October 16, 2015

Narrative Review Examines Metabolic Energy Expenditure of Ambulation in Lower-Limb Amputees

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A narrative review of studies about the metabolic energy expenditure of ambulation among people with lower-limb amputations found that methods used to quantify the metabolic energy expenditure do not emulate typical mobility conditions among this population. Stating that the increased metabolic cost of ambulation has been suggested as an important contributor to reduced mobility among people with lower-limb amputations, the reviewers evaluated related research from the perspectives of ecological validity of the research methods and the relative contribution to functional improvement in amputees.

Actual mobility among people with lower-limb amputations is characterized by short bouts of activity with starting, stopping, and changing direction. However, typical metabolic testing protocols require at least five minutes of steady state linear walking on a treadmill, and therefore have limitations to the extent in which they accurately reflect the effect of amputation level, amputation etiology, and prosthetic components on energy consumption during walking.

Further, wrote the researchers, the broader perspective on outcomes after dysvascular amputation and sports participation limitations raises questions about the relative importance of improving metabolic costs and its potential effect on improving mobility in individuals with amputations. They recommend future research that uses methods with improved ecological validity, and the ability to translate metabolic energy expenditure outcomes into functional terms that are meaningful to both clinicians and patients.

The study, “Metabolic energy expenditure of ambulation in lower extremity amputees: what have we learned and what are the next steps?” was published online October 12 in Disability and Rehabilitation.

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