Epidemiology of major lower limb amputation using routinely collected electronic health data in the UK: a systematic review protocol

Abstract

IntroductionIt is estimated that peripheral arterial disease occurs in one in five people aged over 60 years in the UK. Major lower limb amputation is a debilitating and life-changing potential outcome of peripheral arterial disease. A number of risk factors are involved in the development of the disease including smoking and diabetes. There is debate over the prevalence of major lower limb amputation in the UK with regional variations unexplained. The choice of data source can affect the epidemiological calculations and sources can also differ in the ability to explain variation. This study will aim to estimate the prevalence/incidence/number of major lower limb amputation in the UK. It will also identify sources of routinely collected electronic health data which report the epidemiology of major lower limb amputation in the UK.Methods and analysisA systematic search of peer-reviewed journals will be conducted in Medline, Excerpta Medica database, Cumulative Index of Nursing and Allied Health Literature, Allied and Complementary Medicine Database, The Cochrane Library and Scopus. A grey literature search for government and parliament publications, conference abstracts, theses and unpublished articles will be performed. Articles will be screened against the inclusion/exclusion criteria and data extracted using a pretested extraction form by two independent reviewers. Prevalence, incidence or number of cases (depending on data reported) will be extracted. Disagreements will be resolved by discussion. Data synthesis will be performed either as a narrative summary or by meta-analysis. Heterogeneity will be assessed using the I2 statistic. If heterogeneity is low-moderate, pooled estimates will be calculated using random-effects models. If possible, meta-regression for time trends in the incidence of major lower limb amputation will be performed along with subgroup analysis, primarily in regional variation.Ethics and disseminationEthics approval is not required for this study as study data are anonymised and available in the public domain. Dissemination will be by publication in a peer reviewed journal and by appropriate conference presentation.PROSPERO registration numberCRD42020165592

Double-counting of populations in evidence synthesis in public health: a call for awareness and future methodological development

“…When conducting a systematic review on the reasons for variation in reported incidence of major lower limb amputation [ 16 , 17 ], a major issue was the overlap of study period. Data syntheses including whole country population studies may mean combining studies with a major participant overlap.…”

“…Various aspects of double-counting of populations in included observational and real-world evidence studies in meta-analysis, henceforth referred to as the overlapping populations problem for brevity, will be discussed with case-studies used to highlight particular issues. The case studies used to illustrate the common issues with overlapping populations have been identified through involvement of authors of this manuscript with multiple applied synthesis projects [15][16][17][18]. Each case study has utilised various approaches of addressing the problem; in each scenario the method used to address this issue by authors was discussed, which considered the most appropriate approach to answer the research question and maximise the data available.…”

Understanding variations in reported epidemiology of major lower extremity amputation in the UK: a systematic review

“…Metaanalysis of incidence/prevalence and meta-regression of time trends using a random effects model were planned but not performed as extracted data were not suitable for pooling. 19 Patient and public involvement Patients or the public were not involved in the design, or conduct, or reporting, or dissemination plans of our research.…”

Impact of Kinesiotherapy and Hydrokinetic Therapy on the Rehabilitation of Balance, Gait and Functional Capacity in Patients with Lower Limb Amputation: A Pilot Study

“…[ 17 , 18 , 19 , 20 , 21 ]. Studies show that approximately 90% of amputation cases involve the lower limbs, and the incidence of these amputations in Europe has increased considerably in the last 25 years, ranging from 180–200 patients to 1 million and it is estimated that this negative dynamic will continue in the coming 15–20 years [ 22 , 23 , 24 , 25 , 26 ].…”