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Fitness, Function, and Exercise Training Responses after Limb Salvage With a Lower Limb Megaprosthesis: A Systematic Review
Author(s) -
Wilson Paula J.,
Steadman Peter,
Beckman Emma M.,
Connick Mark J.,
Carty Christopher P.,
Tweedy Sean M.
Publication year - 2019
Publication title -
pmandr
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.617
H-Index - 66
eISSN - 1934-1563
pISSN - 1934-1482
DOI - 10.1002/pmrj.12045
Subject(s) - medicine , physical therapy , physical medicine and rehabilitation , flexibility (engineering) , strengthening the reporting of observational studies in epidemiology , observational study , lower limb , population , checklist , rehabilitation , surgery , psychology , mathematics , environmental health , statistics , cognitive psychology
Objective To describe the fitness, function, and exercise training responses of patients following reconstruction of the lower limb with a total femoral (TF), proximal femoral (PF), distal femoral (DF), or proximal tibial (PT) megaprosthesis. Type Systematic review. Literature Survey Five research databases were searched systematically for original studies published in English from 2006 to 2017 that reported fitness, functioning, or exercise training responses for one or more of the four types of lower limb megaprosthesis listed above. Methodology Methodologic quality was assessed using a 22‐item modified STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) checklist. Synthesis Of the 5342 articles retrieved, 28 met the inclusion criteria. Thirteen studies reported fitness outcomes, primarily in PT, with none in TF. Impaired knee extensor strength of the affected limb was reported following limb salvage with PF, DF, and PT megaprosthetics. Impaired flexibility was reported following limb salvage with DF and PT megaprosthetics. Functional outcomes were described in all studies and were most commonly reported using the Musculoskeletal Tumor Society (MSTS) system score. Results indicated no clear difference in functional outcomes between megaprosthesis locations. No studies evaluated exercise training responses. Conclusions This review identified impairments of lower limb strength and flexibility following limb salvage with a lower limb megaprosthesis. Similarity in functional outcomes for all four reported megaprosthetic locations may indicate a lack of sensitivity in outcome measures, including the absence of items assessing higher‐level functioning. Exercise interventions that aim to improve fitness and function in this population have not been evaluated but are required given increasing 5‐year survival rates. Level of Evidence I