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PREDICTING WALKING ABILITY AFTER AMPUTATION 127

Similar to the original Sansam et al. SR, a standardized
CINAHL
Embase
checklist was used to extract each report’s methods, (n = 107) (n = 130) Cochrane (n = 216)
PubMed
(n = 23)
population, outcome measures, and predictive factors Identification
(5). Additionally, the UK National Service Frame- Records retrieved from searches
work for Long-term Conditions (3,9) was used to (n = 476)
assess the quality of each study, as it allows assess-
ment of quality in non-randomized cohort studies. Screening Records retrieved from Duplicates removed
searches
The reports and data extracted were verified by at (n = 476) (n = 157)
least two independent authors who agreed on final
Articles’ titles and
scoring and data extraction. The International Clas- abstracts screened Records excluded
sification of Functioning, Disability and Health (4) Eligibility (n = 319) (n = 220)
was used to present the predictive factors identified Full-text articles
Full-text articles
from these studies. Following study evaluation and assessed for eligibility excluded, after full
data extraction, factors predictive of walking ability (n = 99) article review
(n = 78)
following LEA were aggregated and compared nar- Studies included in
ratively with the findings of the original Sansam et Included quantitative synthesis
(meta-analysis)
al. SR. (n = 21)
RESULTS Figure 1. PRISMA 2009 flow diagram. Reprinted with permis-
sion from PLoS Medicine (Moher D, Liberati A, Tetzlaff J, Al-
Number of Identified Studies tman DG, The PRISMA Group. Preferred Reporting tems for
Systematic Reviews and Meta-Analyses: The PRISMA Statement.
A total of 319 unique studies were identified PLoS Med. 2009;6(7):e1000097), copyright 2009. For more infor-
through the electronic search. Of these, 298 were mation, visit www.prisma-statement.org.
eliminated, leaving a total of 21 for full evaluation
(Figure 1). (BMI) of 30.2 kg/m (median: 31.3 (IQR: 4); range:
2
27.6 to 31.6 kg/m ). Within the described control
2
Description of Sample group of subjects with LEA, the reported etiology was
The original SR from Sansam et al. included a typically PVD with comorbid diabetes mellitus. Their
total (n) of 9,080 subjects (5). Conclusions from this mean age was 61.8 years (median 66.7 (IQR: 11.8);
updated study are drawn from a total recruited sam- range: 46.0 to 67.7 years) and mean BMI was 29.6 kg/
2
ple (n) of 15,207 subjects. A total of 12,410 subjects m ± 6.3. Age and BMI were not different (p > 0.05)
completed the respective studies (18% attrition). between experimental and control subjects with LEA.
There was incomplete and inconsistent reporting of Finally, there was a smaller group of non-amputee,
anthropometric, demographic, and etiologic data; of otherwise healthy control subjects described whose
those studies sufficiently reporting this information, mean age was 49.0 years (median 59.2 years (IQR:
the lower extremity limb loss had the following dis- 35.6); range: 26.1 to 61.7 years) and mean BMI was
2
tribution: 37% peripheral vascular disease (PVD), 25.7 kg/m (Table 1).
27% trauma, 17% diabetic, 12% cancer, 6% infec-
tion, and 2% congenital. Three sub-groups of subjects Settings, Study Designs, and Independent
were included: an experimental group of subjects Variables
with LEA, a control group of subjects with LEA, and The predominant setting for these studies was the
another control group of otherwise healthy non-am- rehabilitation center. These were in varied organiza-
putee controls. Within the experimental group of LEA tions, including university medical centers, Veterans
patients, the subjects described had a mean age of 57.3 Administration hospitals, private sector hospitals,
years (median 60.9 (interquartile range (IQR): 8.5); and skilled nursing facilities. In addition to these,
range: 48.1 to 69.8 years) and a mean body mass index data were also collected from military treatment