Rehabilitation of Lower Limb Amputation
Publication Date: September 1, 2019
Last Updated: March 14, 2022
Recommendations
All rehabilitation phases
We suggest that patient education be provided by the rehabilitation care team throughout all phases of amputation rehabilitation. (Weak for)
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We suggest an assessment of behavioral health and psychosocial functioning at every phase of amputation management
and rehabilitation. (Weak for)
and rehabilitation. (Weak for)
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When assessing pain, we suggest that measurement of the intensity of pain and interference with function should be separately assessed for each pain type and location using standardized tools. (Weak for)
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We suggest offering a multimodal, transdisciplinary individualized approach to pain management including transition to a nonnarcotic phannacological regimen combined with physical, psychological, and mechanical modalities throughout the rehabilitation process. (Weak for)
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We recommend providers consider the patient's birth sex and self-identified sex identity in developing individualized treatment plans. (Strong for)
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We suggest offering peer support interventions, including visitation by a certified peer visitor, as early as feasible and throughout the rehabilitation process. (Weak for)
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Perioperative phase
Prior to surgery, we suggest that rehabilitation goals, outcomes, and other implications be included in shared decision-making about residual limb length and amputation level. (Weak for)
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There is insufficient evidence to recommend one surgical amputation procedure over another. ()
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We suggest the use of a rigid or semirigid dressing to promote healing and early prosthetic use as soon as feasible postamputation
in transtibial amputation. Rigid postoperative dressings are preferred in situations where limb protection is a priority. (Weak for)
in transtibial amputation. Rigid postoperative dressings are preferred in situations where limb protection is a priority. (Weak for)
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We suggest performing cognitive screening before establishing rehabilitation goals, to assess the patient's ability and suitability for appropriate prosthetic technology. (Weak for)
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We suggest that in the perioperative phase after amputation, patients receive physical rehabilitation and appropriate durable medical equipment/assistive technology. (Weak for)
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We suggest, when applicable, treatment in an acute inpatient rehabilitation program over a skilled nursing facility. (Weak for)
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We suggest the initiation of mobility training as soon as feasible postamputation. In appropriate patients, this may include ipsilateral side weight-bearing ambulation with a pylon to improve physical function and gait parameters. (Weak for)
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We recommend instituting rehabilitation training interventions, using both open and closed chain exercises and progressive resistance to improve gait, mobility, strength, cardiovascular fitness and activities of daily living performance in order to maximize function. (Strong for)
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Preprosthetic phase
We suggest offering microprocessor knee units over nonmicroprocessor knee units for ambulation to reduce risk of falls and maximize patient satisfaction. There is insufficient evidence to recommend for or against any particular socket design, prosthetic foot categories, and suspensions and interfaces. (Weak for)
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Prosthetic training
We recommend the use of valid, reliable, and responsive functional outcome measures, including, but not limited to, the Comprehensive High-level Activity Mobility Predictor, Amputee Mobility Predictor, 10-rneter walk test, and 6-min walk test. (Strong for)
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We suggest the use of a combination of measures with acceptable psychometric properties to assess functional outcomes. (Weak for)
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We recommend offering further evaluation and interventions for factors that are associated with poorer outcomes such as smoking, cornorbidities, psychosocial functioning, and pain. (Strong for)
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Recommendation Grading
Overview
Title
Rehabilitation of Lower Limb Amputation
Authoring Organization
Veterans Health Administration / Department of Defense
Endorsing Organization
American Academy of Physical Medicine and Rehabilitation
Publication Month/Year
September 1, 2019
Last Updated Month/Year
January 31, 2024
Supplemental Implementation Tools
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Inclusion Criteria
Female, Male, Adult, Older adult
Health Care Settings
Ambulatory, Emergency care, Home health, Hospital, Medical transportation, Operating and recovery room, Outpatient
Intended Users
Surgical technologist, social worker, physical therapist, mri technologist, epidemiology infection prevention, nurse, nurse practitioner, physician, physician assistant
Scope
Rehabilitation, Management
Diseases/Conditions (MeSH)
D000671 - Amputation
Keywords
amputation, rehabilitation, clinical practice, prosthetic, limb salvage, Lower Limb
Methodology
Number of Source Documents
133
Literature Search Start Date
January 1, 2007
Literature Search End Date
July 1, 2016