title: Quality of life, functional ability and physical activity after different surgical interventions for bone cancer of the leg: A systematic review.
abstract: OBJECTIVE
  To systematically review published studies comparing Quality of Life (QoL), functional ability and/or physical activity between different surgical interventions due to a malignant bone tumour of the leg.
  
  
  METHODS
  A systematic literature search, covering the years 2000-2010 was performed using the PubMed, Embase, Web of science and Cochrane databases. Studies were included if they described and statistically compared QoL, functional ability and/or physical activity of at least two surgical interventions for lower extremity bone cancer. In addition, the methodological quality of the selected studies was evaluated by using a 24-point scale. Where appropriate, a qualitative analysis or meta-analysis was performed.
  
  
  RESULTS
  The search strategy resulted in a list of 246 citations. Based on titles and abstracts 50 full-text articles were selected, of which 13 articles describing 12 studies, were finally included. Overall, the methodological quality of the studies was moderate. Studies were heterogeneous with respect to their categorisation of surgical interventions, average age of patients and average duration of follow-up. Overall, results regarding differences between ablative and limb-sparing surgery varied largely. Meta-analysis was considered to be not appropriate due to clinical heterogeneity, methodological differences and flaws.
  
  
  CONCLUSIONS
  Twelve studies comparing the outcomes of QoL, functional ability and physical activity between limb-sparing and ablative surgery groups were identified, with an overall moderate methodological quality. Their largely varying outcomes suggest that no general conclusions on the advantage of either limb-sparing or ablative surgery in patients with malignant bone tumours of the lower extremity can be drawn.
authors.affiliation: Department of Physical Therapy, Leiden University Medical Center, The Netherlands. W.P.Bekkering@LUMC.NL
authors.forename: W Peter
authors.initials: WP
authors.lastname: Bekkering
authors.forename: Theodora P M
authors.initials: TP
authors.lastname: Vliet Vlieland
authors.forename: Marta
authors.initials: M
authors.lastname: Fiocco
authors.forename: Hendrik M
authors.initials: HM
authors.lastname: Koopman
authors.forename: Jan W
authors.initials: JW
authors.lastname: Schoones
authors.forename: Rob G H H
authors.initials: RG
authors.lastname: Nelissen
authors.forename: Antonie H M
authors.initials: AH
authors.lastname: Taminiau
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D001859:Bone Neoplasms / Q000601:surgery*; D002648:Child; D015444:Exercise / Q000502:physiology; D006801:Humans; D007866:Leg; D008875:Middle Aged; D010809:Physical Fitness / Q000502:physiology; D011788:Quality of Life; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult