Effects of prosthetic rehabilitation interventions for patients with major lower limb amputation due to diabetes or peripheral arterial disease: A systematic review

Abstract

Purpose

This systematic review evaluates the effects of prosthetic rehabilitation interventions including post-amputation stump management techniques, microprocessor assisted foot or knee prosthesis and functional mobilization procedures on stamp healing, prosthetic adaptation time, functional mobility, balance and mortality in patients with a major lower limb amputation due to diabetes mellitus or peripheral arterial disease.

Methods

PubMed, Cochrane, Science Direct, Scopus, PEDro, and Web of Science databases were systematically searched from their inception until February 2025 using combinations of keywords and MeSH terms related to diabetes mellitus, lower limb amputation, and rehabilitation interventions, including stump management techniques, physical therapy and prosthetic equipment. Studies published in peer-reviewed journals in English or French were included. The data extracted included information regarding study provenance and design, as well as patient-specific variables, the nature of the rehabilitation interventions, and the resulting clinical outcomes.

Results

From 4426 identified records, 11 studies were selected, including a total of 2227 patients. The included studies comprised five randomized controlled trials and six observational studies. Nine studies had moderate risk of bias. The most used prosthetic rehabilitation interventions were rigid, semi-rigid dressings, silicone liner and prostheses with microprocessor-controlled knees. Stump healing, prosthesis fitting time, functional mobility and mortality were the most examined effects.

Conclusion

Rigid, semi-rigid dressings and silicone liners improve stump healing and reduce time to prosthetic fitting compared with soft dressings; microprocessor-controlled knee or foot also improve functional mobility compared with conventional prostheses. A biopsychosocial approach is strongly recommended to support the rehabilitation process of this population.