Extremity Trauma & Amputation Center of Excellence (EACE), US Department of Veterans' Affairs, US Department of Defense, 13000 Bruce B. Downs Blvd., Tampa, FL, 33612, USA; School of Physical Therapy & Rehabilitation Sciences, Morsani College of Medicine, University of South Florida, 3515 E. Fletcher Ave. Tampa, FL, 33612, USA; 319th Minimal Care Detachment, U.S. Army Reserves, Pinellas Park, 2801 Grand Ave. Pinellas Park, FL, USA, 33782.
Center of Innovation on Disability & Rehabilitation Research, James A. Haley Veterans' Administration Hospital, 8900 Grand Oak Ci, Tampa, FL, 33637, USA.
Spine J. 2019 Mar;19(3):552-563. doi: 10.1016/j.spinee.2018.08.011. Epub 2018 Aug 24.
Lower extremity amputation (LEA) is associated with an elevated risk for development and progression of secondary health conditions. Low back pain (LBP) is one such condition adversely affecting function, independence, and quality of life.
The purpose of this study was to systematically review the literature to determine the strength of evidence relating the presence and severity of LBP secondary to LEA, thereby supporting the formulation of empirical evidence statements (EESs) to guide practice and future research.
STUDY DESIGN/SETTING: Systematic review of the literature.
A systematic review of five databases was conducted followed by evaluation of evidence and synthesis of EESs.
Seventeen manuscripts were included. From these, eight EESs were synthesized within the following categories: epidemiology, amputation level, function, disability, leg length, posture, spinal kinematics, and osseointegrated prostheses. Only the EES on epidemiology was supported by evidence at the moderate confidence level given support by eight moderate quality studies. The four EESs for amputation level, leg length, posture, and spinal kinematics were supported by evidence at the low confidence level given that each of these statements had some evidence not supporting the statement but ultimately more evidence (and of higher quality) currently supporting the statement. The remaining three EESs that addressed function, disability and osseointegrated prosthetic use were all supported by single studies or had comparable evidence that disagreed with study findings rendering insufficient evidence to support the respective EES.
Based on the state of the current evidence, appropriate preventative and, particularly, treatment strategies to manage LBP in persons with LEA remain a knowledge gap and an area of future study.
下肢截肢（LEA）与继发性健康状况的发展和恶化风险增加有关。下腰痛（LBP）就是这样一种会对功能、独立性和生活质量产生不利影响的疾病。
本研究旨在系统地回顾文献，以确定与 LEA 继发的 LBP 的存在和严重程度相关的证据强度，从而支持制定经验证据陈述（EES）来指导实践和未来的研究。
研究设计/环境：文献的系统回顾。
对五个数据库进行了系统的回顾，然后对证据进行评估并综合 EES。
共纳入 17 篇论文。从中综合了以下 8 个 EES：流行病学、截肢水平、功能、残疾、腿长、姿势、脊柱运动学和骨整合假体。只有关于流行病学的 EES 得到了中等质量研究的证据支持，证据可信度为中等。截肢水平、腿长、姿势和脊柱运动学的四个 EES 得到了低可信度水平的证据支持，因为这些陈述中的每一个都有一些不支持陈述的证据，但最终更多的证据（且质量更高）目前支持该陈述。其余三个 EES 分别涉及功能、残疾和骨整合假体的使用，它们都基于单一研究或具有与研究结果相矛盾的可比性证据，从而导致支持各自 EES 的证据不足。
基于目前的证据状况，针对 LEA 患者的 LBP 进行适当的预防和治疗策略，特别是治疗策略，仍然是一个知识空白，也是未来研究的一个领域。
