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108 HIGHSMITH ET AL.

Table 5. External Validity Assessment of Included Manuscripts
Table 5. External Validity Assessment of Included Manuscripts

Study Classification Sample adequately described Sample representative Outcomes adequately described Outcomes valid for the study Intervention adequately described Findings clinically significant Conclusion placed in literary Findings support conclusions Number of Threats

Year Author context
2001 Sjodahl et al. E5       2
2002 Sjodahl et al. E5         0
2002 Yigiter et al. E1         0
2003 Sjodahl et al. E5         0
2003 Cole et al. O6      3
2005 Faucher et al. O6       2
2006 Black et al. O6       2
2006 Isakov et al. E1        1
2009 Barnett et al. E3       2
2009 Hyland et al. E1         0
2011 Darter et al. O6       2
2012 Yang et al. E5       2
Highsmith et
2012 X2     4*
al.
2013 Agrawal et al. E3         0
2013 Darter et al. E3         0
2014 Lamberg et al. E2         0
2014 Mikami et al. O6        1
Highsmith et
2014 X2     4*
al.

All manuscripts had high external validity except those noted with (*) which had moderate external
All manuscripts had high external validity except those noted with (*) which had moderate external
validity. The three manuscripts by Sjodahl et al. represent a single project and are thus counted as a
validity. The three manuscripts by Sjodahl et al. represent a single project and are thus counted as a
single “manuscript” for the purposes of this review and analysis. A dot in the box indicates the criteria
single “manuscript” for the purposes of this review and analysis. A dot in the box indicates the criteria was
was identified by reviewers whereas a blank box represents a criteria not identified.
identified by reviewers whereas a blank box represents a criteria not identified.

Treadmill-Based Gait Training self-selected walking speed, reliance on an assistive

Improved bioenergetic efficiency was the most device, or gait deviations, as the amputee attempts

prevalent finding for treadmill-based gait training to reduce energy expenditure while ambulating,

that differed from traditional overground gait training therefore emphasizing the importance of improv-

(12,33,36). Lower limb amputees demonstrate a less ing bioenergetic efficiency for this population. Our

efficient gait pattern as observed by higher O2 cost, findings support a low level of evidence that demon-

which becomes more pronounced with higher level strates improved bioenergetic efficiency was observed

of amputation or bilateral involvement (42). This following a supervised treadmill training program

can lead to other gait implications, such as reduced that included a structured home exercise program,