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Exercise and Physical Activity Interventions for People with Lower Limb Amputations: A Scoping Review

Background: 

People with lower limb amputations (LLAs) living in the community have persistent challenges with mobility and have low levels of participation in physical activity (PA). Exercise and PA interventions have potential to improve quality of life and reduce cardiovascular risk factors in a growing population of Canadians with LLAs. The objective of this scoping review is to examine what is known about exercise and PA interventions delivered in outpatient or community-based settings for people with LLAs. We identified the types of research studies conducted; the characteristics of adults with LLAs included in studies; and characteristics of exercise/PA interventions and outcomes.

Methods:

The following databases were searched from inception: PsycINFO, Embase, CINAHL, Medline, SPORTDiscus, and the Cochrane Central Register Controlled Trials. Articles were included if they met the following criteria: PA and/or exercise interventions for people with major LLA (amputations above the ankle) who were ≥18 years of age and living in a community setting. Only English language studies were included. Two independent reviewers screened the articles for inclusion, and disagreements were resolved by consensus. The reviewers independently extracted the following data from the included articles: study design, sample characteristics, description and characteristics of the intervention, and study outcomes.

Results:

We retrieved 11,855 studies following removal of duplicates. After review of titles and abstracts, 115 full text articles were assessed and 42 articles were included in the study. Sixteen studies were randomized controlled trials (RCTs) (two papers reporting on the same trial), two studies with a non-amputee control group, 13 single group design studies with pre-test and post-test comparisons of outcomes, and 10 case studies. There were a total of 881 study participants across studies (range N=1-154). Of studies which reported sex, 71.2% of participants were males. The mean/median age was < 50 years in 19 studies, 50-65 years in 16 studies and > 65 years in 5 studies. The studies included people with LLA from multiple causes, most commonly trauma (n=28), dysvascular/infection (n=19) or cancer (n=11). Eighteen studies reported all or >50% of participants had transtibial amputations, 15 studies reported that all or >50% of participants had transfemoral amputations. Interventions commonly included strength training (19 studies), balance exercises (17 studies), and arm or leg ergometry (13 studies). While most studies reported promising results with some improvements in outcomes, there was considerable variation in the outcomes commonly assessed, which included aerobic capacity (12 studies), walking endurance (11 studies), gait parameters (16 studies), functional performance measures (12 studies), balance performance (nine studies), and strength (seven studies).

Conclusion:

This scoping review identified that exercise and PA interventions in community settings for people with LLA have not been widely studied, particularly using experimental study designs. Studies were consistently limited by small sample sizes. There was heterogeneity across studies in the patient populations, intervention characteristics, and outcome measures. To inform clinical practice, additional research is needed to enhance our understanding of the effectiveness of specific exercise/PA interventions for people with LLA.

N=487 (max 500)

 

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