From outcome measurement to improving health outcomes after lower limb amputation—A narrative review exploring outcome measurement from a clinical practice perspective

Abstract

Outcome measurement is essential to understand the impact of clinical interventions and the performance of services. Despite national and professional body encouragement, and successful examples of system level outcome measurement within some health care settings, many barriers still exist preventing outcome measurement from becoming embedded in clinical practice. This paper presents a narrative review which aims to describe the state of the outcome measurement evidence base in prosthetic rehabilitation, as applied in clinical practice, with a view to identifying areas for future work aimed at making outcome measurement in prosthetic rehabilitation a meaningful reality. A literature search of four databases was undertaken, following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis principals appropriate to narrative reviews, and using the search terms outcome, measur*, tool, scale, instrument, prosthe*, amput* and limb loss. A total of 1116 papers were identified. Following screening 35 papers, focusing on four main themes, were included in the review. Themes were: 1) What outcome domains should be measured? 2) How can these outcome domains be measured? 3) What are the barriers to outcome measurement? and 4) What can be learnt from examples of ROM in prosthetic rehabilitation?Findings suggest that successful outcome measurement is multifaceted. Understanding and embedding value at every step appears to be key to success. Addressing the questions of ‘what’ outcome domains to measure and ‘how’ to measure them, may help establish consensus. Routine outcome measurement practice at the clinical level should ensure data collection is valuable to clinical practice, makes use of information technology solutions and has organisational engagement.

Development of the ECLIPSE model of meaningful outcome domains following lower limb amputation and prosthetic rehabilitation, through systematic review and best fit framework synthesis

“…The recommendations also include many outcome measures capturing the same outcome domain (i.e., mobility via measures such as the Six Minute Walk test, Timed Up and Go, or the Amputee Mobility Predictor). A recent narrative review highlighted the absence of outcome measure consensus in the field of prosthetic rehabilitation, and suggested it may be driven by a lack of understanding around which outcome domains characterise a meaningful recovery following prosthetic rehabilitation, and should therefore be measured [ 9 ].…”

Clinical evaluation of fall risk in older adults who use lower‐limb prostheses: A scoping review

“…25,26 Clinical outcome measures that are self-reported questionnaires (e.g., Activities-Specific Balance Confidence) or functional mobility tests (e.g., Timed Up and Go [TUG]) are clinically feasible ways to potentially evaluate fall risk, but there is still no consensus on which clinical outcome measures are most important for evaluating fall risk for general prosthetic rehabilitation. 27,28 Studies in non-prosthetic populations have suggested gait assessments may be stronger indicators of fall risk than clinical outcome measure scores 32,33 or could supplement clinical outcome measure scores 34,35 to improve fall risk screening. Therefore, gait assessments that are spatiotemporal (e.g., walking speed), kinematic (e.g., joint angles), or kinetic (e.g., joint moments or powers) may also be useful to evaluate fall risk in older adults who use lowerlimb prostheses.…”