Clarke Leigh, Ridgewell Emily, Dillon Michael P
Discipline of Prosthetics and Orthotics, Department of Physiotherapy, Podiatry, Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia.
The Australian Orthotic Prosthetic Association, Camberwell, Australia.
Disabil Rehabil. 2023 Mar;45(6):1103-1113. doi: 10.1080/09638288.2022.2049902. Epub 2022 Mar 17.
Prosthetic research seems focused on measuring gait-related outcomes that may not adequately measure real-world benefits of prosthetic interventions. Systematically cataloguing a comprehensive range of outcomes is an important steppingstone towards developing a holistic way to measure the benefits of prosthetic interventions for future health economic evaluations. The purpose of this research was to identify and catalogue the outcomes measured in lower-limb prosthetic research using the International Classification of Functioning, Disability, and Health (ICF) framework and a custom clinical framework, and thereby describe the existing research focus and identify evidence gaps.
A structured literature search identified systematic reviews of lower-limb prosthetic interventions. Reported outcomes were extracted from included studies and linked to the ICF- and clinical-frameworks.
Of the 1297 extracted outcomes, 1060 were linked to the ICF framework. Most outcomes linked to second- (63.8%) or third-level categories (33.4%), such as (, 49.8%). Most of these outcomes (31.2%) describe temporospatial, kinematic or kinetic gait measures as categorised by the clinical framework.
Lower-limb prosthetic research is focused on laboratory-based measures of gait. There are evidence gaps describing participation in real-world activities - important outcomes to inform policy and investment decisions that determine the prosthetic interventions available for people with limb-loss.Implications for rehabilitationCataloguing the outcomes used in prosthetic research to the International Classification of Functioning, Disability, and Health (ICF) allows important evidence gaps to be illuminated given the holistic description of function and disability.Establishing a comprehensive list of prosthetic outcomes, described using an internationally recognised framework with unified and consistent language, is an important steppingstone towards developing a core outcome set (COS) for prosthetic interventions and informing the benefits measured in future prosthetic health economic evaluations (HEEs).Being able to measure the benefits of a prosthesis that are most important to prosthesis users and funders has potential to fundamentally change future HEEs that influence funding policies, and ultimately the prostheses made available to people living with limb-loss.
假肢研究似乎侧重于测量与步态相关的结果，而这些结果可能无法充分衡量假肢干预在现实世界中的益处。系统地编目一系列全面的结果是朝着制定一种整体方法迈出的重要一步，该方法用于衡量假肢干预对未来卫生经济评估的益处。本研究的目的是使用国际功能、残疾和健康分类（ICF）框架和一个自定义临床框架来识别和编目在下肢假肢研究中测量的结果，从而描述现有研究重点并识别证据空白。
通过结构化文献检索确定了下肢假肢干预的系统评价。从纳入的研究中提取报告的结果，并将其与ICF框架和临床框架相关联。
在1297个提取的结果中，1060个与ICF框架相关联。大多数结果与第二级（63.8%）或第三级类别（33.4%）相关，例如（，49.8%）。这些结果中的大多数（31.2%）描述了临床框架分类的时空、运动学或动力学步态测量。
下肢假肢研究侧重于基于实验室的步态测量。在描述参与现实世界活动方面存在证据空白——这些重要结果可为政策和投资决策提供信息，而这些决策决定了为肢体缺失者提供的假肢干预措施。对康复的启示将假肢研究中使用的结果编目到国际功能、残疾和健康分类（ICF）中，鉴于对功能和残疾的整体描述，可以揭示重要的证据空白。使用具有统一和一致语言的国际认可框架描述假肢结果的综合列表，是朝着为假肢干预制定核心结局集（COS）以及为未来假肢卫生经济评估（HEE）中测量的益处提供信息迈出的重要一步。能够测量对假肢使用者和资助者最重要的假肢益处，有可能从根本上改变影响资助政策的未来HEE，并最终改变为肢体缺失者提供的假肢。
