Abstract
BackgroundGrowing discontent with the k-level system for functional classification of patients with limb loss and movement of healthcare toward evidence-based practice has resulted in the need for alternative forms of functional classification and development of clinical practice guidelines to improve access to quality prosthetic interventions. The purpose of this project was to develop and present a clinical practice recommendation for exercise testing in prosthetic patient care based on the results and synthesis of a systematic literature review.MethodsDatabase searches of PubMed, Google Scholar, Web of Science, and Cochrane were conducted and articles reviewed. Of the potential 1386 articles 10 met the criteria for inclusion. These articles were assessed using the critical appraisal tool of the United Kingdom National Service Framework for Long-Term Conditions. Of the 10 included articles eight were of high, one of medium, and one of low, quality. Data from these articles were synthesized into 6 empirical evidence statements, all qualifying for research grade A. These statements were used to develop the proposed clinical practice guideline.ResultsWhile the results of this systematic review were not able to support the direct connection between cardiorespiratory performance and K-levels, the literature did support the ability of exercise testing results to predict successful prosthetic ambulation in some demographics. Both continuous maximum-intensity single lower extremity ergometer propelled by a sound limb and intermittent submaximal upper extremity ergometer protocols were found to be viable evaluation tools of cardiorespiratory fitness and function in the target population.ConclusionThe ability to sustain an exercise intensity of ≥50% of a predicted VO2max value in single leg cycle ergometry testing and achievement of a sustained workload of 30 W in upper extremity ergometry testing were found to be the strongest correlates to successful ambulation with a prosthesis. VO2 values were found to increase in amputee subjects following a 6-week exercise program. These synthesized results of the systematic literature review regarding exercise testing in patients with loss of a lower extremity were used to develop and a present a clinical treatment pathway.
Highlights
Growing discontent with the k-level system for functional classification of patients with limb loss and movement of healthcare toward evidence-based practice has resulted in the need for alternative forms of functional classification and development of clinical practice guidelines to improve access to quality prosthetic interventions
Half of the articles were written by a group of authors from a university hospital in Japan while two were written by one author in Slovenia and the remaining three articles originated from two groups in the Netherlands
While no study identified in this review demonstrated the effect of a rehabilitation program to improve cardiorespiratory capacity of a subject below the levels specified to indicate successful prosthetic use to surpass them, a similar positive outcome was concluded by Erjavec et al in a study using the Upper extremity ergometry (UEE) modality [20]
Summary
Growing discontent with the k-level system for functional classification of patients with limb loss and movement of healthcare toward evidence-based practice has resulted in the need for alternative forms of functional classification and development of clinical practice guidelines to improve access to quality prosthetic interventions. Stipulating that “physicians should tailor their history and examination to the individual patient’s condition,” the letter suggests that evaluation should take into account “past medical history,” “symptoms limiting ambulation,” and “other comorbidities impacting the use of a new prosthesis.”. Within this context, “Cardiopulmonary examination” is included Stipulating that “physicians should tailor their history and examination to the individual patient’s condition,” the letter suggests that evaluation should take into account “past medical history,” “symptoms limiting ambulation,” and “other comorbidities impacting the use of a new prosthesis.” Within this context, “Cardiopulmonary examination” is included
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