a very quick update on research in amputees

A Very Quick Update on Research in

Amputees

Process

Search of AMED, Medline, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of SR, Cochrane Database of Abstracts of Reviews and Effects 22150 Entries

2010 87 entries

Process

Cochrane Reviews 4 (3 complete, 1 protocol)

Cochrane Reviews

At its core is the collection of Cochrane Reviews, a database of systematic reviews and meta-analyses which summarise and interpret the results of medical research.

The Cochrane Library aims to make the results of well-conducted controlled trials readily available and is a key resource in evidence-based medicine.

Pharmacological interventions for treating phantom limb pain (2009)

Phantom Pain

Do pharmacological agents given post operatively when phantom pain occurs provide : Short term pain relief

Improved sleep Changes in sleep Changes in function Changes in QOL

Transcutaneous electrical nerve stimulation (TENS) for phantom pain and stump pain following amputation in adults (2010)

TENS for Phantom and Stump Pain

Criteria All RCT’s Adults with phantom limb or stump

pain TENS vs comparison group (ie no Rx,

sham, a pharmacological intervention, a non-pharmacological intervention)

TENS for Phantom and Stump Pain

Outcome measures Primary (Pain validated scale – VAS,

NRS) Secondary (lots)

TENS for Phantom and Stump Pain

72 published studies initially identified

14 considered relevant

Nil meet criteria

TENS for Phantom and Stump Pain

Insufficient evidence for practice

10 of the 14 studies reported benefits from using TENS

1 reported no benefit 2 were inconclusive 1 did not provide sufficient

information

Prosthetic rehabilitation for older dysvascular people following a unilateral transfemoral review (2009)

Prosthetic Training

To summarise the evidence evaluating prosthetic rehabilitation interventions post TFA in older dysvascular patients

Criteria RCT’s Male or female over 60 years old Living in the community or in institutional care Dysvascular A TFA or through knee amputation and

provided a prosthesis for mobilising

Prosthetic Training

Interventions Education on Don/doff Education on skin care Therapeutic interventions Balance and mobility training Functional training General advice

Prosthetic Training

Primary measure User satisfaction Level of function Amputee specific functional tests

Secondary measures General quality of life measures

Prosthetic Training

38 published studies initially identified

5 considered relevant

1 suitable for inclusion

Prosthetic Training

Prosthetic weight effect on gait speed and preference

Prescription of prosthetic ankle-foot mechanisms after lower limb amputation(2009)

Ankle-foot prescription

To establish precise criteria for the prescription of prosthetic ankle-foot mechanisms in individuals with lower limb amputations

Criteria RCT’s and Quasi RCT’s Comparing different types of feet

Ankle-foot mechanisms

Outcomes Subjective findings Energy expenditure Stride characteristics Kinetic and kinematic parameters

Ankle-foot Prescription

348 references initially identified

37 studies considered relevant

26 suitable for inclusion

Ankle-foot Prescription

Insufficient evidence from high quality comparative studies for the overall superiority of any type of prosthetic foot ankle mechanism

Take Home message

A lack of high quality comparative studies

Lack of randomisation

Poor description of procedures