The effect of exercise interventions on gait outcomes in subacute and chronic rehabilitation from lower-limb amputation: A systematic review and meta-analysis

Abstract

Successful walking is a substantial contributor to quality of life in people with lower-limb amputation (PLLA), yet gait difficulties are common. Evidence-based exercise guidelines are necessary for PLLA with different clinical characteristics and at different phases of recovery. To systematically review the literature evaluating effects of exercise interventions on gait outcomes in PLLA at subacute and chronic stages of recovery. Databases MEDLINE, EMBASE, CINAHL, SPORTDiscus, Scopus, and the Cochrane Library were searched (inception to May 10, 2022). Inclusion criteria: randomized controlled trials assessing gait outcomes following exercise intervention; subjects were PLLA ≥18 years of age and used a prosthesis for walking. Meta-analysis using random effects with inverse variance to generate standardized mean differences (SMDs) was completed for primary gait outcomes. Subgroup analysis was conducted for the recovery phase (i.e., subacute and chronic) and level of amputation (e.g., transfemoral and transtibial). Of 16 included articles, 4 studies examined the subacute phase of recovery, whereas 12 examined the chronic phase. Subacute interventions were 30 minutes, 1–7 times/week, for 2–12 weeks. Chronic interventions were 15–60-minutes, 2–3 times/week, for 4–16 weeks. Low–moderate level evidence was shown for a small improvement in the subacute phase (SMD = 0.42, 95% confidence interval [0.06–0.79], I2 = 46.0%) and a moderate improvement in the chronic phase (SMD = 0.67, 95% confidence interval [0.40–0.94], I2 = 0.0%) in favor of exercise intervention groups. Multicomponent exercise programs consisting of gait, balance, and strength training are effective at improving gait outcomes in PLLA at subacute and chronic phases of recovery. The optimal duration and frequency of exercise is unclear because of variation between interventions, highlighting an area for future work.

Outcomes of Patients with Lower Limb Loss after Using a Training Prosthesis: A Retrospective Case Series Study

“…Limb amputation remains a major cause of public health concern today [ 5 ], and amputee rehabilitation holds an important place and represents a major challenge for rehabilitation physicians [ 6 , 7 ]. Multicomponent exercise programs showed gait improvements during the early and chronic phases of recovery [ 8 ]. Esquenazi and Meier [ 6 ] proposed a nine-phase description of amputee rehabilitation: pre-operative, amputation surgery/reconstruction surgery, acute post-surgical, pre-prosthetic, prosthetic prescription, prosthetic training, community integration, vocational rehabilitation, and follow-up.…”

Outcomes of Patients with Lower Limb Loss after Using a Training Prosthesis: A Retrospective Case Series Study

“…Limb amputation remains a major cause of public health concern today [5], and amputee rehabilitation holds an important place and represents a major challenge for rehabilitation physicians [6,7]. Multicomponent exercise programs showed gait improvements during the early and chronic phases of recovery [8]. Esquenazi and Meier [6] proposed a nine-phase description of amputee rehabilitation: pre-operative, amputation surgery/reconstruction surgery, acute post-surgical, pre-prosthetic, prosthetic prescription, prosthetic training, community integration, vocational rehabilitation, and follow-up.…”