Journal of NeuroEngineering and Rehabilitation

RESEARCH Open Access The role of exercise testing in predicting successful ambulation with a lower extremity prosthesis: a systematic literature review and clinical practice guideline Tyler D. Klenow 1* , Larry J. Mengelkoch 2 , Phillip M. Stevens 3,4 , Chris A. Ràbago 5 , Owen T. Hill 6 , Gail A. Latlief 7 , Rodrigo Ruiz-Gamboa 8 and M. Jason Highsmith 9,10,11 From Second World Congress hosted by the American Orthotic & Prosthetic Association (AOPA) Las Vegas, NV, USA. 06-09 September 2017 Abstract Background: Growing discontent with the k-level system for functional classification of patients with limb loss and movement of healthcare toward evidence-based practice has resulted in the need for alternative forms of functional classification and development of clinical practice guidelines to improve access to quality prosthetic interventions. The purpose of this project was to develop and present a clinical practice recommendation for exercise testing in prosthetic patient care based on the results and synthesis of a systematic literature review. Methods: Database searches of PubMed, Google Scholar, Web of Science, and Cochrane were conducted and articles reviewed. Of the potential 1386 articles 10 met the criteria for inclusion. These articles were assessed using the critical appraisal tool of the United Kingdom National Service Framework for Long-Term Conditions. Of the 10 included articles eight were of high, one of medium, and one of low, quality. Data from these articles were synthesized into 6 empirical evidence statements, all qualifying for research grade A. These statements were used to develop the proposed clinical practice guideline. Results: While the results of this systematic review were not able to support the direct connection between cardiorespiratory performance and K-levels, the literature did support the ability of exercise testing results to predict successful prosthetic ambulation in some demographics. Both continuous maximum-intensity single lower extremity ergometer propelled by a sound limb and intermittent submaximal upper extremity ergometer protocols were found to be viable evaluation tools of cardiorespiratory fitness and function in the target population. Conclusion: The ability to sustain an exercise intensity of ≥ 50% of a predicted VO 2max value in single leg cycle ergometry testing and achievement of a sustained workload of 30 W in upper extremity ergometry testing were found to be the strongest correlates to successful ambulation with a prosthesis. VO 2 values were found to increase in amputee subjects following a 6-week exercise program. These synthesized results of the systematic literature review regarding exercise testing in patients with loss of a lower extremity were used to develop and a present a clinical treatment pathway. Keywords: Aerobic capacity, Amputee, Artificial limb, Ergometry, Limb loss, Rehabilitation, Work load * Correspondence: tklenow@opcenters.com 1 Orthotic & Prosthetic Centers, Inc, 3005 Caring Way, Suite 3, Port Charlotte, FL 33952, USA Full list of author information is available at the end of the article © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/ ) , which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated. Klenow et al. Journal of NeuroEngineering and Rehabilitation 2018, 15 (Suppl 1):64 https://doi.org/10.1186/s12984-018-0401-z