Department of Rehabilitation Medicine, Center for Rehabilitation, University Medical Center Groningen, Groningen, The Netherlands.
J Am Med Dir Assoc. 2012 May;13(4):319-25. doi: 10.1016/j.jamda.2010.12.097. Epub 2011 Mar 17.
Elderly people with a lower limb amputation impose a heavy burden on health resources, requiring extensive rehabilitation and long term care. Mobility is key to regaining independence; however, the impact of multiple comorbidities in this patient group can make regaining mobility a particularly challenging task. An evidence-based prognosis for mobility is needed for rehabilitation and long term care planning. This systematic review summarizes the prosthetic and nonprosthetic mobility outcomes achieved by elderly people with a lower limb amputation, to determine whether an accurate prognosis for mobility can be made. MEDLINE, EMBASE, and CINAHL were searched for studies published before May 2010 in English, German, Dutch, or French, using keywords and synonyms for elderly, mobility, rehabilitation, and amputation. Mobility focused on actual movement (moving from one place to another) and was limited to long-term measurements, 6 months after amputation or 3 months after discharge from rehabilitation. The 15 included studies featured a diversity of objective outcome measures and mobility grades that proved difficult to compare meaningfully. In general, studies that included selected populations of prosthetic walkers showed that advanced prosthetic mobility skills can be achieved by the elderly person with a lower limb amputation, including outdoor/community walking. Studies that included all subjects undergoing a lower limb amputation reported that less than half of the elderly population achieved a household level of prosthetic mobility. The predominant findings from the included studies were incomplete reporting of study populations and poor reporting of the reliability of the mobility measures used. The strength of conclusions from this review was therefore limited and the prognosis for mobility in elderly people after lower limb amputation remains unclear. Further research into mobility outcomes of this population is needed to provide evidence that enables more informed choices in rehabilitation and long term care.
老年人下肢截肢给卫生资源带来了沉重负担，需要广泛的康复和长期护理。行动能力是恢复独立的关键；然而，该患者群体的多种合并症会使恢复行动能力成为一项特别具有挑战性的任务。需要为康复和长期护理规划提供基于证据的移动能力预后。本系统综述总结了老年人下肢截肢后使用假肢和非假肢实现的移动能力结果，以确定是否可以对移动能力进行准确的预后。使用老年人、移动能力、康复和截肢的关键字和同义词，在英语、德语、荷兰语或法语中搜索了截止到 2010 年 5 月之前发表的 MEDLINE、EMBASE 和 CINAHL 中的研究。移动能力侧重于实际运动（从一个地方移动到另一个地方），并且限于长期测量，即截肢后 6 个月或从康复出院后 3 个月。15 项纳入的研究具有各种客观的结果测量指标和移动能力等级，难以进行有意义的比较。一般来说，包括假肢步行者选择人群的研究表明，下肢截肢的老年人可以实现高级假肢移动能力，包括户外/社区行走。包括所有接受下肢截肢的受试者的研究报告称，不到一半的老年人群体达到了假肢移动的家庭水平。纳入研究的主要发现是研究人群的报告不完整，以及使用的移动能力测量方法的可靠性报告不佳。因此，本综述结论的强度受到限制，下肢截肢后老年人的移动能力预后仍不清楚。需要对该人群的移动能力结果进行进一步研究，以提供更明智地选择康复和长期护理的证据。
