Interventions for motor rehabilitation in people with transtibial amputation due to peripheral arterial disease or diabetes

• Published in: Cochrane database of systematic reviews 2023-06, Vol.6 (6), p.CD013711
• Main Authors: B Aledi, Luciane, Flumignan, Carolina Dq, Trevisani, Virginia Fm, Miranda, Jr, Fausto
• Format: Article
• Language: English
• Subjects: Amputation; Amputation, Surgical; Diabetes Mellitus; Endocrine & metabolic; Heart & circulation; Humans; Peripheral Arterial Disease - surgery; Phantom Limb; Walking
• ISSN: 1469-493X; 1469-493X
• DOI: 10.1002/14651858.CD013711.pub2

Amputation is described as the removal of an external part of the body by trauma, medical illness or surgery. Amputations caused by vascular diseases (dysvascular amputations) are increasingly frequent, commonly due to peripheral arterial disease (PAD), associated with an ageing population, and increased incidence of diabetes and atherosclerotic disease. Interventions for motor rehabilitation might work as a precursor to enhance the rehabilitation process and prosthetic use. Effective rehabilitation can improve mobility, allow people to take up activities again with minimum functional loss and may enhance the quality of life (QoL). Strength training is a commonly used technique for motor rehabilitation following transtibial (below-knee) amputation, aiming to increase muscular strength. Other interventions such as motor imaging (MI), virtual environments (VEs) and proprioceptive neuromuscular facilitation (PNF) may improve the rehabilitation process and, if these interventions can be performed at home, the overall expense of the rehabilitation process may decrease. Due to the increased prevalence, economic impact and long-term rehabilitation process in people with dysvascular amputations, a review investigating the effectiveness of motor rehabilitation interventions in people with dysvascular transtibial amputations is warranted. To evaluate the benefits and harms of interventions for motor rehabilitation in people with transtibial (below-knee) amputations resulting from peripheral arterial disease or diabetes (dysvascular causes). We used standard, extensive Cochrane search methods. The latest search date was 9 January 2023. We included randomised controlled trials (RCT) in people with transtibial amputations resulting from PAD or diabetes (dysvascular causes) comparing interventions for motor rehabilitation such as strength training (including gait training), MI, VEs and PNF against each other. We used standard Cochrane methods. Our primary outcomes were 1. prosthesis use, and 2. Our secondary outcomes were 3. mortality, 4. QoL, 5. mobility assessment and 6. phantom limb pain. We use GRADE to assess certainty of evidence for each outcome. We included two RCTs with a combined total of 30 participants. One study evaluated MI combined with physical practice of walking versus physical practice of walking alone. One study compared two different gait training protocols. The two studies recruited people who already used prosthesis; therefore, we could not assess