Understanding variations in reported epidemiology of major lower extremity amputation in the UK: a systematic review

Abstract

ObjectiveEstimate the prevalence/incidence/number of major lower extremity amputations (MLEAs) in the UK; identify sources of routinely collected electronic health data used; assess time trends and regional variation; and identify reasons for variation in reported incidence/prevalence of MLEA.DesignSystematic review and narrative synthesis.Data sourcesMedline, Embase, EMcare, CINAHL, The Cochrane Library, AMED, Scopus and grey literature sources searched from 1 January 2009 to 1 August 2021.Eligibility criteria for selecting studiesReports that provided population-based statistics, used routinely collected electronic health data, gave a measure of MLEA in adults in the general population or those with diabetes in the UK or constituent countries were included.Data extraction and synthesisData extraction and quality assessment using the Joanna Briggs Institute Critical Appraisal Instruments were performed by two reviewers independently. Due to considerable differences in study populations and methodology, data pooling was not possible; data were tabulated and narratively synthesised, and study differences were discussed.ResultsTwenty-seven reports were included. Incidence proportion for the general population ranged from 8.2 to 51.1 per 100 000 and from 70 to 291 per 100 000 for the population with diabetes. Evidence for trends over time was mixed, but there was no evidence of increasing incidence. Reports consistently found regional variation in England with incidence higher in the north. No studies reported prevalence. Differences in database use, MLEA definition, calculation methods and multiple procedure inclusion which, together with identified inaccuracies, may account for the variation in incidence.ConclusionsUK incidence and trends in MLEA remain unclear; estimates vary widely due to differences in methodology and inaccuracies. Reasons for regional variation also remain unexplained and prevalence uninvestigated. International consensus on the definition of MLEA and medical code list is needed. Future research should recommend standards for the reporting of such outcomes and investigate further the potential to use primary care data in MLEA epidemiology.Systematic review registrationPROSPERO CRD42020165592.

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“…There was a consensus of optimism in participant accounts about the potential to make a difference. While barriers to seeking care for those with PAD are well-documented, 18 19 the findings confirm that the period between diagnosis of early-stage PAD (eg, claudication) and subsequent potential diagnosis of advanced PAD with severe symptoms, is a time of no man’s land, when patients do not receive any help, education, support or appropriate medication to address their condition. 9 As such, the benefits of the LEGS intervention were identified in terms of meeting the needs of this subgroup of patients, and to address the gap in care.…”

Exploring the Associations between the Biomechanical and Psychological Mechanistic Pathways of Lower Back Pain Development amongst Persons with Lower-Limb Amputation

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