Duration, frequency, and factors related to lower extremity prosthesis use: systematic review and meta-analysis

Abstract

Purpose

A systematic review and meta-analysis investigating the duration and frequency of lower extremity prosthesis use and what factors were associated with changes in their use.

Materials and methods

A search of PubMed, CINAHL, and Scopus over 20 years revealed 2409 articles. After review, 29 studies remained, representing 4814 participants with lower limb loss. Quality, funding, publication, and quantitative analyses were addressed.

Results

The mean prosthesis use was 9.6 (5.3) hours/day and 6.4 (1.9) days/week. Distal amputation sites averaged more hours/day of prostheses use than proximal amputations (13.2 [3.2] vs. 10.8 [5.0], p < .001). After hemipelvectomy or hip dislocations, average prostheses use was less hours/day (6.0 [4.7]) than after transfemoral (12.9 [4.8]) or transtibial amputations (14.0 [4.5]) (p < .05). Pooled effects revealed an association between comorbidities and abandonment (OR 0.35, p = .03). The data supported six empirical evidence statements concerning age, sex, social support, amputation proximity, balance, skin condition, comorbidities, pain, falls, and fitness in association with changes in prosthesis utilization.

Conclusions

The study provided systematic data on lower-extremity prosthesis use, thus helping to inform clinical decision-making and patient education. It also elucidated a path for future studies focused on modifiable factors related to prosthesis use and related outcomes.

Implications for rehabilitation

• Lower limb loss can trigger costly and debilitating sequela, which could be mitigated by increased prosthesis use and functionality, but there is no consensus on how often prostheses are being used and what affects changes in their use.

• When counseling patients on what they can expect after a lower extremity amputation and to set goals, the aggregated means of 9.6 (5.3) hours per day and 6.4 (1.9) days per week can be informative.

• Individuals who use a lower extremity prosthesis or may have to use one in the future can increase their prosthesis use and mobility by limiting further health deterioration.

• Rehabilitative care involving the multidisciplinary prioritization of proper socket fit, fitness training, gait training, and social support is associated with increased prosthetic device usage.

Keywords:

• Artificial limb
• limb loss
• mobility
• rehabilitation
• amputee function
• amputation
• systematic review
• meta-analysis

Acknowledgements

The authors wish to thank Chloe Trusty, Brandon Lang, and Juhi Dhuka for their assistance, as this study could not have been completed without them.

Disclosure statement

The authors report there are no competing interests to declare and received no funding. Contents of this manuscript represent the opinions of the authors and not necessarily those of the US Department of Veterans Affairs, the University of Texas Health San Antonio, University of South Florida or any other academic or healthcare agency or institution. A portion of this project was funded by the University of South Florida, School of Physical Therapy & Rehabilitation Sciences’ Center for Neuromusculoskeletal Research.