Objective: After amputation, people with lower-limb loss (PLL) face challenges to regain their previous physical activity level. Assessing the scope of evidence regarding physical activity in PLL can identify sources of evidence and gaps within the literature that can influence amputation-related research, outcome assessment choices, and wellness activities. The purpose of this scoping review was to map the evidence regarding steps per day as a physical activity measure for PLL. Specific aims were to 1) identify research designs, 2) catalog population subgroups, 3) document steps per day measurement methods, and 4) provide descriptive data for steps per day in PLL.
Methods: The Medline, CINAHL, Embase, Web of Science, and AMED databases; and the Journal of Prosthetics and Orthotics archive were searched without language or time limits. Exclusion criteria included: no PLL subjects, not peer-reviewed, and no direct step count measure. Inclusion criteria allowed any sample size, non-prosthetic use, and self-reported step count. As a scoping review, only descriptive statistics were compiled, and no methodologic quality assessment was performed.
Results: 21 articles using crossover (8), cohort (4), cross-section (8), and case-study (1) designs were included that reported accelerometer (19) or pedometer (2) data. Studies often mixed amputation etiologies (15/21) and most (13/21) excluded transfemoral amputations (TFA). Studies primarily examined people with transtibial amputations (TTA = 81.2%) and people at independent community walking levels (K3 = 49.2%, K4 = 36.3%). All 21 studies had N < 100, and overall included 515 combined subjects (343, 66.6% male), aged 53.2 (22.1) years. Pooled steps per day for PLL was 5087 (2998): 5929 (3047) for TTA and 3553 (2030) for TFA.
Conclusions: Most PLL have low activity levels compared to the 10,000 generally recommended or 6000 common in people with diabetes. Research with larger samples, defined subgroups, and data along the recovery continuum would enhance knowledge of physical activity level in PLL. Impact statement: This scoping review has identified gaps in the research related to steps per day as a measure of physical activity in people with lower-limb loss to guide future research. Lay Summary: People with lower-limb loss take fewer steps per day than suggested for general health. Increasing steps per day may be a useful goal for this population, and this study is a first step in improving knowledge of physical activity levels in people with lower-limb loss.
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