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Clinical Practice Guidelines for the Rehabilitation of Lower Limb Amputation

An Update from the Department of Veterans Affairs and Department of Defense

Webster, Joseph1,2; Crunkhorn, Andrea3,4,5; James, Sall6,7; Highsmith, M. Jason1,3,8; Pruziner, Alison3,4,5; Randolph, Billie J.3

American Journal of Physical Medicine & Rehabilitation: May 6, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/PHM.0000000000001213
Analysis & Perspective: PDF Only

Between 2015 and 2017, the US Department of Veterans Affairs (VA) and the US Department of Defense (DoD) developed a Clinical Practice Guideline (CPG) for Rehabilitation of Lower Limb Amputation to address key clinical questions. A multidisciplinary workgroup of VA and DoD amputation care subject-matter-experts was formed and an extensive literature search was performed which identified 3,685 citations published from January 2007 through July 2016. Articles were excluded based upon established review criteria resulting in 74 studies being considered as evidence addressing one or more of the identified key issues. The identified literature was evaluated and graded utilizing the National Academies of Science GRADE criteria. Recommendations were formulated following extensive review. Eighteen recommendations were confirmed with four having strong evidence and workgroup confidence in the recommendation. Key recommendations address patient and caregiver education, consideration for the use of rigid and semi-rigid dressings, consideration for the use of microprocessor knees, and managed lifetime care that includes annual transdisciplinary assessments. In conclusion, this CPG utilized the best available evidence from the past 10 years to provide key management recommendations to enhance the quality and consistency of rehabilitation care for persons with lower limb amputation.

1 US Department of Veterans Affairs Rehabilitation and Prosthetic Services

2 Virginia Commonwealth University

3 US Departments of Defense and Veterans Affairs Extremity Trauma & Amputation Center of Excellence

4 Uniformed Services University, Department of Rehabilitation Medicine

5 Department of Rehabilitation, Walter Reed National Military Medical Center

6 US Department of Veterans Affairs Office of Quality, Safety and Value

7 Texas A&M University – Corpus Christi, College of Nursing and Health Sciences

8 University of South Florida. School of Physical Therapy & Rehabilitation Sciences.

Corresponding Author: Joseph B. Webster, M.D.; 1201 Broad Rock Boulevard, Richmond, VA 23112, 804-675-7036,

Disclosure: This work represents the opinions of the authors and not necessarily those of any government agency, academic institution or healthcare agency. This work was fully funded by the Departments of Defense and Veterans Affairs. No funding was received from any commercial entity. Material was presented at the 2018 AAPM&R Annual Assembly on October 26, 2018.

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