Consensus, Recommendations, and Guidelines for Prosthetic Limb Prescription: A Scoping Review

ABSTRACT Background Prosthetists must consider numerous factors when selecting prosthetic components to optimize outcomes for their patients, potentially consulting Clinical Practice Guidelines to do so. However, given the vast array of prosthetic components available, gaps in guidelines may exist, and for some cutting-edge prosthetic developments, clinical evidence may be sparse. Objectives The aims of the study were to compile and summarize the available literature concerning consensus, guidelines, or recommendations for prosthetic prescription, including prosthetic components, connectors, suspension, and alignment. Study Design This scoping review adhered to PRISMA-ScR guidelines. Records from Cochrane Reviews, Cochrane Trials, Embase, PubMed, and Web of Science databases were independently screened by pairs of reviewers. Records were included if they focused on prosthesis selection and used knowledge synthesis methodology. Knowledge synthesis employed meta-study methodology and focused on the role of prosthetists’ decision making in this process. Results An overwhelming majority of reports included in this scoping review focused on prosthetic componentry for people with lower-limb amputation, while substantially fewer focused on prosthetic componentry for upper-limb amputation. In both cases, reports frequently did not explicitly consider prosthetic components for patients with joint disarticulation amputation or partial foot/hand amputation. Additionally, all studies based their recommendations on the assumption that patients were using socket prostheses. It is therefore unclear to what extent recommendations can be successfully translated to patients with osseointegration. Conclusions Few recommendations exist regarding prosthetic care for joint disarticulation or partial foot/hand amputation, pediatric cases, and bone-anchored limbs. Addressing these knowledge gaps will contribute to ongoing efforts within the field to enhance quality of life for individuals with limb loss and limb difference. Clinical Relevance Most consensus, recommendations, and guidelines for prosthetic limb prescription focus on prosthetic feet and knees for patients with transtibial and transfemoral amputations. Few, if any, recommendations exist for pediatric prostheses, joint disarticulation prostheses, and prosthetic components for patients with bone-anchored limbs.