Reporting of Rehabilitation Outcomes in the Traumatic Lower Limb Amputation Literature: A Systematic Review

Shashank Ghai; Sander L Hitzig; Lindsay Eberlin; Joshua Melo; Amanda L Mayo; Virginie Blanchette; Natalie Habra; Audrey Zucker-Levin; Diana Zidarov

doi:10.1016/j.apmr.2023.08.028

Reporting of Rehabilitation Outcomes in the Traumatic Lower Limb Amputation Literature: A Systematic Review

Arch Phys Med Rehabil. 2023 Sep 12:S0003-9993(23)00522-1. doi: 10.1016/j.apmr.2023.08.028. Online ahead of print.

Authors

Shashank Ghai¹, Sander L Hitzig², Lindsay Eberlin³, Joshua Melo³, Amanda L Mayo⁴, Virginie Blanchette⁵, Natalie Habra⁶, Audrey Zucker-Levin⁷, Diana Zidarov⁸

Affiliations

¹ Department of Political, Historical, Religious and Cultural Studies, Karlstads Universitet, Karlstad, Sweden; Centre for Societal Risk Research, Karlstads Universitet, Karlstad, Sweden; Psychology of Learning and Instruction, Department of Psychology, School of Science, Technische Universität Dresden, Dresden, Germany; Centre for Tactile Internet with Human-in-the-loop (CeTI), Technische Universität Dresden, Dresden, Germany. Electronic address: shashank.ghai@kau.se.
² Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada; St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada; Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
³ Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
⁴ St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada; Division of Physical Medicine and Rehabilitation, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada; Centre for Quality Improvement and Patient Safety (CQuIPS), Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
⁵ VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Québec, Canada; Department of Human Kinetics and Podiatric Medicine, Université du Québec à Trois-Rivières, Trois-Rivières, Canada.
⁶ Faculté de Médecine, Université de Montréal, Montréal, Canada; Centre de Recherche Interdisciplinaire en Réadaptation (CRIR), Institut universitaire sur la réadaptation en déficience physique de Montréal (IURDPM), Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, Canada.
⁷ School of Rehabilitation Science, University of Saskatchewan, Saskatoon, Canada.
⁸ Centre de Recherche Interdisciplinaire en Réadaptation (CRIR), Institut universitaire sur la réadaptation en déficience physique de Montréal (IURDPM), Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, Canada; École de readaptation, Faculté de Médecine, Université de Montréal, Montréal, Québec, Canada. Electronic address: diana.zidarov@umontreal.ca.

PMID: 37708929
DOI: 10.1016/j.apmr.2023.08.028

Abstract

Objective: To synthesize the outcomes reported in the rehabilitation and community literature for adults with traumatic lower limb amputation (LLA).

Data sources: The search strategy was conducted in 3 databases (Medline, EMBASE, and CINAHL) from inception to April 2022.

Study selection: To be eligible, articles could be of any design but were required to have at least 50% adult individuals with traumatic LLA and had to report on interventions and outcomes in either a rehabilitation or community setting.

Data extraction: The extracted outcomes were classified using Dodd's framework, which is designed for organizing research outcomes. Heterogeneity was observed in the outcome measures (OMs) used for evaluation. Two reviewers independently conducted the data extraction, which was verified by a third reviewer.

Data synthesis: Of the 7,834 articles screened, 47 articles reporting data on 692 individuals with traumatic LLA, met our inclusion criteria. Four core areas encompassing 355 OMs/indicators were identified: life effect (63.4%), physiological/clinical (30.1%), resource use (5.1%), and adverse events (1.4%). Physical functioning (eg, gait, mobility) was the most frequently reported outcome domain across studies, followed by nervous system outcomes (eg, pain) and psychiatric outcomes (eg, depression, anxiety). Domains such as global quality of life and role/emotional functioning were seldomly reported.

Conclusion: The study provides a list of outcome indicators explicitly published for adults with traumatic LLA, highlighting inconsistent reporting of outcome indicators. The lack of a standardized set of OMs is a barrier to performing meta-analyses on interventions, preventing the identification of effective care models and clinical pathways. Developing a core outcome set that includes OMs relevant to the needs of the traumatic LLA population may address these issues.

Keywords: Amputation; Community health; Lower extremity; Outcome assessment; Rehabilitation; Traumatic.

Publication types

Review