Timing of Biomechanical Assessment Lacks Research

While hundreds of investigations have been performed that examine biomechanical outcomes of various types of prostheses, it is unclear when biomechanical investigations should be performed. Toward this end, researchers have conducted a literature review to determine how much time a person with a lower-limb amputation should be given to accommodate to a new prosthesis prior to undergoing biomechanical testing. According to their review, a lack of research specifically examining accommodation, as well as the high variability in the results, indicates that it remains undecided how much accommodation is necessary, and that there is a need for longitudinal biomechanical investigations to determine how outcomes change as people with lower-limb amputations accommodate to new prostheses. The study was published online December 20 in Prosthetics and Orthotics International.

In the systematic review, the researchers examined the literature using PubMed and Scopus for accommodation time given during biomechanical investigations to determine whether consensus exists. The search set out to find original research articles examining biomechanical parameters in people with unilateral lower-limb amputations. The search terms were: (lower limb OR lower-limb OR thigh OR leg OR shank) AND (amput* OR transtibial OR transfemoral) AND (prosth*). The search was limited to peer-reviewed journal articles, human participants, and the English language. The database searches included titles, keywords, abstracts, and Medical Subject Headings (MeSH) terms, resulting in 156 investigations.

Twenty-eight studies did not provide an accommodation or were unclear (e.g., provided a "break-in period"); in five studies, participants were tested more than once; and in 25 studies, participants were tested only once and on the same day they received their new prostheses. In the remaining 98 studies (three included people with hip disarticulations, 53 included people with transfemoral amputations, and 42 included people with transtibial amputations) participants were tested once and were given a minimum of one day for accommodation. In the hip disarticulation studies, the median accommodation time was 77 days, ranging from 60 to 180 days. In the transfemoral-focused studies, the median accommodation time was 42 days, ranging from one to 540 days. The cohorts of people with transtibial amputations were given the shortest accommodation times, with a median of 21 days, and a range of one to 475 days.

The results of the review indicate that little research has been done regarding how people with lower-limb amputations accommodate to a new prosthesis. Improper accommodation could lead to increased variability in results and results that are not reflective of long-term use, and could cause clinicians to make inappropriate decisions regarding a prosthesis, the study authors wrote.