BACKGROUND

Lower limb amputation (LLA) compromises key functional areas such as gait, balance, functional mobility, increased falls risk and fear of falling (1,2). Training interventions have been developed to improve mobility and balance confidence, broadly classified into prosthetic (e.g. microprocessor knees, energy storing feet) and therapeutic (e.g. exercise, virtual reality). Despite the range of treatment, previous reviews (3,4) have not clearly differentiated the effects of specific treatment types, limiting clinicians' ability to make informed decisions to improve these key functional outcomes.

AIM

To determine the effectiveness of different treatments designed to improve gait, balance, functional mobility, falls incidence, and fear of falling in people with LLA.

METHOD

A systematic review was conducted across 6 databases. Inclusion criteria encompassed therapuetic treatment of the identified outcomes. A multi-level meta-analysis accounted for correlations between multiple effect sizes from the same study, allowing for a more comprehensive evaluation both within and between studies. This approach is appropriate when studies report multiple outcome measures assessing the same underlying construct (e.g., gait), leading to correlated effect sizes within studies. Subgroup analysis determined differences in treatment type effectiveness. Effect sizes were calculated as standardized mean differences (SMDs) using Hedges' g, which corrects for small sample bias. SMDs can be interpreted using Cohen's benchmarks (small = 0.2, moderate = 0.5, and large = 0.8 effects).

RESULTS

Of 4,220 articles, 16 were analyzed. Treatments included proprioceptive neuromuscular facilitation (PNF, n = 2), exercise (n = 8), computerized balance training (CBT, n = 1), cognitive training (n = 3), and virtual reality (n = 4). Most studies were randomized controlled trials (n = 15), with sample sizes from 5 to 154 participants (73% male overall). Collectively, treatments moderately improved gait (SMD = 0.54) and balance (SMD = 0.47), and had small to moderate improvements in functional mobility (SMD = 0.30) and fear of falling (SMD = 0.27). Table 1 characterizes treatment effects.

DISCUSSION AND CONCLUSION

Cognitive training and virtual reality statistically significantly improved gait and balance respectively. Despite these promising results, further research is needed to align statistical improvements with meaningful patient benefits. Understanding the factors that modulate intervention effectiveness will be crucial for developing optimized rehabilitation protocols tailored to individual needs.

REFERENCES

1. Miller WC. Phys Ther. 2002.

2. Miller WC. Disabil Rehabil. 2004.

3. Edward M. POI. 2024.

4. Abou L. Clin Rehabil. 2022.

Objective

To evaluate the effectiveness of therapeutic interventions on gait, balance, functional independence, and balance confidence in individuals with lower limb amputation. Additionally, to examine effects by intervention type and determine their clinical significance.

Data Sources

Seven databases (AMED, APA PsycInfo, MEDLINE, CINAHL, PubMed, Scopus, Web of Science) were searched up to May 26, 2025. Reference lists of included studies and related systematic reviews were also screened.

Study Selection

Studies were included if they evaluated a therapeutic intervention in adults with lower limb amputation, had evidence of reliability, validity, and responsiveness in people with limb amputation, and had a PEDro score ≥6. Twenty-one studies met inclusion criteria; 18 were included in the meta-analysis.

Data Extraction

Studies were divided across six reviewers, who then independently extracted data using a standardized form (participant characteristics, intervention type and duration, outcome measures, and results). Study quality was reported using the PEDro scale.

Data Synthesis

Twenty-one studies (654 participants) contributed 34 gait outcomes (13 studies), 26 balance outcomes (10 studies), 11 functional independence outcomes (8 studies), and five balance confidence outcomes (5 studies). A three-level random-effects meta-analysis showed that therapeutic interventions statistically significantly improved gait (Standardized mean difference (SMD) = 0.54), balance (SMD = 0.68), and functional independence (SMD = 0.30), with smaller effects on balance confidence (SMD = 0.27). Cognitive training had the largest effect on gait, exercise on balance, virtual reality on balance confidence, and proprioceptive neuromuscular facilitation on functional independence. All effects were statistically significant except virtual reality on balance confidence. Only seven of 54 outcomes met minimal clinically important difference or minimal detectable change thresholds.

Conclusions

Therapeutic interventions improve functional outcomes in individuals with a lower limb amputation, though clinical significance was limited. Future research should tailor interventions and standardize outcome measures to better align with meaningful patient improvements.

When the members of the Local Organizing Committee (LOC) for the International Society for Prosthetics and Orthotics (I.S.P.O.) 20th World Congress initially formulated the theme for the Congress, we were faced with a difficult decision. Selection of the theme for a biennial, international, multidisciplinary event such as this needs to be selected with careful consideration to maximize the exposure of the topic to a larger audience and to increase the likelihood of future benefit for all involved. At the time, we were well aware of countless efforts to enact The 2030 Agenda for Sustainable Development,1 and the 17 Sustainable Development Goals (SDGs), and how prosthetics and orthotics (P&O)–and assistive technology more generally–are integral in our efforts to contribute to attaining these goals.2 It seemed fitting then to use this Congress as a means to increase awareness of the SDGs. In doing so, we hoped to be able to actively contribute by making use of this important event in attaining the objectives set out in The 2030 Agenda. This resulted in the 20th World Congress theme: “Science in Practice, Practice in Science: Collaboration and innovation towards sustainable rehabilitation,” which focuses on working toward sustainability across the field through sharing best practice, the development of novel devices, education, provision, and the interrelationships between science and practice.

Background: Education research, as a field of study, is relatively new to the health professions. Research and scholarship in prosthetics and orthotics education is limited, and the priority areas and needs of individuals interested in pursuing this area of research and scholarship are unknown.

Objectives: The objectives of this study were to collaboratively identify the areas in which education research in prosthetics and orthotics is needed, to prioritize these areas, and to evaluate the resources needed to support those interested in pursuing education research.

Study design: Mixed methods.

Methods: The researchers used a participatory action research approach. Focus group sessions were held at the 2022 International Society for Prosthetics and Orthotics (ISPO) Global Educators Meeting. Findings from the focus groups informed creation of a survey that was distributed internationally. The results of this survey were presented to attendees at the 2023 ISPO World Congress for review and ranking.

Results: Findings from focus group discussions were used to create a 20-item survey. High priority categories included providing feedback to students, program evaluation, and clinical education and internship. Protected time and funding, faculty development, and program resources were identified as items needed to support faculty in pursuing education research. At the ISPO World Congress, participants highly rated the categories of academic v. clinical practice, program resources, and program evaluation.

Conclusions: Many categories were identified as priorities for orthotic and prosthetic education research, and ways to support faculty pursuing this work were highlighted. This study identified opportunities for education researchers to focus their efforts on directly impacting needs of education programs and the profession.

Research findings over several years and across the globe have demonstrated that education and training for individuals who serve on the front line of wheelchair service provision is inadequate. It is a problematic situation that challenges equitable access to an appropriate wheelchair for the 80 million wheelchair users worldwide. It is a situation that requires social change initiated by those in the field. As a methodology whose objective it is to co-create knowledge and promote social change, participatory action research (PAR) was a natural choice for the creation of the Wheelchair Educators’ Package (WEP). This paper describes our use of a 10-step PAR process combined with the Participation Choice Points model to actively recruit and engage a 32-member team of community partners affected by this situation to develop the WEP. As a team representing the interests of the ultimate beneficiaries of wheelchair service providers (i.e., wheelchair users), our members were carefully chosen to contribute to a WEP that would be of use to educators in diverse contexts across the globe but not all members were trained in research. The PAR process, designed to optimize and support participation at the desired level of our team members, as well as the measurement of team member engagement, experience, and level of satisfaction with the PAR process are described in this paper. We also offer reflections on the use of our methods and describe how this work provides insights into the way in which academic and global partners may co-create an environment that empowers community partners, many of whom volunteer their time to complete works such as the WEP.

Purpose: To evaluate the long-term effects of an Arts on Prescription (AoP) programme on sense of coherence (SOC) in Sweden.

Design: A controlled intervention study with a quasi-experimental prospective design, including questionnaires at baseline, with follow-ups at 6 and 12 months. Participants were on sick leave due to common mental disorders (CMD) and/or non-specific musculoskeletal pain, recruited from primary care in six regions. The intervention group also included participants from open psychiatric care. The study sample comprised 586 participants (335 in the intervention group and 251 in the control group).

Results: Both groups showed a significantly stronger SOC at follow-up, with a medium effect size for the intervention group and a small effect size for the control group. No statistically significant difference in SOC change over time was observed between the groups. Participants from open psychiatric care in the intervention group showed a significant improvement in SOC compared to those from primary care. Concerns about finances had a significant main effect on SOC for the entire study population.

Originality: Unlike most AoP studies, this controlled study with a relatively large sample provides insights into the long-term effects of AoP on SOC, with results reported using p-values and effect sizes.

Background and purpose: Despite the presence of both national and regional clinical practical guidelines (CPGs) in Sweden, no previous studies have investigated the quality of CPGs or the level of agreement between national and regional CPGs. This study aimed to examine the quality of national CPGs recommending prosthetics and orthotics (P&O), and; quantify agreement between national and regional CPGs in Sweden.

Materials and Methods: National and regional CPGs were identified in public databases and by surveyed local Nurse Practitioners. Quality of the national guidelines was assessed by using AGREE II. Agreement between recommendations in the national and regional CPGs were quantified on a four-grade rating scale ("similar", "partially similar", "not similar/not present" and "different").

Results: Of 18 national CPGs, three CPGs (CPGs of Diabetes, Musculoskeletal disorders and Stroke) had nine recommendations related to P&O. The Musculoskeletal disorders and Stroke CPGs had quality scores >60% in all domains and the Diabetes CPG had scores >60% in five out of six domains according to AGREE II. Seven regional CPGs for P&O treatment were identified. Three national recommendations (in Diabetes CPG) showed "similar" content for all regions and two national recommendations (in Diabetes CPG) showed "not similar" content for all regions. The remaining four national recommendations (in Diabetes, Musculoskeletal disorders and Stroke CPGs) had varying agreement with regional CPGs.

Interpretation: There is a limited number of national recommendations for treatment within P&O. There was variation in the agreement of P&O-related recommendations in national and regional CPGs, which might lead to unequal care throughout the national healthcare system.

Background: Many healthcare professionals collaborate in the clinical care of individuals who have undergone a Transtibial Amputation (TTA), and a good start to their rehabilitation is essential. The Prosthetist plays a long-term role in patient care, while surgeons often have limited follow-up, typically 1-2 weeks post-surgery.

Objective: This paper aims to present the perspective of two Prosthetists on the subject of TTA: why this perspective is needed, the effect of the limb length, the incision techniques used, new alternatives in postoperative treatment, and its impact on early prosthetic fitting, within a Swedish context.

Methodology: To address this aim, each section was discussed individually, summarizing relevant evidence from a professional perspective, using various evidence sources (e.g., peer-reviewed literature, and national patient registries).

Findings: From the authors' view, when using modern postoperative treatment and prosthetic technology, the Sagittal Incision (SF) incision may be beneficial to Posterior Flap (PF) incision in TTA, if the aim is to reduce the time to prosthetic fitting. New postoperative treatment methods are being made more accessible and recognized. This might not be a valid solution in all places, but they contribute to the evidence base used for decision-making following TTAs.

Conclusion: From a Prosthetist perspective, more could be done to improve the pathway from amputation to prosthetic fitting and ensure the best functional outcome for the patient. Traditional methods from the 1950s have been discussed, and other alternatives have been contrasted.

Introduction

Practice of ankle-foot orthoses (AFO) provision for ambulatory children with cerebral palsy is underreported and the literature is not consistent on choice of AFO-design. This study describes clinical practice of AFO provision for children with cerebral palsy and evaluates how clinical practice aligns with existing recommendations.

Methods

An online, cross-sectional survey was conducted, inviting all Norwegian orthotists working with children with cerebral palsy. Orthotic practice was investigated using a self-reported survey design.

Results

From all eligible orthotists, 54% responded, revealing that AFO provision involves patients, physicians, and physiotherapists at different stages. Patient preference directly influenced the ultimate AFO-design. Shank vertical angle was evaluated by 79%. For children with crouch gait and those with short gastrocnemius, a majority preferred a combination of rigid and articulated/flexible AFO-designs. Instrumented gait analysis was conducted by 51% at AFO delivery stage.

Conclusions

The findings show that AFO provision in Norway is collaborative, involving clinical team members and consideration of patient preferences. A discrepancy between clinical practice and existing recommendations for children with crouch gait and those with short gastrocnemius is observed.