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REVIEW OF AMPUTEE GAIT TRAINING 101

METHODS following initial criteria within EndNote:
A multidisciplinary review team planned meth- 1. Foreign language (i.e., non-English language)
odology in accordance with that used previously in 2. Non-human subject (i.e., materials science,
prosthetic research (8) in addition to standards estab- finite element studies)
lished by the Prisma Statement (20,21). Reviewers 3. Pediatric studies
had graduate education or professional healthcare
training in physical therapy or prosthetics. The team Following the EndNote search using the afore-
met on three occasions and outlined search method- mentioned exclusion criteria, remaining intervention
ology to include multiple databases and key search articles were divided up equally between reviewers.
terms (primary and secondary) that would assure Each article was assigned a primary and second-
identification of available evidence to address gait ary reviewer. The reviewers independently screened
training interventions for those with LE amputation. references according to inclusion/exclusion criteria
Search methodology was based upon a broad view and classified them as either: 1) pertinent, 2) not
of LE amputations with regard to gait training inter- pertinent or 3) uncertain pertinence. Full-text articles
vention. Preliminary test searches were conducted were reviewed for all citations classified as pertinent
and outcomes previewed at pre-search meetings to or uncertain pertinence. Disagreement regarding
assure adequate inclusion of key articles in terms of citations of uncertain pertinence were resolved by
both quantity and quality within the topic of interest. discussion at weekly follow-up meetings with the
The search statement was planned to be sensitive to two other reviewers. Review of full-text articles and
include patients with LE amputation and gait training associated discussion led to group consensus and ulti-
interventions. The search term sets sought to combine mate inclusion/exclusion. Exclusion criteria applied
all levels of LE amputation with all forms of clinical during the EndNote search were applied at this stage
gait training. Complete search term sets are listed in of screening. Inclusion criteria applied were:
Table 1. 1. Peer-reviewed manuscript
On December 15, 2014, the following databases 2. Gait training intervention for LE Amputees
were searched: 1.) MEDLINE (Pubmed), 2.) the 3. Published within the aforementioned time-
Cumulative Index to Nursing and Allied Health line
Literature (CINAHL)(Ovid), and 3.) Web of Science.
The following date limits were implemented as part Quality Assessment
of the database search parameters: 2000 Jan 1 to 2014
Dec 14. One month after the initial search, the search Evaluation of Internal and External Validity
was repeated by a pair of separate information scien- Methodological quality of included publications
tists. was independently assessed by two reviewers accord-
ing to the American Academy of Orthotists and
Article Screening Prosthetists (AAOP) State-of-the-Science Evidence
Resulting references were exported to EndNote Report Guidelines protocol (22). The AAOP Study
(vX6, Thompson, CA, USA) reference management Design Classification Scale was used to describe the
software. Duplicate references were eliminated. design type of included studies (22). The State of the
Remaining articles were preliminarily sorted by arti- Science Conference (SSC) Quality Assessment Form
cle type. Exclusion criteria were selected to eliminate was used to rate the methodological quality of studies
manuscripts that did not include gait training for classified as experimental (E1 to E5) or observational
adults with LE amputation who used prostheses. (O1 to O6) (22). The form identifies 18 potential
Foreign language articles were eliminated relative threats to internal validity, with the first four threats
to prohibitive costs associated with translation. not applicable for study classifications E3 to E5 and
Manuscripts were screened for exclusion using the the first five threats not applicable for classifications