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Archives of Physical Medicine and... Mar 2017To conduct a systematic review of community integration measures used with populations with limb trauma, amputation, or both, and to evaluate each measure's focus,... (Review)
Review
OBJECTIVES
To conduct a systematic review of community integration measures used with populations with limb trauma, amputation, or both, and to evaluate each measure's focus, content, and psychometric properties.
DATA SOURCES
Searches of PubMed and CINAHL for the terms social participation, community integration, social function, outcome assessment, wounds and injuries, and amputation/rehabilitation.
STUDY SELECTION
Included English-language articles with a sample size of ≥20 adults with limb trauma or amputation. Measures were deemed eligible if they contained a majority of items related to the construct of participation as defined by the International Classification of Functioning, Disability and Health.
DATA EXTRACTION
Data on internal consistency; test-retest, interrater, and intrarater reliability; content, structural, construct, concurrent, and predictive validity; responsiveness; and floor/ceiling effects were extracted from each article and confirmed by a second investigator.
DATA SYNTHESIS
A total of 156 articles containing 34 measures and 94 subscales were reviewed. Psychometric properties were rated, and an overall score was calculated for each measure. Content of the highest scoring measures was examined. Scant evidence was found regarding the psychometric properties of most measures. Eight scales from 5 instruments had the strongest measurement properties: the Trinity Amputation and Prosthesis Experience (TAPES) social restriction and adjustment to limitation scales; Community Reintegration of Injured Service Members (CRIS) extent of participation and perceived limitations scales; Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) role-physical and social functioning scales; the 136-item Sickness Impact Profile (SIP) psychosocial domain scale; and the World Health Organization Disability Assessment Schedule 2.0 (WHODAS-II) 12-item total score.
CONCLUSIONS
Eights scales from 5 instruments-the TAPES, CRIS, SF-36, the 136-item SIP, and the WHODAS-II 12-item measure-had the strongest measurement properties.
Topics: Amputation, Surgical; Amputation, Traumatic; Community Integration; Disability Evaluation; Disabled Persons; Humans; Psychometrics; Quality of Life; Social Adjustment; Social Participation
PubMed: 27612941
DOI: 10.1016/j.apmr.2016.08.463 -
Journal of Psychosocial Oncology 2017Children and adolescents who require limb amputation as part of cancer treatment face many physical and emotional challenges. Preparatory interventions may serve to... (Review)
Review
Children and adolescents who require limb amputation as part of cancer treatment face many physical and emotional challenges. Preparatory interventions may serve to facilitate positive coping and improve long-term adjustment during pediatric cancer treatment, including decreasing anxiety and postoperative distress. This review aimed to examine and identify the type and degree of psychosocial preparation provided to the child with cancer and family prior to amputation. Electronic databases including Embase, PubMed, and PsycINFO were searched for relevant research articles. Five studies were identified that satisfied inclusion criteria and revealed common themes for preparatory interventions, but results were limited by a lack of empirical approaches and revealed little consensus on pre-operative support prior to amputation. These findings demonstrate that there is a lack of studies to date that have adequately addressed psychosocial preparation prior to amputation for pediatric oncology patients. Future research on preparatory interventions is needed using prospective and quantitative research to establish evidence-based recommendations for interventions to support this vulnerable population.
Topics: Adaptation, Psychological; Adolescent; Amputation, Surgical; Child; Humans; Neoplasms
PubMed: 28318419
DOI: 10.1080/07347332.2017.1307894 -
Journal of Vascular Surgery May 2023Postoperative morbidity in patients undergoing lower extremity amputation (LEA) has remained high. Studies investigating the influence of the anesthetic modality on the... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Postoperative morbidity in patients undergoing lower extremity amputation (LEA) has remained high. Studies investigating the influence of the anesthetic modality on the postoperative outcomes have yielded conflicting results. The aim of our study was to assess the effects of regional anesthesia vs general anesthesia on postoperative complications for patients undergoing LEA.
METHODS
We systematically searched PubMed, Embase, MEDLINE, Web of Science, and Google Scholar from 1990 to 2022 for studies investigating the effect of the anesthetic modality on the postoperative outcomes after LEA. Regional anesthesia (RA) included neuraxial anesthesia and peripheral nerve blocks. The outcomes included 30-day mortality, respiratory failure (unplanned postoperative intubation, failure to wean, mechanical ventilation >24 hours), surgical site infection, cardiac complications, urinary tract infection, renal failure, sepsis, venous thrombosis, pneumonia, and myocardial infarction.
RESULTS
Of the 25 studies identified, we included 10 retrospective observational studies with 81,736 patients, of whom 69,754 (85.3%) had received general anesthesia (GA) and 11,980 (14.7%) had received RA. In the GA group, 50,468 patients were men (63.8%), and in the RA group, 7813 patients were men (62.3%). The results of the meta-analyses revealed that GA was associated with a higher rate of respiratory failure (odds ratio, 1.38; 95% confidence interval, 1.06-1.80; P = .02) and sepsis (odds ratio, 1.21; 95% confidence interval, 1.11-1.33; P < .0001) compared with RA. No differences were found in postoperative 30-day mortality, surgical site infection, cardiac complications, urinary tract infection, renal failure, venous thrombosis, pneumonia, and myocardial infarction between the GA and RA groups.
CONCLUSIONS
The results of our meta-analysis have shown that GA could be associated with a higher rate of respiratory failure and sepsis compared with RA for LEA.
Topics: Male; Humans; Female; Surgical Wound Infection; Retrospective Studies; Treatment Outcome; Anesthesia, Conduction; Amputation, Surgical; Pneumonia; Myocardial Infarction; Anesthesia, General; Lower Extremity; Respiratory Insufficiency; Postoperative Complications
PubMed: 36243265
DOI: 10.1016/j.jvs.2022.10.005 -
The Journal of Foot and Ankle Surgery :... 2021Chronic wounds that lead to major lower extremity amputation have immense consequences on quality of life, and ultimately, mortality. However, mortality rates after... (Meta-Analysis)
Meta-Analysis Review
Chronic wounds that lead to major lower extremity amputation have immense consequences on quality of life, and ultimately, mortality. However, mortality rates after lower extremity amputation for a chronic wound are broad within the literature and have escaped precise definition. This systematic review aims to quantify long-term mortality rates after major lower extremity amputation in the chronic wound population available in the existing literature. Ovid MEDLINE was searched for publications which provided mortality data after major, nontraumatic, primary lower extremity amputations. Lower extremity amputations were defined as below and above the knee amputation. Data from included studies was analyzed to obtain pooled 1-, 2-, 3-, 5- and 10-year mortality rates. Sixty-one studies satisfied inclusion criteria representing 36,037 patients who underwent nontraumatic major lower extremity amputation. Pooled mortality rates were 33.7%, 51.5%, 53%, 64.4%, and 80% at 1-, 2-, 3-, 5- and 10-year follow-up, respectively. Within the 8184 diabetic patients (types 1 and 2), 1- and 5-year mortality was 27.3% and 63.2%. Sources of mortality data were varied and included electronic medical records, national health and insurance registries, and government databases. Mortality after nontraumatic major lower extremity amputation is high, both in patients with diabetes as well as those without. Methods used to measure and report mortality are inconsistent, lack reliability, and may underestimate true mortality rates. These findings illustrate the need for a paradigm shift in wound management and improved outcomes reporting. A focus on amputation prevention and care within a multidisciplinary team is critical for recalcitrant ulcers.
Topics: Amputation, Surgical; Humans; Lower Extremity; Quality of Life; Registries; Reproducibility of Results; Risk Factors
PubMed: 33509714
DOI: 10.1053/j.jfas.2020.06.027 -
Plastic and Reconstructive Surgery Dec 2008The question of whether to recommend amputation or salvage after type IIIB and IIIC tibial fractures remains unanswered. The purpose of this study was to conduct a... (Review)
Review
BACKGROUND
The question of whether to recommend amputation or salvage after type IIIB and IIIC tibial fractures remains unanswered. The purpose of this study was to conduct a systematic review to derive evidence-based recommendations concerning primary amputation versus limb salvage for type IIIB and IIIC open tibial fractures.
METHODS
Articles from Medline, Cinahl, and Embase that met predetermined criteria were included. Outcomes of interest included length of hospital stay, complications, rehabilitation time, quality of life, limb function, pain, and return to work data. Pooling of statistical data was performed when possible.
RESULTS
The authors reviewed 1947 articles, and 28 observational studies were included. Length of hospital stay was 56.9 days for salvage patients and 63.7 days for amputees. The most common complications after salvage attempt were osteomyelitis (17.9 percent), nonunion (15.5 percent), secondary amputation (7.3 percent), and flap failure (5.8 percent). Rehabilitation time for salvaged patients was reported as time to union (10.2 months) and time to full weight-bearing (8.1 months). Pain, quality of life, and limb function outcomes were assessed differently among studies and could not be combined. The proportion of patients who returned to work was 63.5 percent for salvage patients and 73 percent for amputees.
CONCLUSIONS
The current literature offers no evidence to support superior outcomes of either limb salvage or primary amputation for type IIIB and IIIC tibial fractures. When outcomes are similar between two treatment strategies, economic analysis that incorporates cost and preference (utility) may define an optimal treatment strategy to guide physicians and patients.
Topics: Amputation, Surgical; Humans; Limb Salvage; Postoperative Complications; Plastic Surgery Procedures; Tibial Fractures
PubMed: 19050533
DOI: 10.1097/PRS.0b013e31818d69c3 -
Journal of Orthopaedic Science :... May 2011Abdominosacral amputation is a potentially curative surgical approach for patients with recurrent rectal cancer. Previous reports have described differing extents of... (Review)
Review
BACKGROUND
Abdominosacral amputation is a potentially curative surgical approach for patients with recurrent rectal cancer. Previous reports have described differing extents of sacral resection. Most of these reports stated that high sacral involvement of the tumor is a contraindication for surgery; however, the basis for this is unclear.
METHODS
In this study, we reviewed the highest level of sacral amputation and the "contraindications" for this technique. Using a systematic literature survey, we analyzed the theoretical basis and the changes in surgical indications for recurrent rectal cancer.
RESULTS
We retrieved 33 articles from Medline and one study from the Cochrane Center Register of Controlled Trials. The highest level of resection was at the level of L5/S and S1 in one article, S1/2 and S2 in nine articles and S2/3 and S3 in 11 articles. Fifteen articles stated contraindications regarding sacral level, including tumor involvement of S1, the S1/2 junction, or the level above the S2/3 junction. Reasons stated for these contraindications included the risks associated with surgery, namely bladder dysfunction, anorectal dysfunction, genital dysfunction, walking disorder, and spinal fluid leak. In terms of the rationale for the contraindications, three articles referred to four previously published reviews or case series. None of these supporting publications were randomized controlled trials and they did not include any statistical evaluation.
CONCLUSION
The consensus for contraindications for sacral amputation was formed empirically, without strong supporting evidence. The balance between curability and dysfunction should be further evaluated scientifically.
Topics: Amputation, Surgical; Bone Neoplasms; Contraindications; Decision Making; Humans; Neoplasm Recurrence, Local; Rectal Neoplasms; Risk Factors; Sacrum
PubMed: 21451973
DOI: 10.1007/s00776-011-0050-6 -
Plastic and Reconstructive Surgery Jul 2015Revision amputation is often the treatment for traumatic finger amputation injuries. However, patient outcomes are inadequately reported, and their impact is poorly... (Review)
Review
BACKGROUND
Revision amputation is often the treatment for traumatic finger amputation injuries. However, patient outcomes are inadequately reported, and their impact is poorly understood. The authors performed a systematic review to evaluate outcomes of revision amputation and amputation wound coverage techniques.
METHODS
The authors searched all available English literature in the PubMed and Embase databases for articles reporting outcomes of nonreplantation treatments for traumatic finger amputation injuries, including revision amputation, local digital flaps, skin grafting, and conservative treatment. Data extracted were study characteristics, patient demographic data, sensory and functional outcomes, patient-reported outcomes, and complications.
RESULTS
A total of 1659 articles were screened, yielding 43 studies for review. Mean static two-point discrimination was 5.0 ± 1.5 mm (n = 23 studies) overall, 6.1 ± 2.4 mm after local flap procedures, and 3.8 ± 0.4 mm after revision amputation. Mean total active motion was 93 ± 8 percent of normal (n = 6 studies) overall. It was 90 ± 9 percent of normal after local flap procedures and 95 percent of normal after revision amputation. Seventy-seven percent of patients reported cold intolerance after revision amputation. Ninety-one percent of patients (217 of 238) reported "satisfactory" or "good/excellent" ratings regardless of treatment.
CONCLUSIONS
Revision amputation and conservative treatments result in better static two-point discrimination outcomes compared with local flaps. All techniques preserve total active motion, although arc of motion is slightly better with revision amputation. Revision amputation procedures are frequently associated with cold intolerance. Patients report "satisfactory," "good," or "excellent" ratings in appearance and quality of life with all nonreplantation techniques.
Topics: Amputation, Surgical; Amputation, Traumatic; Finger Injuries; Humans; Plastic Surgery Procedures; Reoperation; Skin Transplantation; Surgical Flaps; Treatment Outcome
PubMed: 26111316
DOI: 10.1097/PRS.0000000000001487 -
World Journal of Surgery Aug 2023The influence of diabetes mellitus (DM) on mortality following lower extremity amputation (LEA) remains controversial. This systematic review and meta-analysis aimed to... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The influence of diabetes mellitus (DM) on mortality following lower extremity amputation (LEA) remains controversial. This systematic review and meta-analysis aimed to determine the influence of DM on long-term mortality (LTM) and short-term mortality (STM) after amputation.
MATERIALS AND METHODS
The Medline, the Cochrane library, and Embase databases were searched. The primary and secondary outcomes were LTM and STM following amputation. One-year and 30-day all-cause mortality after amputation were considered as LTM and STM, respectively. A random-effects model was utilized to pool results. To evaluate the stability of results, subgroup analyses and sensitivity analyses were conducted.
RESULTS
Twenty-three cohort studies with a total of 58,219 patients were included, among which 31,750 (54.5%) patients had DM. The mean score of included studies evaluated by Newcastle-Ottawa Scale was 7.65, indicating moderate to high quality. The pooled results showed no significant difference in 1-year LTM (risk ratio [RR], 0.96; 95% CI 0.86-1.07) after amputation. However, 3-year (RR, 1.22; 95% CI 1.01-1.47) and 5-year (RR, 1.18; 95% CI 1.07-1.31) LTMs of DM patients were obviously higher than that of NDM (non-diabetes mellitus) patients. The STM of the DM group was significantly lower than the NDM group (RR, 0.80; 95% CI 0.64-0.98).
CONCLUSIONS
The current study revealed that DM patients had an obvious lower STM following LEA, but the risk of DM on LTM after amputation was gradually increased with time. More attention should be paid to the long-term survival of DM patients after LEA.
Topics: Humans; Diabetes Mellitus; Cohort Studies; Lower Extremity; Amputation, Surgical
PubMed: 37084108
DOI: 10.1007/s00268-023-07019-z -
JBJS Reviews Oct 2017Traditional socket prostheses are not a viable option for all lower-limb prosthetic users. Discomfort, pain in the residual limb, and problems related to the fit of the... (Review)
Review
BACKGROUND
Traditional socket prostheses are not a viable option for all lower-limb prosthetic users. Discomfort, pain in the residual limb, and problems related to the fit of the socket are common and have been shown to negatively impact quality of life and mobility. Osseointegrated or bone-anchored prosthetic implants have evolved over the past 2 decades as a promising alternative for patients who are experiencing substantial issues with socket prostheses.
METHODS
A review of the literature was performed to identify studies focusing on the evolution, clinical outcomes, success rates, and complications of osseointegrated lower-limb prostheses. Articles were summarized according to the implant type, amputation level, and study characteristics, with rating of the Level of Evidence. Information on patient selection criteria, outcomes, and complications was extracted.
RESULTS
Fourteen articles (with Level-II, III, or IV evidence) met the inclusion criteria. Infection and soft-tissue irritation at the stoma were the most common complications. It is evident that, over the years, changes in implant design, surgical technique, perioperative and postoperative care, and rehabilitation protocols have resulted in improvements in functional outcomes and health-related quality of life, and reduction in rates of complications.
CONCLUSIONS
Osseointegration for limb amputation has become an established clinical treatment option for persons with lower-limb amputation not tolerating traditional socket prostheses. Osseointegration could provide substantial benefits regarding function and quality of life for appropriately selected patients who accept the documented risks.
LEVEL OF EVIDENCE
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Topics: Amputation, Surgical; Amputees; Artificial Limbs; Evidence-Based Medicine; Humans; Lower Extremity; Osseointegration; Prosthesis Implantation; Quality of Life; Treatment Outcome
PubMed: 29087966
DOI: 10.2106/JBJS.RVW.17.00037 -
European Journal of Orthopaedic Surgery... Apr 2022Severe upper limb injuries can result in devastating consequences to functional and psychological well-being. Primary objectives of this review were to evaluate... (Review)
Review
PURPOSE
Severe upper limb injuries can result in devastating consequences to functional and psychological well-being. Primary objectives of this review were to evaluate indications for amputation versus limb salvage in upper limb major trauma and whether any existing scoring systems can aid in decision-making. Secondary objectives were to assess the functional and psychological outcomes from amputation versus limb salvage.
METHODS
A systematic review was carried out in accordance with PRISMA guidelines. A search strategy was conducted on the MEDLINE, EMBASE, and Cochrane databases. Quality was assessed using the ROBINS-I tool. The review protocol was registered in PROSPERO.
RESULTS
A total of 15 studies met inclusion criteria, encompassing 6113 patients. 141 underwent primary amputation and 5972 limb salvage. General indications for amputation included at least two of the following: uncontrollable haemodynamic instability; extensive and concurrent soft tissue, bone, vascular and/or nerve injuries; prolonged limb ischaemia; and blunt arterial trauma or crush injury. The Mangled Extremity Severity Score alone does not accurately predict need for amputation, however, the Mangled Extremity Syndrome Index may be a more precise tool. Comparable patient-reported functional and psychological outcomes are seen between the two treatment modalities.
CONCLUSIONS
Decision regarding amputation versus limb salvage of the upper limb is multifactorial. Current scoring systems are predominantly based on lower limb trauma, with lack of robust evidence to guide management of the upper extremity. Further high-quality studies are required to validate scoring systems which may aid in decision-making and provide further information on the outcomes from the two treatment options.
Topics: Amputation, Surgical; Humans; Injury Severity Score; Leg Injuries; Limb Salvage; Retrospective Studies; Treatment Outcome; Upper Extremity
PubMed: 34050819
DOI: 10.1007/s00590-021-03008-x