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126 KAHLE ET AL.

INTRODUCTION and update using similar methods from a previous
Guidelines for amputee rehabilitation are available SR to help establish a wider, more current base of
nationally and internationally (1-4). However, there evidence regarding walking ability following lower
is not a clear clinical recommendation for the deter- limb amputation.
mination of prosthetic candidacy. Moreover, while
multidisciplinary decision support is recognized in METHODS
the aforementioned guidelines, the guidelines do not Search Strategy for Extension of Previous Sansam
delineate which member(s) of the multidisciplinary et al. Systematic Review
team are responsible for prosthetic candidacy deci-
sions nor which factors will best predict a positive An electronic literature search was executed from
outcome. Also not clearly addressed is a patient-cen- August 1, 2007, to December 31, 2015, using MED-
tered decision-making role, which is crucial to any LINE (Pubmed), Embase, The Cumulative Index to
clinical decision process. Nursing and Allied Health Literature (CINAHL)
In a systematic review (SR), Sansam et al. reported (Ovid), and Cochrane and using the following key-
on the prediction of walking ability following lower words in the title or abstract:
extremity amputation (LEA) (5). Conclusions of that Amput* AND ambulat* OR mobil* OR walk* AND
SR were that adequately powered prospective studies predict* OR prognos* OR probability
reporting predictive ability of factors measured before
the onset of rehabilitation could accurately estimate Manuscripts were selected or eliminated based on
an individual’s walking potential (5). Prospective the following criteria:
reports could establish clinic practice guidelines Inclusion criteria:
(CPG) for predicting prosthetic candidacy and • Adult subjects with unilateral or bilateral lower
functional level. Further, predictive factors that are limb amputation
modifiable through preemptive therapies could be • Published after August 1, 2007
explored further to establish whether targeting these • Examined the relationship between predictive
factors would lead to improvements in walking out- variables recorded prior to amputee rehabilita-
come. Lastly, Sansam et al. reported there was mixed tion and measures of walking ability following
heterogeneity of methods and outcome measures used rehabilitation
in comparing predictive factors (5). Investigation • Studies using health outcomes with a mobility
of predictive factors is needed to estimate walking component, such as the Functional Indepen-
potential more accurately, targeting modifiable factors dence Measure
to optimize outcome after LEA. Ultimately, this would • English language
help establish much needed CPGs (5). All factors • Observational, retrospective studies if predic-
should be considered when determining walking tor variables were available
capacity, as not walking following amputation could • Randomized clinical trials
lead to physical deterioration and comorbidities and Exclusion criteria:
be detrimental to overall health (6,7). • Non-adult
The quality of rehabilitation studies has improved • Prosthetic device or rehabilitation interven-
in the last decade (8). Sansam et al.’s SR included tions studies
literature up to August 2007. There have been many • Animal studies
changes and proposed changes to health care regard- • Case reports and series
ing LEA, particularly in the U.S. These changes may • Letters, editorials, conference proceedings
have initiated more contemporary reports of predict- • Manuscripts from developing nations
ing walking ability. Therefore, the purpose of this SR
is to establish factors to predict walking ability with a Two authors independently assessed selected
prosthesis following LEA. This review is an extension papers for content, quality, and critical appraisal.