A Very Quick Update on Research in Amputees

Process  Search of AMED, Medline, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of SR, Cochrane Database of Abstracts of Reviews and Effects Entries  entries

Process  Cochrane Reviews 4 (3 complete, 1 protocol)

Cochrane Reviews  At its core is the collection of Cochrane Reviews, a database of systematic reviews and meta-analyses which summarise and interpret the results of medical research.  The Cochrane Library aims to make the results of well-conducted controlled trials readily available and is a key resource in evidence-based medicine.

Pharmacological interventions for treating phantom limb pain (2009)

Phantom Pain  Do pharmacological agents given post operatively when phantom pain occurs provide : Short term pain relief Improved sleep Changes in sleep Changes in function Changes in QOL

Transcutaneous electrical nerve stimulation (TENS) for phantom pain and stump pain following amputation in adults (2010)

TENS for Phantom and Stump Pain  Criteria All RCT’s Adults with phantom limb or stump pain TENS vs comparison group (ie no Rx, sham, a pharmacological intervention, a non-pharmacological intervention)

TENS for Phantom and Stump Pain  Outcome measures Primary (Pain validated scale – VAS, NRS) Secondary (lots)

TENS for Phantom and Stump Pain  72 published studies initially identified  14 considered relevant  Nil meet criteria

TENS for Phantom and Stump Pain  Insufficient evidence for practice  10 of the 14 studies reported benefits from using TENS  1 reported no benefit  2 were inconclusive  1 did not provide sufficient information

Prosthetic rehabilitation for older dysvascular people following a unilateral transfemoral review (2009)

Prosthetic Training  To summarise the evidence evaluating prosthetic rehabilitation interventions post TFA in older dysvascular patients  Criteria RCT’s Male or female over 60 years old Living in the community or in institutional care Dysvascular A TFA or through knee amputation and provided a prosthesis for mobilising

Prosthetic Training  Interventions Education on Don/doff Education on skin care Therapeutic interventions Balance and mobility training Functional training General advice

Prosthetic Training  Primary measure User satisfaction Level of function Amputee specific functional tests  Secondary measures General quality of life measures

Prosthetic Training  38 published studies initially identified  5 considered relevant  1 suitable for inclusion

Prosthetic Training  Prosthetic weight effect on gait speed and preference

Prescription of prosthetic ankle-foot mechanisms after lower limb amputation (2009)

Ankle-foot prescription  To establish precise criteria for the prescription of prosthetic ankle-foot mechanisms in individuals with lower limb amputations  Criteria RCT’s and Quasi RCT’s Comparing different types of feet

Ankle-foot mechanisms  Outcomes Subjective findings Energy expenditure Stride characteristics Kinetic and kinematic parameters

Ankle-foot Prescription  348 references initially identified  37 studies considered relevant  26 suitable for inclusion

Ankle-foot Prescription  Insufficient evidence from high quality comparative studies for the overall superiority of any type of prosthetic foot ankle mechanism

Take Home message  A lack of high quality comparative studies  Lack of randomisation  Poor description of procedures