title: A systematic review of the key factors affecting tissue viability and rehabilitation outcomes of the residual limb in lower extremity traumatic amputees.
abstract: Most traumatic lower limb amputees ambulate using a prosthetic limb. Comfort, appearance of the missing limb and function are confirmed as being important during rehabilitation post-amputation. Emerging evidence suggests that impaired tissue viability of the stump affects rehabilitation and thus clinical ability to provide optimum care. The primary objective of this systematic review was to identify key factors relating to tissue viability of the residual limb in lower extremity traumatic amputees. A secondary objective was to identify factors that affect rehabilitation post-amputation. In total, 218 studies were assessed; 37 met pre-determined criteria. Studies were classified according to the WHO ICF framework and the NHMRC level of evidence. Five key themes emerged; Prosthetic Fit; The Residuum; Quality of Life; Amputee Care and Prosthetic Use. The evidence indicates that high frequencies of skin problems affecting tissue viability within this population are inherently linked to intolerance of the prosthesis. Stump integrity, amputee care regimen and pain were also identified as impacting on quality of life, affecting rehabilitation and the ability to become independently mobile. Levels of evidence within all studies were low and indicative of the majority being non-randomised cohort studies or case-control studies. As there are a limited number of interventional studies, further development of robust outcome measures, clinical trials and prospective studies are of utmost importance to unravel the links between tissue viability and the other key factors. This will inform clinical management strategies and help develop targeted therapies and care pathways.
authors.affiliation: Centre for Innovation & Leadership, Faculty of Health Sciences, University of Southampton, United Kingdom.
authors.forename: Katrina
authors.initials: K
authors.lastname: Butler
authors.affiliation: Centre for Innovation & Leadership, Faculty of Health Sciences, University of Southampton, United Kingdom.
authors.forename: Catherine
authors.initials: C
authors.lastname: Bowen
authors.affiliation: Centre for Innovation & Leadership, Faculty of Health Sciences, University of Southampton, United Kingdom.
authors.forename: Ann-Marie
authors.initials: AM
authors.lastname: Hughes
authors.affiliation: Electronics and Computer Sciences, Faculty of Physical Sciences & Engineering, University of Southampton, United Kingdom.
authors.forename: Russel
authors.initials: R
authors.lastname: Torah
authors.affiliation: Electronics and Computer Sciences, Faculty of Physical Sciences & Engineering, University of Southampton, United Kingdom.
authors.forename: Ivo
authors.initials: I
authors.lastname: Ayala
authors.affiliation: Electronics and Computer Sciences, Faculty of Physical Sciences & Engineering, University of Southampton, United Kingdom.
authors.forename: John
authors.initials: J
authors.lastname: Tudor
authors.affiliation: Centre for Innovation & Leadership, Faculty of Health Sciences, University of Southampton, United Kingdom; Electronics and Computer Sciences, Faculty of Physical Sciences & Engineering, University of Southampton, United Kingdom. Electronic address: C.D.Metcalf@soton.ac.uk.
authors.forename: Cheryl D
authors.initials: CD
authors.lastname: Metcalf
mesh_terms: D000673:Amputation, Traumatic / Q000534:rehabilitation*; D001186:Artificial Limbs; D006801:Humans; D007869:Leg Injuries / Q000534:rehabilitation*; D017755:Prosthesis Fitting; D011788:Quality of Life; D014022:Tissue Survival; D016896:Treatment Outcome
keywords: Amputation; Systematic review; Transfemoral; Transtibial; Trauma