Supervised walking, muscle strengthening, balance exercises, gait training, and functional training programs demonstrated small to large effect size gait performance improvements in people with lower limb amputation. Self-selected gait speed was the most consistent outcome measure. Exercise programs emphasizing resisted gait and functional training were more effective than supervised walking.

Purpose: No consensus exists regarding best practice for prosthetic rehabilitation programs after unilateral lower-limb amputation. A program integrating manual therapy with exercise for people using lower-limb prostheses has not been systematically investigated. The objectives of this pilot study were to determine whether a four-session physical therapy program of manual therapy, exercise, and functional training would (1) be feasible for people with lower-limb amputation and (2) produce medium to large effect size changes in balance and walking ability and self-reported prosthetic function. Methods: Five subjects were recruited for this pretest-posttest design pilot study. Outcome measures included self-report scales (Houghton Scale, Prosthetics Evaluation Questionnaire, fear of falling, and Activities-Specific Balance Confidence) and clinical performance assessments: Berg Balance Scale, 2-minute walk test, and timed up and go test. One week after the four-session manual therapy, exercise, and functional training program concluded, measures were reassessed. Effect size d and Wilcoxon P values were calculated. Results: Five subjects (average age, 54.0 years), with unilateral amputations of mixed etiology and level, completed the study without adverse event. Berg Balance Scale (d = 1.7, p < 0.05), timed up and go (d = 1.05, p > 0.05), and 2-minute walk test (d = 1.18, p < 0.05) had large effect size changes. Conclusions: A four-session program of manual therapy, exercise, and functional training proved feasible and increased balance and walking ability in people with lower-limb amputation. Controlled research to determine the effects of manual therapy and exercise in this population appears warranted. (J Prosthet Orthot. 2016;28:95-100.) KEY INDEXING TERMS:Berg balance scale, exercise, functional mobility, gait, limb loss, lower-limb, manual therapies, prosthesis, 2-minute walk test T he prevalence of people with amputations is expected to more than double to 3.6 million by 2050, with 40% having had major lower-limb loss. 1 After lower-limb amputation, a multitude of individual and clinical factors can impact community mobility and participation outcomes among users of prostheses. 2 In a review of 48 studies, balance impairment was identified as the most consistent clinical finding associated with decreased prosthetic function. 3 Gait dysfunction persists, with approximately half not achieving a satisfactory level of prosthetic use even after multiple years. 4,5 As hospital lengths of stay have decreased for individuals after amputations, 6 more prosthetic gait training occurs in outpatient settings. A recent systematic review found that few detailed outpatient rehabilitation programs for users of lower-limb prostheses have been researched. 7 Although no best practice consensus approach was determined, rehabilitation programs ranging from specific exercises, balance training, resisted gait training, and indoor and outdoor functional walking have been shown to improve gait performance as assessed by gait speed. 7 ...