Describe the outcomes of dysvascular partial foot amputation and how these compare to transtibial amputation: a systematic review protocol for the development of shared decision-making resources

Systematic Reviews, Dec 2015

Background Helping people make well-informed decisions about dysvascular partial foot amputation is becoming increasingly important as improvements in diabetes care and vascular surgery make more distal amputations increasingly possible. The high rates of complications and reamputations associated with partial foot amputation are of concern, particularly given that transtibial amputation seems to result in similar outcomes (e.g., mobility and quality of life) with comparatively few complications and reamputations. The aim of this review is to describe the outcomes of dysvascular partial foot amputation and compare these to transtibial amputation. Results from the review are intended for use in the development of shared decision-making resources. Methods/design A comprehensive range of databases—MEDLINE, EMBASE, PsycINFO, AMED, Cumulative Index of Nursing and Allied Health Literature (CINAHL), ProQuest Nursing and Allied Health, and Web of Science—will be searched using National Library of Medicine, Medical Subject Headings (MeSH) terms as well as title, abstract, and keywords relating to different amputation levels and outcomes of interest; specifically: incidence, prevalence, and rate of amputation; rate of mortality, wound failure, dehiscence, and time between index and ipsilateral reamputations; and mobility, functional ability, activity and participation, quality of life, pain, and psychosocial outcomes including depression and anxiety. Articles that meet the inclusion criteria will be hand-searched for relevant citations. A forward citation search using Google Scholar will be used to identify articles not yet indexed. Original research published in the English language after 1 January 2000 will be included. The McMaster Critical Review Forms will be used to assess methodological quality and identify sources of bias. Included articles will be independently appraised by two reviewers. Data will be extracted using a spreadsheet based on the Cochrane Consumers and Communication Review Group’s data extraction template by a primary reviewer and checked for accuracy and clarity by a second reviewer. Findings from the review will be reported as a narrative without meta-analysis given the anticipated heterogeneity of the literature. Discussion Results from the review can be used in the design of shared decision-making resources to help inform difficult decisions about partial foot amputation. Systematic review registration PROSPERO CRD42015029186

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Describe the outcomes of dysvascular partial foot amputation and how these compare to transtibial amputation: a systematic review protocol for the development of shared decision-making resources

Dillon et al. Systematic Reviews Describing the outcomes of dysvascular partial foot amputation and how these compare to transtibial amputation: a systematic review protocol for the development of shared decision making resources Michael P Dillon 0 Stefania Fatone 1 Matthew Quigley 0 0 Discipline of Prosthetics and Orthotics, College of Science, Health and Engineering, La Trobe University , Melbourne 3086 , Australia 1 Northwestern University Prosthetic and Orthotic Centre, Feinberg School of Medicine, Northwestern University , 680 N Lake Shore Drive, Suite 1100, Chicago, IL 60611 , USA Background: Helping people make well-informed decisions about dysvascular partial foot amputation is becoming increasingly important as improvements in diabetes care and vascular surgery make more distal amputations increasingly possible. The high rates of complications and reamputations associated with partial foot amputation are of concern, particularly given that transtibial amputation seems to result in similar outcomes (e.g., mobility and quality of life) with comparatively few complications and reamputations. The aim of this review is to describe the outcomes of dysvascular partial foot amputation and compare these to transtibial amputation. Results from the review are intended for use in the development of shared decision-making resources. Methods/design: A comprehensive range of databases-MEDLINE, EMBASE, PsycINFO, AMED, Cumulative Index of Nursing and Allied Health Literature (CINAHL), ProQuest Nursing and Allied Health, and Web of Science-will be searched using National Library of Medicine, Medical Subject Headings (MeSH) terms as well as title, abstract, and - (Continued from previous page) Systematic review registration: PROSPERO CRD42015029186 Background Lower limb amputation is an all too common sequel to advanced peripheral vascular disease and the long-term effects of diabetes that results in a wide range of adverse health outcomes such as impaired mobility [ 1, 2 ], chronic pain [3], and depression [ 4 ]. These consequences of lower limb amputation often lead to significant disability and reduced quality of life [ 5, 6 ]. Therefore, it is not surprising that the decision to proceed with amputation surgery is a difficult one, even for people facing decisions about, socalled, minor or partial foot amputation. Helping people make well-informed decisions about partial foot amputation has become increasingly important given that, over the last 15 years, there has been a dramatic shift in the types of lower limb amputation performed [ 7– 11 ]. The incidence of transtibial amputation has declined steadily since about the year 2000 [ 7, 12–15 ], and there is some evidence that partial foot amputation has increased proportionately [ 7, 10, 13 ]. If these trends hold true into the future, the incidence of partial foot amputation is estimated to triple across the first half of this century [ 7 ]. However, there is some uncertainty about these observations given the way different health jurisdictions and researchers measure and report these data [ 16, 17 ]. For example, counting of first-ever (index) amputation underestimates the number of surgeries compared to counting all amputation procedures but may better capture the number of people affected [ 16, 17 ]. This is particularly problematic in people with partial foot amputation given that one third of amputations are revised to a higher level [ 18–22 ]. Many studies only count major amputations (e.g., above-the-ankle) [ 14, 23 ] and under-report the incidence of all lower limb amputations given that up to three quarters of all lower limb amputations are partial foot amputations [ 7, 24 ]. These variations in study design cloud our understanding of changes in types of lower limb amputations being performed; particularly the shift from transtibial to partial foot amputation. A better understanding of these changes is important to help plan for the increased number of people living with partial foot amputation and the specialist clinical services they require (e.g., wound care and high-risk foot clinics and prosthetic, orthotic, and pedorthic services). The shift to a more distal, partial foot amputation will be seen by many as a significant improvement given the assumption that a more distal amputation results in better outcomes such as improved mobility [ 25 ], improved quality of life [ 26–28 ], and lower mortality [ 29–31 ]. However, partial foot amputation has been associated with a significant rate of failure and numerous complications. Between 30 and 50 % of people with partial foot amputation will experience complications including : dehiscence, ulceration, or complete failure of the wound to heal [ 22, 26, 27, 32–34 ]. Only about 50 % of all partial foot amputations heal with no appreciable difference based on the level of partial foot amputation [ 19–22, 35, 36 ]. The rate of healing of partial foot amputation is on (...truncated)


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Michael P Dillon, Stefania Fatone, Matthew Quigley. Describe the outcomes of dysvascular partial foot amputation and how these compare to transtibial amputation: a systematic review protocol for the development of shared decision-making resources, Systematic Reviews, 2015, pp. 173, 4, DOI: 10.1186/s13643-015-0161-9