Effectiveness of (Active) Lifestyle Interventions in People With a Lower Limb Amputation: A Systematic Review.

Only 13 trials were eligible, so the whole review rests on a small evidence base. Nine of the 13 trials were at high risk of bias, mostly because people were not truly randomly assigned to their group, and in most studies participants did not receive the intervention they were assigned to or other treatments were not described. The authors say the results should be interpreted with caution. The individual trials were very small (14 to 154 people) and covered a wide mix of ages, amputation levels and causes, so results from any one trial may not apply to the patient in front of you. Coverage was uneven: 11 of the 13 trials were about physical activity and 2 about stress management, with nothing on nutrition, smoking or alcohol. Most trials reported only immediate or short-term outcomes, so it is unknown whether any of these programmes produce lasting change, and the authors note a risk of publication bias because negative results are hard to publish. Only randomised and quasi-randomised trials were included, so effective interventions tested with other designs, such as a before-and-after study, would have been missed. The authors' recommendations about how to build a rehabilitation programme come from general exercise prescription principles rather than from the trials in the review.

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Do not read this review as proof that exercise programmes work after a lower limb amputation. Nine of the 13 trials were at high risk of bias and most were very small, so the positive results are promising rather than established. The closing recommendation of two to three supervised strength and balance sessions a week plus telephone coaching is the authors' expert opinion drawn from general exercise guidelines, not something these trials tested.