Global Prosthetic Provision Rate After Major Lower Extremity Amputation for Dysvascular Populations From Four Continents: A Scoping Review
Abstract
Importance: Lower extremity amputation (LEA) is a worldwide public health problem leading to large disability burdens and health care costs. After LEA, prostheses improve functional mobility and quality-of-life. However, health care costs are high and prosthetic provision worldwide is unknown.
Objective: The objective was to map the worldwide evidence for prosthetic provision rates after major dysvascular LEA to identify evidence gaps.
Design: This scoping review followed best practices and PRISMA-Sc guidelines. Of 609 abstracts screened and 28 full texts reviewed, 18 articles were included.
Setting/exposures: Five databases were searched without language limits using Medical Subject Headings (MeSH) and keyword search terms. The Population-Concept-Context framework included people with major dysvascular LEA, prosthetic provision, and health care models.
Participants: Seventeen cohorts and 1 case-control study involved 31,982 people (7.7% female, 16.5% Americans from racial and ethnic minority groups), mean age 68.1 years, 85.0% after dysvascular LEA (61.4% transtibial).
Main outcomes: The outcome of interest was prosthetic provision rates.
Results: The overall prosthetic provision rate from 10 countries was 48.5%: 48.6% for high-income (16/18) and 39.2% for middle-income (2/18) countries. The 1 Bismarck not-for-profit universal health care model country had the highest provision rate (73.7%); 4 studies from 3 Beveridge/Bismarck model countries reported 59.3% provision. Most…
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