Search

Background. Measurements of residual limb volume often guide decisions on the type and timing of prosthetic prescription. To help inform these decisions, it is important that clinicians use measurement tools that are reliable and valid. Purpose. The aim of this systematic review was to investigate the reliability and validity of measurement tools for residual limb volume in people with limb amputations. Data Sources. A comprehensive search on MEDLINE, EMBASE, CINAHL, Scopus, and Web of Science was performed on July 11, 2016. Study Selection. Studies were included if they examined the reliability or validity of measurement tools for residual limb volume, were conducted on humans, and were published in English. Data Extraction. Data were extracted from 11 reliability and 4 validity studies and included study characteristics, volumetric estimates, and reliability and validity estimates. The quality of the studies was also rated. Data Synthesis. Data from 2 studies (38 participants) indicated good to excellent intrarater (intraclass correlation coefficient [ICC] [greater than or equal to]0.88) and interrater (ICC [greater than or equal to]0.88) reliability and high between-session reliability (coefficient of variation [CV] = 10%) for water displacement volumetry. One study (28 participants) reported excellent intrarater and interrater reliability (ICC [greater than or equal to]0.93) for the circumferential method, and data from 2 studies (19 participants) indicated high between-session reliability for the optical surface scanner (CV [less than or equal to]9.8%). Three studies (26 participants) indicated good to excellent between-session reliability results for computed tomography (CV = 9-2%-10.9%). One study (7 participants) showed moderate within-session reliability (CV = 50%). Using water displacement volumetry as the gold standard, 2 studies (79 participants) indicated excellent validity for the circumferential method ( r [greater than or equal to]0.92; ICC [greater than or equal to]0.92). All studies reporting measures of reliability or validity were performed with people who had transtibial amputations. Limitations. Only studies published in English and in which water displacement volumetry was used as the gold standard were included in this review. The reliability and validity of the quality rating scale used in this review have not been tested. Conclusions. On the basis of a limited number of moderate- to high-quality studies with small sample sizes, circumferential and water displacement methods were found to be reliable, and the circumferential method was found to be valid in people with transtibial amputations. There are inadequate data for drawing conclusions about volume measurement methods in people with other types of limb amputations., Residual limb volume is routinely measured in people after limb amputations. These volumetric measurements are important because clinicians rely on them to make decisions on the timing and type of [...]

Background. The quality of clinical practice guidelines (CPGs) is important to ensure guideline adoption by clinicians. Purpose. The aim of this review was to identify CPGs for the management of limb amputations, appraise the quality of CPGs, and synthesize recommendations from comprehensive CPGs of high quality. Data Sources. MEDLINE, EMBASE, CINAHL, PEDro, guideline-specific websites, websites for associations or networks for people with amputations, and Google Scholar were searched from April 2007 to April 2017. Study Selection. Publications were included if they were CPGs or consensus statements/standards endorsed by a certified organization, covered the management of limb amputations, were freely accessible, and were written in English. Data Extraction. Two reviewers independently screened tides and abstracts for eligible CPGs and rated the quality of CPGs using the Appraisal of Guidelines Research and Evaluation (AGREE-II) instrument. Data Synthesis. Of the 15 included CPGs, ll were of low to moderate quality and 4 were of high quality. Mean (or median) domain scores on AGREE-II were as follows: 83% for domain 1 (scope and purpose), 61% for domain 2 (stakeholder involvement), 7% for domain 3 (rigor of development), 65% for domain 4 (clarity and presentation), 24% for domain 5 (applicability), and 21% for domain 6 (editorial independence). Strong recommendations from comprehensive and high-quality CPGs were few and focused on the development of individualized treatment plans, exercises for improving physical function and the ability to perform activities of daily living, and the assessment of physical function and prognostic factors. Limitations. CPGs that were not written in English were excluded. Final recommendations from CPGs might differ if different criteria were used. Low domain scores on the AGREE-II might be due to poor reporting rather than poor methodology in the CPG development process. Conclusions. Few CPGs for the management of limb amputations were of high quality, and few recommendations were strong. To improve the quality of future CPGs, guideline developers should report funding and competing interests of members, provide information to aid in the practical application of CPGs, and use a systematic approach to search for evidence and derive strength of recommendations., There is considerable variation in the incidence of limb amputations reported across the globe. Due to heterogeneity in the definition and measurement of amputations, reviews have reported incidence rates of [...]