June 29, 2016

Literature Review: Evidence Base for Elevated Vacuum Suspension

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An optimal suspension system can improve comfort and quality of life in people with limb loss. To guide practice on prosthetic vacuum suspension systems, assessment of the current evidence and professional opinion are required. Toward that end, a team of researchers based in Canada conducted a literature review and provided professional feedback on the evidence base for the use of elevated vacuum suspension in patients with lower-limb prostheses. The results were published online June 22 in the journal Clinical Biomechanics.

The researchers examined the PubMed, Web of Science, and Google Scholar databases to find related articles. Search terms were amputees, artificial limb, prosthetic suspension, prosthetic liner, vacuum, and prosthesis. The results were refined by vacuum socket or vacuum-assisted suspension or subatmospheric suspension. Study design, research instrument, sample size, and outcome measures were reviewed. An online questionnaire was also designed and distributed worldwide among professionals and prosthetists via www.ispoint.org, the OANDP-L listserv, LinkedIn, and personal e-mail.

According to the findings, 26 articles were published from 2001 to March 2016. The number of study participants averaged seven for those with transtibial amputations and six for those with transfemoral amputations. Most studies evaluated the short-term effects of vacuum systems by measuring residual-limb volume changes, gait parameters, pistoning, interface pressures, satisfaction, balance, and wound healing. In total, 155 professionals replied to the questionnaire and supported results from the literature.

Highlights from the literature review were as follows:

  • Elevated vacuum system could decrease residual-limb volume changes during the day and improve prosthesis control.
  • Elevated vacuum suspension systems can improve proprioception, comfort, gait symmetry, circulation, prosthetic use, and quality of life for device users.
  • Elevated vacuum systems may have some advantages over the other suspension systems, but may not be appropriate for all people with amputations.

The researchers stated that future investigations with larger sample sizes are needed to provide strong statistical conclusions and to evaluate the long-term effects of elevated vacuum suspension systems.

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