Identifying and Acknowledging a Sex Gap in Lower-Limb Prosthetics Research: A Review

Abstract

ABSTRACT Introduction Sex bias in research and treatment is a known phenomenon in medicine. This review seeks to identify and highlight the disparity in sex or gender representation in lower-limb prosthetic research, as well as examine what types of studies are less likely to exclude females. Methods The electronic databases of Journal of Prosthetics and Orthotics and Prosthetics and Orthotics International were reviewed for lower-limb prosthetic literature to determine how frequently sex is considered when conducting research on the fit and function of a device over the last 5 years. Metadata about various study characteristics was copied and analyzed for patterns. Results A total of 191 manuscripts were analyzed in this review. All together, the studies included 25.4% of female participants, which is below the approximate 34.6% female individuals living with amputation. No apparent difference in recruitment was noted between the sample size of the study, and a 32.9% increase of female representation was seen over the time frame of the study. Conclusions Although a positive increase in female participants over time was identified, a significant disparity in male and female research subjects is still prevalent throughout prosthetic research. In particular, high-validity study types such as randomized control trials and systematic reviews both fell well short of the approximate number of females with amputations. Studies that were analyzing prosthetic components and developing troubleshooting/diagnostic techniques were also well below the necessary female participants, likely contributing to poor fitting outcomes. Clinical Relevance Although evidence-based care aims to integrate research with clinical expertise with the ideal of providing the most appropriate treatment for the patient, this article demonstrates that a third of the population of persons living with amputation are rarely included in research trials. This article can be used as a tool for clinicians in deciding when the research should and should not be considered for a particular patient.