Exercise programs to improve gait performance in people with lower limb amputation: A systematic review.

BACKGROUND: Few studies have explored the effects of exercise on gait performance in people with lower limb amputations.
OBJECTIVES: To (1) summarize the effects of exercise programs on gait performance and (2) assess the overall quality of the evidence for adults ambulating with leg prostheses. STUDY
DESIGN: Systematic review.
METHODS: Six databases were searched for one- and two-group studies published through June 2013 reporting effects of exercise on gait speed, a universal measure of performance in lower limb prosthetic users. The search adhered to a predetermined protocol following Cochrane Collaboration guidelines.
RESULTS: In all, 623 citations were reviewed and eight studies included. The quality level of the combined evidence was low with few randomized control trials and multiple sources of bias evident within the heterogeneous group of studies. The 11 exercise programs, including three control conditions, demonstrated small to large effect size improvements in self-selected gait speed. Use of exercise to improve gait speed was supported by low-quality level evidence, with low-moderate quality evidence to suggest that specific functional exercise programs were more effective than supervised walking.
CONCLUSION: Using exercise to improve gait speed in people with lower limb amputation received a B grade recommendation. Future high-quality research is required. CLINICAL RELEVANCE: Supervised walking, muscle strengthening, balance exercises, gait training, and functional training programs demonstrated small to large effect size gait performance improvements in people with lower limb amputation. Self-selected gait speed was the most consistent outcome measure. Exercise programs emphasizing resisted gait and functional training were more effective than supervised walking. © The International Society for Prosthetics and Orthotics 2014.