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When to biomechanically examine a lower-limb amputee: A systematic review of accommodation times

Background: Hundreds of investigations examining biomechanical outcomes of various prostheses have been completed, but one question remains unanswered: how much time should an amputee be given to accommodate to a new prosthesis prior to biomechanical testing? Objective: To examine the literature for accommodation time given during biomechanical investigations to determine whether consensus exists. Study design: Systematic review. Methods: A systematic search was completed on 7 January 2016 using PubMed and Scopus. Results: The search resulted in 156 investigations. Twenty-eight studies did not provide an accommodation or were unclear (e.g. provided a “break in period”), 5 studies tested their participants more than once, 25 tested only once and on the same day participants received a new prosthesis (median (range): above-knee: 60 (10–300) min; below-knee: 18 (5–300) min), and 98 tested once and gave a minimum of 1 day for accommodation (hip: 77 (60–180) days; above-knee: 42 (1–540) days; below-knee: 21 (1–475) days). Conclusion: The lack of research specifically examining accommodation and the high variability in this review’s results indicates that it remains undecided how much accommodation is necessary. There is a need for longitudinal biomechanical investigations to determine how outcomes change as amputees accommodate to a new prosthesis. Clinical relevance The results of this review indicate that little research has been done regarding lower-limb amputees accommodating to a new prosthesis. Improper accommodation could lead to increased variability in results, results that are not reflective of long-term use, and could cause clinicians to make inappropriate decisions regarding a prosthesis.