Article

Amputation results in reduced mobility and contributes to reduced
quality of life. The increased metabolic cost of ambulation has been suggested as
an important contributor to reduced mobility in this population. Current research
on the metabolic energy expenditure of ambulation will be critically reviewed
from the perspectives of ecological validity of the research methods and the
relative contribution to functional improvement in amputees. Recommendations will
be made regarding possible future directions for research and their potential
clinical utility. METHODS: Narrative review. RESULTS: The methods used to
quantify metabolic energy expenditure of amputee ambulation do not emulate
typical mobility conditions that amputees experience. Amputee mobility is
characterized by short bouts of activity with starting, stopping and changes of
direction. This is opposed to the typical metabolic testing protocol that
requires at least 5 min of steady state linear walking on a treadmill. These
studies, therefore, have limitations in ecological validity and therefore
limitations in the extent to which they accurately reflect the effect of
amputation level, amputation etiology and prosthetic components on energy
consumption during walking. Further, the broader perspective on outcomes after
dysvascular amputation and sports participation limitations, raises questions
about the relative importance of improving metabolic costs and its potential
effect on improving mobility in amputees. CONCLUSION: The greatest potential
clinical impact of future research requires methods with improved ecological
validity, and the ability to translate metabolic energy expenditure outcomes into
functional terms that are meaningful to both clinicians and patients.
Implications for Rehabilitation The search for objective measurements to define
the effects of amputation on outcome and the consequences of prosthetic
components on mobility has focused in part on the use of study designs
incorporating metabolic measurement. However, there are important limitations to
the ecological validity of these measures and their relative importance as an
outcome measure in dysvascular amputees as well as in sports/leisure
participation. Novel research approaches are required to quantify the functional
impact of increased metabolic energy expenditure and to better understand the
psychophysical limitations that result.

Langue : ANGLAIS