The role of exercise testing in predicting successful ambulation with a lower extremity prosthesis: a systematic literature review and clinical practice guideline

Abstract

BackgroundGrowing discontent with the k-level system for functional classification of patients with limb loss and movement of healthcare toward evidence-based practice has resulted in the need for alternative forms of functional classification and development of clinical practice guidelines to improve access to quality prosthetic interventions. The purpose of this project was to develop and present a clinical practice recommendation for exercise testing in prosthetic patient care based on the results and synthesis of a systematic literature review.MethodsDatabase searches of PubMed, Google Scholar, Web of Science, and Cochrane were conducted and articles reviewed. Of the potential 1386 articles 10 met the criteria for inclusion. These articles were assessed using the critical appraisal tool of the United Kingdom National Service Framework for Long-Term Conditions. Of the 10 included articles eight were of high, one of medium, and one of low, quality. Data from these articles were synthesized into 6 empirical evidence statements, all qualifying for research grade A. These statements were used to develop the proposed clinical practice guideline.ResultsWhile the results of this systematic review were not able to support the direct connection between cardiorespiratory performance and K-levels, the literature did support the ability of exercise testing results to predict successful prosthetic ambulation in some demographics. Both continuous maximum-intensity single lower extremity ergometer propelled by a sound limb and intermittent submaximal upper extremity ergometer protocols were found to be viable evaluation tools of cardiorespiratory fitness and function in the target population.ConclusionThe ability to sustain an exercise intensity of ≥50% of a predicted VO2max value in single leg cycle ergometry testing and achievement of a sustained workload of 30 W in upper extremity ergometry testing were found to be the strongest correlates to successful ambulation with a prosthesis. VO2 values were found to increase in amputee subjects following a 6-week exercise program. These synthesized results of the systematic literature review regarding exercise testing in patients with loss of a lower extremity were used to develop and a present a clinical treatment pathway.Electronic supplementary materialThe online version of this article (10.1186/s12984-018-0401-z) contains supplementary material, which is available to authorized users.

An enhancement of the Genium™ microprocessor-controlled knee improves safety and different aspects of the perceived prosthetic experience for unilateral and bilateral users

“…Situation avoidance leads to activity avoidance and reductions in social and community participation which ultimately results in reduced FIGURE 1 Genium and Genium X3 images, reprinted with permission from Otto Bock Healthcare LP. quality of life (7)(8)(9)(10). However, these reductions may be avoided if features are created to improve the experience of bilateral users because previous research has shown relative fulfilment of rehabilitative potential has a greater impact on mental health and quality of life than the laterality of amputation (11,12).…”

Interobserver and intraobserver reliabilities of determining the ventilatory thresholds in subjects with a lower limb amputation and able-bodied subjects during a peak exercise test on the combined arm-leg (Cruiser) ergometer

“…Before starting exercise training, a valid, reliable and safe physical exercise test especially with regard to cardiovascular risks is required to design exercise training programs. Additionally, outcomes of exercise tests should help to predict successful ambulation with a prosthesis [6][7][8].…”

TRIA-MF protocol as an innovative tool in the comprehensive treatment and outcome evaluation of lower limb amputees before and after prosthesis use

“…In Europe diabetic management costs are various: from 1.305 €/year in Spain, to 3.576 €/year in Germany. In Italy the main cost is about 2.990 €/year, for a national expenditure of 5 billion euros every year [4][5][6]. 60% of this expenditure is caused by in-hospital care, other for ambulatorial cares and drugs.…”