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A Very Quick Update on Research in Amputees. Process  Search of AMED, Medline, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database.

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Presentation on theme: "A Very Quick Update on Research in Amputees. Process  Search of AMED, Medline, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database."— Presentation transcript:

1 A Very Quick Update on Research in Amputees

2 Process  Search of AMED, Medline, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of SR, Cochrane Database of Abstracts of Reviews and Effects Entries  entries

3 Process  Cochrane Reviews 4 (3 complete, 1 protocol)

4 Cochrane Reviews  At its core is the collection of Cochrane Reviews, a database of systematic reviews and meta-analyses which summarise and interpret the results of medical research.  The Cochrane Library aims to make the results of well-conducted controlled trials readily available and is a key resource in evidence-based medicine.

5 Pharmacological interventions for treating phantom limb pain (2009)

6 Phantom Pain  Do pharmacological agents given post operatively when phantom pain occurs provide : Short term pain relief Improved sleep Changes in sleep Changes in function Changes in QOL

7 Transcutaneous electrical nerve stimulation (TENS) for phantom pain and stump pain following amputation in adults (2010)

8 TENS for Phantom and Stump Pain  Criteria All RCT’s Adults with phantom limb or stump pain TENS vs comparison group (ie no Rx, sham, a pharmacological intervention, a non-pharmacological intervention)

9 TENS for Phantom and Stump Pain  Outcome measures Primary (Pain validated scale – VAS, NRS) Secondary (lots)

10 TENS for Phantom and Stump Pain  72 published studies initially identified  14 considered relevant  Nil meet criteria

11 TENS for Phantom and Stump Pain  Insufficient evidence for practice  10 of the 14 studies reported benefits from using TENS  1 reported no benefit  2 were inconclusive  1 did not provide sufficient information

12 Prosthetic rehabilitation for older dysvascular people following a unilateral transfemoral review (2009)

13 Prosthetic Training  To summarise the evidence evaluating prosthetic rehabilitation interventions post TFA in older dysvascular patients  Criteria RCT’s Male or female over 60 years old Living in the community or in institutional care Dysvascular A TFA or through knee amputation and provided a prosthesis for mobilising

14 Prosthetic Training  Interventions Education on Don/doff Education on skin care Therapeutic interventions Balance and mobility training Functional training General advice

15 Prosthetic Training  Primary measure User satisfaction Level of function Amputee specific functional tests  Secondary measures General quality of life measures

16 Prosthetic Training  38 published studies initially identified  5 considered relevant  1 suitable for inclusion

17 Prosthetic Training  Prosthetic weight effect on gait speed and preference

18 Prescription of prosthetic ankle-foot mechanisms after lower limb amputation (2009)

19 Ankle-foot prescription  To establish precise criteria for the prescription of prosthetic ankle-foot mechanisms in individuals with lower limb amputations  Criteria RCT’s and Quasi RCT’s Comparing different types of feet

20 Ankle-foot mechanisms  Outcomes Subjective findings Energy expenditure Stride characteristics Kinetic and kinematic parameters

21 Ankle-foot Prescription  348 references initially identified  37 studies considered relevant  26 suitable for inclusion

22 Ankle-foot Prescription  Insufficient evidence from high quality comparative studies for the overall superiority of any type of prosthetic foot ankle mechanism

23 Take Home message  A lack of high quality comparative studies  Lack of randomisation  Poor description of procedures


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