Improving balance and walking ability in community-dwelling people with lower limb loss: a narrative review with clinical suggestions

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Background: The number of people with lower limb loss has increased rapidly, and more than half do not become independent in community walking. Balance impairment has been identified as a primary constraint to independent walking. However, few physiotherapy programs to improve balance and walking have been researched.Objectives: This narrative review describes (1) programs improving balance and walking ability in community-dwelling people with lower limb loss and (2) clinical recommendations from the reviewed literature.Methods: The Cochrane, Ovid-Medline, and CINAHL databases, and the Journal of Prosthetics and Orthotics archive were searched from 1990 to 2016. Randomized control trials, repeated-measures cohorts, or case-control studies that involved physiotherapy intervention for community-dwelling people with major limb amputations were included.Major findings: Thirteen studies investigated programs to improve balance or walking ability, including 2 randomized control trials with ≥40 subjects; and 10 studies with ≤16 subjects. Six studies used enhanced sensory feedback, external balance perturbations, and stabilization exercises to improve balance ability. Nine studies used primarily functional gait training, progressive resistive exercises, and stabilization exercises to improve walking ability. Few comparison studies, small sample sizes, and subjects without vascular disease limited conclusions about specific treatment approaches for most people with lower limb loss.Conclusions: Evidence supporting physiotherapy for improving balance and gait has recently emerged. Manual therapy, exercise, balance training, resisted gait training, and walking all can benefit people with lower limb loss, but more controlled studies are required to determine the effectiveness of different physiotherapy programs.