.
Topics: Amputation, Surgical; Angioplasty, Balloon; Chi-Square Distribution; Coated Materials, Biocompatible; Constriction, Pathologic; Drug-Eluting Stents; Humans; Limb Salvage; Odds Ratio; Peripheral Arterial Disease; Popliteal Artery; Prosthesis Design; Recurrence; Risk Factors; Time Factors; Treatment Outcome; Vascular Access Devices; Vascular Patency
PubMed: 28103754
DOI: 10.1177/1538574416689426 -
Annals of Vascular Surgery Apr 2014When judging the success or failure of major lower extremity (MLE) amputation, the assessment of appropriate functional and quality of life (QOL) outcomes is paramount.... (Review)
Review
BACKGROUND
When judging the success or failure of major lower extremity (MLE) amputation, the assessment of appropriate functional and quality of life (QOL) outcomes is paramount. The heterogeneity of the scales and tests in the current literature is confusing and makes it difficult to compare results. We provide a primer for outcome assessment after amputation and assess the need for the additional development of novel instruments.
METHODS
MEDLINE, EMBASE, and Google Scholar were searched for all studies using functional and QOL instruments after MLE amputation. Assessment instruments were divided into functional and QOL categories. Within each category, they were subdivided into global and amputation-specific instruments. An overall assessment of instrument quality was obtained.
RESULTS
The initial search revealed 746 potential studies. After a review of abstracts, 102 were selected for full review, and 40 studies were then included in this review. From the studies, 21 different assessment instruments were used 63 times. There were 14 (67%) functional measures and 7 (33%) QOL measures identified. Five (36%) of the functional instruments and 3 (43%) of the QOL measures were specific for MLE amputees. Sixteen instruments were used >1 time, but only 5 instruments were used >3 times. An additional 5 instruments were included that were deemed important by expert opinion. The 26 assessment instruments were rated. Fourteen of the best-rated instruments were then described.
CONCLUSIONS
The heterogeneity of instruments used to measure both functional and QOL outcomes make it difficult to compare MLE amputation outcome studies. Future researchers should seek to use high-quality instruments. Clinical and research societies should endorse the best validated instruments for future use in order to strengthen overall research in the field.
Topics: Activities of Daily Living; Amputation, Surgical; Amputees; Disability Evaluation; Exercise Test; Humans; Lower Extremity; Peripheral Arterial Disease; Predictive Value of Tests; Quality of Life; Recovery of Function; Surveys and Questionnaires; Treatment Outcome
PubMed: 24495325
DOI: 10.1016/j.avsg.2013.07.011 -
Plastic Surgery (Oakville, Ont.) Aug 2022Individuals with an extremity amputation are predisposed to persistent pain that reduces their quality of life. Residual limb pain is defined as pain that is felt in... (Review)
Review
Individuals with an extremity amputation are predisposed to persistent pain that reduces their quality of life. Residual limb pain is defined as pain that is felt in the limb after amputation. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review of 5 databases from inception to June 2020 was performed and is registered under the PROSPERO ID: CRD42020199297. Included studies were clinical trials with residual limb pain assessed at a minimum follow-up of 1 week. Meta-analyses of residual limb pain prevalence and severity were performed with subgroups of extremity and amputation etiology. Twenty clinical trials met criteria and reported on a total of 1347 patients. Mean patient ages ranged from 38 to 77. Residual limb pain prevalence at 1 week, 1 month, 3 months, 6 months, 1 year, and 2 years, respectively, was 50%, 11%, 23%, 27%, 22%, and 24%. Mean residual limb pain severity at the 6 months or longer follow-up was 4.19 out of 10 for cancer amputations, 2.70 for traumatic amputations, 0.47 for vasculopathy amputations, 1.01 for lower extremity amputations, and 3.56 for upper extremity amputations. Residual limb pain severity varies according to the etiology of amputation and is more common after upper extremity amputation than lower extremity amputations. The most severe pain is reported by patients undergoing amputations due to cancer, followed by traumatic amputations, while vascular amputation patients report lower pain severity. Promising methods of reducing long-term pain are preoperative pain control, nerve or epidural blocks, use of memantine, calcitonin-containing blocks, and prophylactic nerve coaptations.
PubMed: 35990396
DOI: 10.1177/22925503211019646