A comprehensive approach to exercise therapy could improve gait in lower limb prosthesis users, according to research recently published in Prosthetics and Orthotics International.
However, few studies have explored the effects of specific exercises on gait, and no universal set of guidelines has been established, Christopher Kevin Wong, PT, PhD, OCS, associate director of physical therapy and associate professor of Rehabilitation Medicine at Columbia University Medical Center, told O&P Business News.
“There are not many research studies describing rehabilitation programs that develop prosthetic walking in lower limb amputees,” Wong said. “I wanted to know what programs there were…and if there was any kind of consensus among them.”
Using a systematic review, Wong and a team of researchers explored six databases for one- and two-group studies reporting the effects of exercise on gait speed. The search followed the Cochrane Collaboration handbook to minimize bias in selection.
A total of 623 studies, published through June 2013, were selected for potential inclusion and screened based on a predetermined eligibility form. Eight studies were selected after ineligible and duplicate studies were removed.
Christopher Kevin Wong
“We went back a really long time – 1970 something, 1980 was the oldest,” Wong said. “The biggest take away was that only eight studies were found, which is not very many given how far we went back.”
The included studies varied in design, participants, outcomes, experimental and comparison condition exposures. Three were randomized control trials and five were pre-test, post-test designs.
The studies involved supervised walking, balance, gait and functional training of specific muscle groups.
Self-selected gait speed served as the primary outcome measure, and secondary outcomes included multidimensional performance measures and kinematic data.
A total of 199 participants with varying age, cause, level and years since amputation were examined.
Findings and limitations
The findings showed that a variety of different exercises could improve self-selected gait speed. They also showed that exercise emphasizing resisted gait and functional training were more effective than supervised walking. However, no consensus on a best approach to exercise was found.
“Overall, the quality of the studies was not very high. Most, until recently, were not randomized control trials,” Wong said.
“That makes it very hard to determine what, if any, effects have been [measured]. Essentially, any training program beyond just supervised [walking] would most likely produce some benefits.”
The lack of level 1 randomized control trial designs, diversity among sample populations, a low number of combined participants and treatment conditions limited overall findings, Wong said.
Exclusion of studies that did not include gait speed as an outcome limited consideration of other performance measures, such as the use of walking aids. Long-term follow-up data, treatment setting, duration and compliance were beyond the scope of the study.
Further, high-quality research is needed to determine which types of exercise are most effective in gait training, Wong said. Researchers also should examine the different characteristics of people with lower limb amputation in order to establish a standardized method of care.
“More high-quality research will help physical therapists know how best to help an amputee after initial prosthetic delivery, [and] more demanding rehabilitation programs can help elevate expectations and outcomes beyond just walking,” he said.
“I think we need to improve study designs, figure out how to improve function and make our standards higher.” – by Shawn M. Carter
Wong C.K. Prosthet Orthot Int. 2014; doi: 10.1177/0309364614546926
Disclosure: Wong has no relevant financial disclosures.