Metabolic costs of activities of daily living in persons with a lower limb amputation: A systematic review and meta-analysis.

Loeke Van Schaik,Jan H B Geertzen,Rienk Dekker,Pieter U Dijkstra,Alena Grabowski

doi:10.1371/journal.pone.0213256

Loeke Van Schaik, Jan H B Geertzen + Show 3 more

Open Access

https://doi.org/10.1371/journal.pone.0213256

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Abstract

ObjectiveTo systematically review the literature on the metabolic costs of activities of daily living (ADL) in persons with a lower limb amputation (LLA).Data sourcesA literature search was undertaken in the Pubmed, Embase, CINAHL, CENTRAL, and PsycINFO databases using keywords and synonyms for LLA, metabolic costs, and ADL. The last search was performed on November 29th, 2017.Study selectionStudies were included if they met the following 2 criteria: participants were adults with a (unilateral or bilateral) LLA and metabolic costs were measured while participants performed a physical activity or ADL.Data extraction and synthesisData of 1,912 participants from 61 studies were included in the systematic review and meta-analysis. The studies used different terms to describe metabolic costs. Participants were recruited in different settings, relatively healthy, with few comorbidities. Limited data were available on metabolic costs of other activities than walking with a prosthesis. A linear mixed model analysis was performed based on the means reported, with study as unit of analysis and test results of different groups and measurement conditions as repeated measures within the unit of analysis. Predictors entered in the analysis were e.g. level and reason of amputation, age, weight, and height. During walking, oxygen consumption (ml O2/kg/min) and heart rate (beats/min) increased with a higher walking speed and a more proximal amputation. Additionally, oxygen consumption was determined by the interaction terms walking speed x amputation level and walking speed squared. Heart rate was determined by the interaction term walking speed squared.ConclusionDuring walking, oxygen consumption (ml O2/kg/min) and heart rate (beats/min) increased with a higher walking speed and a more proximal amputation. Data on metabolic costs of other activities were limited. The poor quality of the studies and the relatively healthy participants limited generalizability of the results of the meta-analysis.

Highlights

In rehabilitation medicine, the main goals for persons with a lower limb amputation (LLA) are walking with a prosthesis and regaining functional capacity with regard to activities of daily living (ADL) [1,2,3]
In the Netherlands, more than 90% of LLAs are due to vascular disease and/or diabetes mellitus (DM) [6,7]
Persons with a LLA who have vascular disease (PVD) are mostly elderly and have comorbidities resulting from atherosclerosis, which limits their physical and aerobic capacity [9,10,11]

Summary

Introduction

The main goals for persons with a lower limb amputation (LLA) are walking with a prosthesis and regaining functional capacity with regard to activities of daily living (ADL) [1,2,3]. Persons with a LLA who have (peripheral) vascular disease (PVD) are mostly elderly and have comorbidities resulting from atherosclerosis, which limits their physical and aerobic capacity [9,10,11]. Few studies have measured VO2max in persons with a LLA These studies used different test protocols [10,15,16]. They reported lower levels of VO2max in participants with a LLA compared with controls. These differences are probably due to deconditioning or comorbidities

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