Predicting Walking Ability and Prosthetic Candidacy Following Lower Extremity Amputation; An Updated Systematic Review and Treatment Pathway

Background: There is not a clear compilation of existing literature that determines walking ability and prosthetic candidacy following lower extremity amputation (LEA). There is no multi-disciplinary instrument or patient centric decision-making protocol accepted that can predict walking ability and prosthetic candidacy nor support a treatment pathway. It is important to determine these factors to better assist clinicians in determining a patient’s MFCL K-level to assist with the delivery of proper prosthetic componentry. Medicare Functional Classification Level (MFCL) K-level is a 0 to 4-point scale of functional level for those with limb loss. The purpose of this systematic literature review is to further develop evidence-based LEA patient centric treatment pathways that determine prosthetic candidacy decisions for LEAs. This evidence will assist the healthcare team in the decision-making process. In a similar systematic review (SR), Kahle., et al. reported into 2016 on the prediction of walking ability following lower limb amputation (LLA). Methods: This search strategy was designed and similarly implemented from the previous Kahle SR based on predicting walking ability. An electronic literature search was executed from 8/1/2007 to 12/31/2015 using MEDLINE, EMBASE, CINAHL, and Cochrane. Results: After electronic search and a thorough review and elimination of articles, a total of 104 quality studies were identified. Of these, 78 were systematically reviewed in two previous reviews and eliminated. Twenty-six remained for full evaluation. These updated study conclusions are drawn from a total sample (n) of 46,651 subjects. The size of this updated study has increased the original Kahle., et al. report by including 300% more subjects for a combined total of 61,858 subjects in the two SRs. Conclusion: In the two combined SRs, cause of amputation (etiology), physical fitness, pre-amputation living status, amputation level, age, cognitive/mood disturbances, social support and comorbidities are included as moderate to strongly supported predictive factors of walking ability and prosthetic candidacy. These factors should be strongly considered in a detailed history and physical examination by the rehabilitation team and documented in the patient healthcare record