State-of-the-Science Review of Transtibial Prosthesis Alignment Perturbation

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Journal of Prosthetics and Orthotics





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A systematic review of research on the effects of transtibial prosthesis alignment perturbation on gait was carried out following guidelines prepared by the American Academy of Orthotists and Prosthetists. Approximately 278 references published since 1973 were obtained by searching key data bases and then screened for relevance, resulting in 34 published research articles, which were evaluated for internal and external validity using published criteria and assigned ratings of high, moderate, or low. A matrix was developed that classified the 34 articles by the type of alignment perturbations undertaken and the outcome measures used. The matrix used eight categories of perturbations and 43 distinct outcomes measures related to the total body, gait symmetry, EMG and oxygen consumption, and kinematic and kinetic measurements of the prosthetic and contralateral limb. These articles were used to generate 113 evidence statements pertaining to the effect of alignment perturbation on gait. Each of the statements was assigned a confidence rating of high, moderate, low, or insufficient evidence based on the volume and quality of the published evidence. Forty-three statements judged to have high or moderate levels of confidence associated with them are presented and discussed, along with recommendations concerning future research on alignment perturbation studies.


Amputees; Amputee gait; Gait in humans; Prosthesis; Prosthesis alignment; Systematic review; Systematic reviews (Medical research)


Biomedical Devices and Instrumentation | Civil and Environmental Engineering | Civil Engineering | Engineering | Kinesiology | Systems and Integrative Engineering




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