Article

Considering transtibial amputation (TTA) rehabilitation costs and complexity,
high-quality literature should inform clinical practice. Systematic reviews (SRs)
suggest this is not the case.
This article's purpose was to review the
highest-quality evidence available to guide clinical practice for TTA regarding
five prosthetic intervention areas. Six databases were searched for high-quality
SRs and prospective clinical trials (randomized clinical trials [RCTs]).
Reviewers screened, sorted, rated (i.e., methodologic quality, bias risk), and
extracted article data. Meta-analyses were conducted when possible. Thirty-one
references were included (25 RCTs and 6 SRs). Five topical areas emerged
(alignment, feet and ankles, interface, postoperative care, pylons). Twenty-three
evidence statements were supported by level 2 evidence and eight by level 1
evidence. All RCTs reported randomization and reasonable data presentation.
Concealed allocation and blinding were not widely used. Mean attrition was 11%.
SRs included no meta-analyses. Functional level was poorly reported. Grouping
feet and ankle components by functional classification enabled meta-analyses,
though variance was considerable given the small sample sizes. Prosthetic
interventions are generally safe for TTAs. High-quality literature enabled
formulation of evidence statements to support select clinical practice areas,
though quantity was lacking. Thus, numerous topics related to TTA care lack
rigorous evidence. Although blinding in prosthetic research requires increased
funding and effort, it could greatly improve the methodologic quality of prosthetic research.

Langue : ANGLAIS