The effect of microprocessor controlled exo-prosthetic knees on limited community ambulators: systematic review and meta-analysis

Abstract

Purpose The clinical benefits of microprocessor-controlled prosthetic knees (MPKs) in community ambulators have been well-established. A systematic review in limited community ambulators published in 2014 found benefits in safety, performance-based, and patient-reported outcomes. This work updates the previous analysis to the current state of the published evidence. Methods Systematic review and meta-analysis of the effect of MPKs in limited community ambulators. Results Thirteen research projects presented in 15 publications were identified. Overall validity was “high” in nine studies, “moderate” in three, and “low” in one. The literature described a total of 2366 patients, with 704 classified as limited community ambulators. The use of MPKs in limited community ambulators led to a reduction in falls (SMD g: –0.59; 95% confidence interval (CI) [–0.85, –0.32; I 2=0%]), fear of falling (SMD g: 1.2; 95%CI [0.55, 1.85; I 2=80%]), risk of falling as indicated by the TUG (SMD g: –0.45, 95%CI [–0.87, –0.02; I 2=0%]), an improvement in mobility grade (0.51; 95%CI [0.47,0.55]), self-selected walking speed (SMD g: 0.47; 95%CI [0.14,0.81; I 2=0%]), and patient-reported ambulation (MD 9.32; 95%CI [3.61, 15.02; I 2=7%]), and utility (MD 7.76; 95%CI [2.05–13.47; I 2=0%]). Other outcomes exhibited trends in favor of MPK use or remained insensitive. No outcome was identified favoring non-MPKs. Conclusions These results suggest that MPKs may be considered a valuable therapeutic option in limited community ambulators with a transfemoral amputation. Implications for rehabilitation Above knee amputees may be treated with a large variety of artificial exo-prosthetic knee components. Microprocessor-controlled prosthetic knees have proven to be advantageous and cost effective for community ambulators. The current analysis shows similar effects in safety, mobility, and patient perception also for limited community ambulators. Microprocessor-controlled prosthetic knees are a viable therapeutic option for limited community ambulators.