Developing a research agenda on exercise and physical activity for people with limb loss in Canada

How has body image been evaluated among people with lower limb loss? A scoping review

PURPOSE

Lower limb loss can result in an altered body image, leading to changes in self-esteem, mental health and quality of life. This scoping review explored how body image has been evaluated among people with lower limb loss.

MATERIALS AND METHODS

Five databases (Embase, Medline, PsychINFO, CINHAL, and Nursing and Allied Health Database) were searched from inception until March 19, 2023. Inclusion criteria: 1) people with lower limb loss; 2) evaluated a body image outcome or theme; and 3) a qualitative, quantitative or mixed methods design.

RESULTS

Twenty-four quantitative (n = 19 cross-sectional, n = 3 intervention cohort and n = 2 prospective cohort), 2 qualitative and 1 mixed methods design studies were included. The definition of body image varied across studies, with 59% of studies not reporting a conceptual or theoretical definition. People with lower limb loss perceived a more negative body image compared to control groups. In prospective cohort studies, changes in body image over time were inconclusive.

CONCLUSION

People with lower limb loss report a negative body image when compared to other populations. Definitions and understanding of body image changed overtime and varied among studies which may impact introducing interventions to promote positive body image during rehabilitation and beyond in this population.

The Influence of Transtibial Prosthesis Type on Lower-Body Gait Adaptation: A Case Study

Gait parameters are altered and asymmetrical in individuals with transtibial amputation. The purpose of this study was to evaluate and compare the effect of four different prosthetic feet on lower-limb biomechanics during gait. A 34-year-old man with transtibial amputation performed four gait analysis sessions with four foot-ankle prostheses (Variflex, Meridium, Echelon, and Kinterra). Kinematic and kinetic parameters and gait symmetry were analyzed in different prosthetic conditions. The type of prosthesis had little effect on the participant's spatiotemporal parameters. Throughout the stance phase, increased hip angle, reduced knee flexion and ankle dorsiflexion were observed in the amputated leg. For kinetic parameters, reduced propulsive force (SI = 0.42-0.65), reduced knee extension moment (mainly during Echelon and Kinterra conditions, SI = 0.17 and 0.32, respectively), and increased knee abduction moment (mainly during the Variflex and Meridium, SI = 5.74 and 8.93, respectively) were measured in the amputated leg. Lower support moments were observed in the amputated leg as compared to the unaffected leg, regardless of the type of prosthesis (SI = 0.61-0.80). The prostheses tested induced different lower-limb mechanical adaptations. In order to achieve the clinical goal of better gait symmetry between lower limbs, an objective gait analysis could help clinicians to prescribe prosthetic feet based on quantitative measurement indicators to optimize gait rehabilitation.