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Amputee – improves physical function

Improves physical function

Evidence summary

A range of targeted physical activity interventions have demonstrated clear improvements in numerous parameters that improve overall function, particularly in those walking with a prosthesis. A systematic review of 8 studies supported the use of exercise programmes that incorporate balance exercises, muscle strengthening, supervised walking, gait training and functional exercises as they have all been shown to improve gait performance [1]. Programmes incorporating these, as well as flexibility exercises, have shown clinically meaningful improvements in walking ability, walking speed, degree of weight bearing through the prosthetic limb and less activity limitation [2-5].

In addition to programmes that incorporate a range of exercises, gait training interventions have also been shown to improve gait performance in those using a prosthetic limb. A systematic review of 13 studies, incorporating individuals that had undergone a lower limb amputation due to dysvascular disease, trauma or malignancy found that supervised gait training improves gait, is safe and improves the bioenergetic efficiency of gait [6]. These benefits have been found with both walking and using a treadmill [6,7]. Balance training may improve physical function [8], as can strengthening the hip abductor muscles [9].

Quality of evidence

Moderate

Strength of recommendation

Strong

Conclusion

The physical function of lower limb amputees, and the walking performance of prosthetic users, improves with physical activity interventions. However, the evidence presented relates to targeted interventions and programmes as opposed to simply increasing physical activity levels. Exercise programmes incorporating exercises to improve muscle strengthening, balance, physical function, flexibility and, if applicable, walking available to amputees during their rehabilitation should be utilised.

Lower limb amputations are performed for a number of clinical indications. Although most evidence around physical activity relates to prosthetic users and for dysvascular amputees, the benefits of physical activity are not exclusive to these groups and should be shared with all lower limb amputees. Lower limb amputees wishing to increase their physical activity levels should be encouraged to do so.

References

  1. Wong CK, Ehrlich JE, Ersing JC, et al. Exercise programs to improve gait performance in people with lower limb amputation: A systematic review. Prosthetics and Orthotics International 2016;40(1):8-17. doi: 10.1177/0309364614546926
  2. Rau B, Bonvin F, De Bie R. Short-term effect of physiotherapy rehabilitation on functional performance of lower limb amputees. Prosthetics and Orthotics International 2007;31(3):258-70. doi: 10.1080/03093640600994615
  3. Godlwana LL, Stewart A, Musenge E. Mobility during the intermediate stage of rehabilitation after lower limb amputation from an under resourced community: a randomized controlled trial. Physiotherapy 2015;101:e458. doi: 10.1016/j.physio.2015.03.3243
  4. Miller CA, Williams JE, Durham KL, et al. The effect of a supervised community-based exercise program on balance, balance confidence, and gait in individuals with lower limb amputation. Prosthetics and Orthotics International 2017;41(5):446-54. doi: 10.1177/0309364616683818
  5. Schafer ZA, Perry JL, Vanicek N. A personalised exercise programme for individuals with lower limb amputation reduces falls and improves gait biomechanics: A block randomised controlled trial. Gait & Posture 2018;63:282-89. doi: 10.1016/j.gaitpost.2018.04.030
  6. Highsmith MJ, Andrews CR, Millman C, et al. Gait Training Interventions for Lower Extremity Amputees: A Systematic Literature Review. Technology and Innovation 2016;18(2-3):99-113. doi: 10.21300/18.2-3.2016.99
  7. Darter BJ, Nielsen DH, Yack HJ, et al. Home-Based Treadmill Training to Improve Gait Performance in Persons With a Chronic Transfemoral Amputation. Archives of Physical Medicine and Rehabilitation 2013;94(12):2440-47. doi: 10.1016/j.apmr.2013.08.001
  8. Matjacic Z, Burger H. Dynamic balance training during standing in people with trans-tibial amputation: a pilot study. Prosthetics and Orthotics International 2003;27(3):214-20. doi: 10.1080/03093640308726684
  9. Pauley T, Devlin M, Madan-Sharma P. A Single-Blind, Cross-Over Trial of Hip Abductor Strength Training to Improve Timed Up & Go Performance in Patients With Unilateral, Transfemoral Amputation. Journal of Rehabilitation Medicine 2014;46(3):264-70. doi: 10.2340/16501977-1270

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