Development of a Clinical Practice Guideline for Lower Limb Amputees. A Knowledge Translation Process in a Middle Income Country.
Ana Maria Posada-Borrero, Daniel Felipe Patiño-Lugo, Jesus Alberto Plata-Contreras and 2 others
PMID 36188954WHAT IT FOUND
Colombia developed a clinical practice guideline for lower limb amputees with 43 recommendations, but 93% were based on low or very low quality evidence.
Patients prioritized walking and stump infection, while economic analyses supported comprehensive rehabilitation and specific prosthetic choices.
Key findings
01The guideline contains 43 recommendations, but 93% of them are supported by low or very low quality evidence.
02Patients identified walking (51.2%) as their most important rehabilitation activity and stump infection (31.7%) as their most important outcome.
03Economic evaluations supported limb reconstruction over primary amputation in selected patients and found that total contact sockets were more cost-effective than patellar-tendon-bearing sockets.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The vast majority of recommendations (93%) are based on low or very low quality evidence, meaning clinical outcomes are uncertain. The implementation results were not available at the time of writing, so the actual impact on patient care in Colombia is unknown. Patient preference data came from a small convenience sample of 20 people, which may not represent the wider amputee population.
Declared interests
One author is a technical director at a non-governmental organization that manufactures lower limb prostheses. The study was financed by the Colombian Ministry of Health and Social Protection and the Ministry of Science, Technology and Innovation.
The easy way to misread this
Do not treat these recommendations as high-certainty evidence. With 93% of the 43 recommendations based on low or very low quality evidence, clinical judgment and patient preference must heavily guide practice.