Is abnormal movement in lower limb amputees a predictor of chronic pain? A systematic review

Abstract

Background Lower limb amputation is a life-change disability affecting millions of people worldwide. Chronic pain is a prevalent and distressing consequence of amputation, with varying factors contributing to its complexity. Altered movement patterns in amputees have been hypothesised to play a role in the onset and progression of chronic pain, but the evidence supporting this link remains inconclusive. Methods A systematic review was conducted following the PRISMA guidelines to investigate the potential association between altered movement patterns and chronic pain in individuals with lower limb amputation. Electronic databases, including PubMed, CINAHL, MEDLINE, and SPORT Discus, were searched up to July 2023 to identify relevant studies. Eligibility criteria were applied to select studies that focused on biomechanical studies of daily living activities, utilised spatial-temporal, kinematic, or kinetic data as outcome measures, assessed pain or discomfort using questionnaires, and were published in English peer-reviewed journals. Findings: Out of 223 articles remaining after removing duplicates, 18 studies met the inclusion criteria. The majority of studies focused on transtibial amputees and utilised walking gait as a functional task. Pain severity was the most frequently measured aspect, followed by location, duration, and interference with daily activities. The Visual Analog Scale was the most commonly used pain assessment tool, although the Prosthetic Evaluation Questionnaire emerged as a comprehensive tool capturing various dimensions of pain experience. However, evidence supporting a direct link between altered movement patterns and chronic pain was limited, with only one study indicating an increase in low back pain in transtibial amputees. Interpretations: The review highlights the complexity of the relationship between altered movement patterns and chronic pain in individuals with lower limb amputation. While some studies show pain reduction without significant changes in movement patterns, a comprehensive approach using multidimensional pain assessment tools and standardised modelling techniques is necessary to better understand their interplay.