title: Comorbidities in amputation: a systematic review of hemiplegia and lower limb amputation.
abstract: OBJECTIVE
  The purpose of this review of the scientific literature was to investigate the incidence and prevalence of hemiplegia with lower limb amputation, and to identify outcomes following the dual disability of hemiplegia and amputation.
  
  
  METHODS
  Electronic searching of the literature identified major studies examining the effects of hemiplegia on rehabilitation following amputation. Data were extracted and levels of evidence assigned for each subtopic area.
  
  
  RESULTS
  The summary conclusions are Level 4 evidence. The prevalence of amputation and hemiplegia is 8-18% and amputation and hemiplegia occur most often in the same leg. Once individuals with hemiplegia and lower limb amputation are selected for prosthetic rehabilitation, rate of successful functional ambulation is greater than 58%. In general there is a lower rate of prosthetic success and independence with hemiplegia than without. Predictive factors associated with success include less severe hemiplegia, laterality of hemiplegia (ipsilateral and right side), transtibial level of amputation and absence of impaired mental function. There is wide variation in length of hospital stay, but a specialty multidisciplinary team reduces length of stay.
  
  
  CONCLUSIONS
  Patients with dual disability of hemiplegia and amputation generally benefit from a prosthetic rehabilitation program. Further study on predictive factors for outcome would be beneficial.
  
  
  CONCLUSIONS
  • The prevalence of hemiplegia with lower limb amputation ranges from 8 to 18%, most frequently affecting the same leg. • The majority of patients attain successful functional levels of ambulation with prosthetic rehabilitation, although lower rates than nonhemiplegic patients. • Predictive factors associated with greater success include less severe hemiplegia, ipsilateral hemiplegia, transtibial level of amputation and absence of impaired mental function.
authors.affiliation: Division of Physical Medicine and Rehabilitation, University of Alberta, Edmonton, Canada. Jacqueline.hebert@albertahealthservices.ca
authors.forename: Jacqueline S
authors.initials: JS
authors.lastname: Hebert
authors.forename: Michael W C
authors.initials: MW
authors.lastname: Payne
authors.forename: Dalton L
authors.initials: DL
authors.lastname: Wolfe
authors.forename: A Barry
authors.initials: AB
authors.lastname: Deathe
authors.forename: Michael
authors.initials: M
authors.lastname: Devlin
mesh_terms: D000203:Activities of Daily Living; D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D000674:Amputees / Q000534:rehabilitation; D001186:Artificial Limbs; D015897:Comorbidity; D006429:Hemiplegia / Q000453:epidemiology* / Q000534:rehabilitation / Q000601:surgery; D006801:Humans; D015994:Incidence; D007866:Leg / Q000601:surgery*; D007902:Length of Stay / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D015995:Prevalence; D020127:Recovery of Function; D016896:Treatment Outcome