A Systematic Review and Narrative Synthesis of Risk Prediction Tools Used to Estimate Mortality, Morbidity, and Other Outcomes Following Major Lower Limb Amputation

Preece, Ryan; Dilaver, Nafi; Waldron, Cherry-Ann; Pallmann, Philip; Thomas-Jones, Emma; Gwilym, Brenig Llwyd; Norvell, Daniel C; Czerniecki, Joseph M.; Twine, Christopher P.; Bosanquet, David C.

doi:10.1016/j.ejvs.2021.02.038

Cited by 10 publications

(11 citation statements)

References 29 publications

(114 reference statements)

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“…Recently, Preece et al have conducted a systematic review and narrative synthesis looking at the performance of different risk prediction models at estimating long-term outcomes in patients undergoing MLLA. 3 In total, 13 risk prediction tools from 12 retrospective observational studies (61 099 MLLAs) were identified that gave estimations for postoperative morbidity, mortality, chance of ambulation, and risk of reamputation. Although most postamputation mortality and morbidity tools demonstrated acceptable predictive capabilities, the risk of bias was generally high and external validation was frequently absent; only 3 of the 13 models were externally validated.…”

Section: Dear Editor(s)mentioning

confidence: 99%

Letter to Editor: R.E “Scoring Model to Predict Major Amputation in Patients With Chronic Limb-Threatening Ischaemia at Wound, Ischaemia, and Foot Infection Clinical Stage 4 After Endovascular Therapy” by Kobayashi et al

2022

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Section: Dear Editor(s)mentioning

confidence: 99%

Letter to Editor: R.E “Scoring Model to Predict Major Amputation in Patients With Chronic Limb-Threatening Ischaemia at Wound, Ischaemia, and Foot Infection Clinical Stage 4 After Endovascular Therapy” by Kobayashi et al

2022

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“…Surgeons typically are worse at predicting longer-term outcomes than short-term outcomes for surgery in general, and their performance relative to outcome prediction tools varies 14 . Long-term (1-year after surgery) outcome prediction models specific to MLLA are available, but validation studies are typically lacking 15 . It is unknown how accurate healthcare professionals, or outcome prediction models, are at predicting the longer-term outcomes following MLLA.…”

Section: Introductionmentioning

confidence: 99%

Long-term risk prediction after major lower limb amputation: 1-year results of the PERCEIVE study

Gwilym,

Pallmann,

Waldron

et al. 2024

BJS Open

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Background Decision-making when considering major lower limb amputation is complex and requires individualized outcome estimation. It is unknown how accurate healthcare professionals or relevant outcome prediction tools are at predicting outcomes at 1-year after major lower limb amputation. Methods An international, multicentre prospective observational study evaluating healthcare professional accuracy in predicting outcomes 1 year after major lower limb amputation and evaluation of relevant outcome prediction tools identified in a systematic search of the literature was undertaken. Observed outcomes at 1 year were compared with: healthcare professionals’ preoperative predictions of death (surgeons and anaesthetists), major lower limb amputation revision (surgeons) and ambulation (surgeons, specialist physiotherapists and vascular nurse practitioners); and probabilities calculated from relevant outcome prediction tools. Results A total of 537 patients and 2244 healthcare professional predictions of outcomes were included. Surgeons and anaesthetists had acceptable discrimination (C-statistic = 0.715), calibration and overall performance (Brier score = 0.200) when predicting 1-year death, but performed worse when predicting major lower limb amputation revision and ambulation (C-statistics = 0.627 and 0.662 respectively). Healthcare professionals overestimated the death and major lower limb amputation revision risks. Consultants outperformed trainees, especially when predicting ambulation. Allied healthcare professionals marginally outperformed surgeons in predicting ambulation. Two outcome prediction tools (C-statistics = 0.755 and 0.717, Brier scores = 0.158 and 0.178) outperformed healthcare professionals’ discrimination, calibration and overall performance in predicting death. Two outcome prediction tools for ambulation (C-statistics = 0.688 and 0.667) marginally outperformed healthcare professionals. Conclusion There is uncertainty in predicting 1-year outcomes following major lower limb amputation. Different professional groups performed comparably in this study. Two outcome prediction tools for death and two for ambulation outperformed healthcare professionals and may support shared decision-making.

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“…The prosthetic possibilities have been continuously improved, relying on the principles of gait biomechanics. Lower limb amputation is a permanent surgical procedure with major functional, psychological and social sequelae that are likely to affect the quality of life [ 5 , 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

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

Cotrobaș-Dascălu

Bădău

Stoica

et al. 2022

JCM

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The purpose of this pilot study was to identify impact differences in the rehabilitation of balance, gait and functional capacity in patients with lower limb amputation performing hydrokinetic therapy and kinesiotherapy programs during the pre-prosthetic and prosthetic phases. The study included 16 male patients aged 40–60 years with amputated lower limbs for 6 to 12 months, which involved transfemoral amputation (TFA), transtibial amputation (TTA), traumatic and vascular amputation, who were divided into the following two groups: the hydrokinetic therapy (HKT) group and the kinesiotherapy (KT) group, named after the content of the rehabilitation programs that were implemented for 2 weeks in the pre-prosthetic and prosthetic periods. The initial and final evaluation of the participants included the following tests: the Berg Scale and the four square test for the evaluation of the balance; the PodoSmart device for gait assessment; through the walking test over 6 min, we evaluated the functional capacity. The results were processed in SPSS 24. Analysis of the results on balance rehabilitation through the Berg Scale highlighted that the progress related to the mean of the total score was 7.62 points, p = 0.00 for the HKT group and 7.50 points, p = 0.00 for the KT group, while in the four square step test, the mean of progress was 6.125 s, p = 0.00 for the HKT group and 6 s, p = 0.000 for the KT group. The PodoSmart gait analysis revealed that the HKT group showed a progress mean of 4.875%, p = 0.00, for the foot symmetry parameter, which was 1.875% less than the score achieved by the KT group whose symmetry progress mean was 6.75%, p = 0.00, while the average progress mean for the cadence parameter was 2.75 steps/min higher for the KT group than the HKT group. The comparative analysis of the impact of these two programs on the patients’ functional capacity indicated that the score recorded by the KT group was a progress mean of 15.12 m, p = 0.00 better than the HKT group for the travelled distance parameter; the implementation of the hydrokinetic therapy program led to better exercise adaptation for the HKT group compared to the KT group at an average HR (HRavg) with 0.50 BPM, p = 0.00. After analyzing the results, it has been found that hydrokinetic therapy programs have a greater impact on balance rehabilitation and exercise adaptation, while kinesiotherapy programs have a greater impact on gait rehabilitation and functional capacity optimization for the travelled distance parameter.

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A Systematic Review and Narrative Synthesis of Risk Prediction Tools Used to Estimate Mortality, Morbidity, and Other Outcomes Following Major Lower Limb Amputation

Cited by 10 publications

References 29 publications

Letter to Editor: R.E “Scoring Model to Predict Major Amputation in Patients With Chronic Limb-Threatening Ischaemia at Wound, Ischaemia, and Foot Infection Clinical Stage 4 After Endovascular Therapy” by Kobayashi et al

Letter to Editor: R.E “Scoring Model to Predict Major Amputation in Patients With Chronic Limb-Threatening Ischaemia at Wound, Ischaemia, and Foot Infection Clinical Stage 4 After Endovascular Therapy” by Kobayashi et al

Long-term risk prediction after major lower limb amputation: 1-year results of the PERCEIVE study

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

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