Lee D J, Repole T, Taussig E, Edwards S, Misegades J, Guerra J, Lisle A
Can Prosthet Orthot J. 2021 Jun 4;4(1):35098. doi: 10.33137/cpoj.v4i1.35098. eCollection 2021.
Self-management is an integral component of managing long-term conditions and diseases. For a person with limb loss, this self-management process involves caring for the residual limb, the prosthesis, and the prosthetic socket-residual limb interface. Failure to properly self-manage can result in unwanted secondary complications such as skin breakdown, falls, or non-use of the prosthesis. However, there is little evidence on what self-management interventions are effective at preventing secondary complications. To understand the impact of self-management after the loss of a limb, it is necessary to determine what the current evidence base supports.
The purpose of this study is to examine the available literature on self-management interventions and/or outcomes for persons with limb loss and describe how it may impact residual limb health or prosthesis use.
A systematic review of multiple databases was carried out using a variety of search terms associated with self-management. The results were reviewed and selected based on the inclusion criteria: self-management interventions or direct outcomes related to self-management, which includes the skin integrity of the residual limb, problem-solving the fit of the prosthesis, and education in the prevention of secondary complications associated with prosthesis use. The Cincinnati Childrens' LEGEND (Let Evidence Guide Every New Decision) appraisal forms were used to analyze the articles and assign grades.
Out of the 40 articles identified for possible inclusion in this study, 33 were excluded resulting in seven articles being selected for this review. Three out of the seven articles focused on silicone liner management while the other four articles focused on skin issues.
Self-management for a person with limb loss is a key component of preventing complications associated with loss of limb and prosthesis use. There is a lack of high-quality experimental studies exploring the most appropriate intervention for teaching self-management when compared to other conditions, specifically diabetes. Further research in the area of self-management is necessary to understand how to best prevent unwanted secondary complications.
自我管理是长期病症和疾病管理的一个重要组成部分。对于肢体缺失者而言，这种自我管理过程包括护理残肢、假肢以及假肢接受腔与残肢的界面。自我管理不当可能会导致诸如皮肤破损、跌倒或不使用假肢等不良的继发性并发症。然而，关于哪些自我管理干预措施能有效预防继发性并发症的证据很少。为了解肢体缺失后自我管理的影响，有必要确定当前的证据基础支持哪些内容。
本研究的目的是审查有关肢体缺失者自我管理干预措施和/或结果的现有文献，并描述其如何可能影响残肢健康或假肢使用。
使用与自我管理相关的各种搜索词对多个数据库进行系统综述。根据纳入标准对结果进行审查和筛选：自我管理干预措施或与自我管理直接相关的结果，其中包括残肢的皮肤完整性、解决假肢适配问题以及预防与假肢使用相关的继发性并发症的教育。使用辛辛那提儿童医院的LEGEND（让证据指导每一个新决策）评估表来分析文章并评定等级。
在确定可能纳入本研究的40篇文章中，排除了33篇，最终选择了7篇文章进行本综述。7篇文章中有3篇关注硅胶衬垫管理，另外4篇关注皮肤问题。
肢体缺失者的自我管理是预防与肢体缺失和假肢使用相关并发症的关键组成部分。与其他病症（特别是糖尿病）相比，缺乏探索最合适的自我管理教学干预措施的高质量实验研究。有必要在自我管理领域进行进一步研究，以了解如何最好地预防不良的继发性并发症。
