The effect of microprocessor controlled exo-prosthetic knees on limited community ambulators: systematic review and meta-analysis

Disabil Rehabil. 2022 Dec;44(24):7349-7367. doi: 10.1080/09638288.2021.1989504. Epub 2021 Oct 25.

Abstract

Purpose: The clinical benefits of microprocessor-controlled prosthetic knees (MPKs) in community ambulators have been well-established. A systematic review in limited community ambulators published in 2014 found benefits in safety, performance-based, and patient-reported outcomes. This work updates the previous analysis to the current state of the published evidence.

Methods: Systematic review and meta-analysis of the effect of MPKs in limited community ambulators.

Results: Thirteen research projects presented in 15 publications were identified. Overall validity was "high" in nine studies, "moderate" in three, and "low" in one. The literature described a total of 2366 patients, with 704 classified as limited community ambulators. The use of MPKs in limited community ambulators led to a reduction in falls (SMD g: -0.59; 95% confidence interval (CI) [-0.85, -0.32; I2=0%]), fear of falling (SMD g: 1.2; 95%CI [0.55, 1.85; I2=80%]), risk of falling as indicated by the TUG (SMD g: -0.45, 95%CI [-0.87, -0.02; I2=0%]), an improvement in mobility grade (0.51; 95%CI [0.47,0.55]), self-selected walking speed (SMD g: 0.47; 95%CI [0.14,0.81; I2=0%]), and patient-reported ambulation (MD 9.32; 95%CI [3.61, 15.02; I2=7%]), and utility (MD 7.76; 95%CI [2.05-13.47; I2=0%]). Other outcomes exhibited trends in favor of MPK use or remained insensitive. No outcome was identified favoring non-MPKs.

Conclusions: These results suggest that MPKs may be considered a valuable therapeutic option in limited community ambulators with a transfemoral amputation.Implications for rehabilitationAbove knee amputees may be treated with a large variety of artificial exo-prosthetic knee components.Microprocessor-controlled prosthetic knees have proven to be advantageous and cost effective for community ambulators.The current analysis shows similar effects in safety, mobility, and patient perception also for limited community ambulators.Microprocessor-controlled prosthetic knees are a viable therapeutic option for limited community ambulators.

Keywords: Above knee amputees; artificial limbs; falls; fear of falling; limited community ambulators; meta-analysis; microprocessor-controlled prosthetic knees; mobility grade.