Authors' objectives:

This report aims to assess the effectiveness of computerised lower limb prostheses, in particular the microprocessor-controlled lower limb prosthesis (the C-LEG (R)).

Authors' recommendations: Potential benefits of the C-LEG include: decreased effort involved in walking; improved gait symmetry; increased confidence by the patient in the prosthesis; more natural movement, including on stairs, inclines, and uneven terrain; the perception that participation in activities such as sports is possible; and the avoidance of falls. The published research is a small body of work. Less than 3% of published and indexed articles represent structured research, with the larger fraction of published articles being purely descriptive or frankly promotional. Most of the available structured research is based on a slightly different microprocessor-controlled prosthesis (the Intelligent Prosthesis (IP), Blatchford, United Kingdom). The IP is associated with many of the same potential benefits as the C-LEG. Published studies have enrolled highly selected samples of amputees who do not have additional medical problems, whose amputations were secondary to trauma or congenital defects, and who are fit and active. These and similar characteristics have been shown to be independently predictive of successful rehabilitation or return to normal living after amputation, and may confound the results of the non-randomized, uncontrolled microprocessor-controlled prosthesis studies that have been published to date. Results in the highly selected patients who have participated in the available published studies may not be directly transferable to VA amputees, who are likely to have multiple additional medical problems and amputations secondary to vascular disease. The selective inclusion criteria for research patients noted above undoubtedly introduce bias into study results, precluding definitive attribution of improvements in gait, energy expenditure, etc. to the computerized prosthesis. The published studies have found: - Energy requirements of ambulation (compared to requirements with conventional prostheses) are decreased at walking speeds slower or faster than the amputees customary speed, but are not significantly different at customary speeds. - Results on the potentially improved ability to negotiate uneven terrain, stairs, or inclines are mixed. Such benefits, however, could be particularly important to meeting existing deficits in the reintegration of amputees to normal living, particularly those related to decreased recreation options.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www4.va.gov/VATAP/docs/ComputerizedLowerLimbProsthese2000tm.pdf

Year Published: 2000

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: VA Technology Assessment Program

Contact Address: Liz Adams, VA Technology Assessment Program, Office of Patient Care Services (11T), VA Boston Healthcare System Room 4D-142, 150 South Huntington Avenue, Boston, MA 02130 USA Tel: +1 617 278 4469; Fax: +1 617 264 6587;

Contact Name: elizabeth.adams@med.va.gov

Contact Email: elizabeth.adams@med.va.gov

Copyright: Technology Assessment Unit, Office of Patient Care Services, US Department of Veterans Affairs (VATAP)