Predicting walking ability following lower limb amputation: a systematic review of the literature.

OBJECTIVE To investigate factors that predict walking with a prosthesis after lower limb amputation. DESIGN Systematic literature review. METHODS A computer-aided literature search of MEDLINE, EMBASE, CINAHL and the Cochrane Library was performed to identify studies published up to August 2007 that investigated factors that predicted walking ability after lower limb amputation. RESULTS A total of 57 studies were selected. Predictors of good walking ability following lower limb amputation include cognition, fitness, ability to stand on one leg, independence in activities of daily living and pre-operative mobility. Longer time from surgery to rehabilitation and stump problems are predictors of poor outcome. The impact of the cause of amputation on walking varies between studies. In general, unilateral and distal amputation levels, and younger age were predictive of better walking ability. Sex probably does not have a significant influence on walking ability. CONCLUSION The heterogeneity of methods and outcome measures used in the identified studies make comparison difficult and, in part, explains conflicting conclusions in relation to predictive factors. Further investigation of predictive factors is needed to estimate walking potential more accurately and guide targeting of modifiable factors to optimize outcome after lower limb amputation.