Lower limb prosthetic outcome measures: A review of the literature 1995 to 2005

A systematic review of outcome measures used in the field of lower limb prosthetics between 1995 and 2005 shows a multitude of measures currently in use in prosthetic rehabilitation; however, there is no agreement on a gold standard. The review was based on a search of the University of Strathclyde's RECAL database and Medline. The search strategies were liberal so as to pick up all potential studies and specific to each database. Abstracts returned by the searches were scanned for relevance by at least two of the three authors. The full text of potentially relevant studies was then obtained and considered for inclusion in the review, again by at least two authors. Any disagreement was resolved with the third author. A data extraction form covering the areas of general information, practicality, reliability, validity, scaling, and potential for bias was developed. The search identified 340 articles, of which 28 met all inclusion criteria and were included in the review. A total of 25 measures were used as primary outcome measures, with many more as comparators. Reliability, validity, and scaling data as reported in the included studies are presented. Some recurring methodological flaws were noted and include inconsistent use of numbers and percentages, insufficient information on patient populations, no analysis of difference between response and nonresponse groups, and conclusions that tend to overstate findings. No single measure emerges as being universally appropriate. There are many measures in use with little agreement regarding which to use and when. Some measures do have proven validity and reliability and are easy to use. Many of the published studies are complex and difficult to read, which may limit the transfer of research findings into clinical practice. Terminology can be inconsistent and confusing. For measuring mobility, a timed walking test that incorporates a sit-to-stand and a turn, such as the timed up and go test, is highly appropriate for amputees. Generic, nonamputee specific measures of function and quality of life are inappropriate for lower limb amputees.