Global Prosthetic Provision Rate After Major Lower Extremity Amputation for Dysvascular Populations From Four Continents: A Scoping Review.

Abstract

<h4>Importance</h4>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.<h4>Objective</h4>The objective was to map the worldwide evidence for prosthetic provision rates after major dysvascular LEA to identify evidence gaps.<h4>Design</h4>This scoping review followed best practices and PRISMA-Sc guidelines. Of 609 abstracts screened and 28 full texts reviewed, 18 articles were included.<h4>Setting/exposures</h4>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.<h4>Participants</h4>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).<h4>Main outcomes</h4>The outcome of interest was prosthetic provision rates.<h4>Results</h4>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 participants were from the hybrid US system, with 6 studies reporting 48.8% provision. Provision rate in 6 studies from 4 Beveridge government-financed care model countries was 41.2%, and 32% in the fee-for-service country. Lower prosthetic provision rates were observed for transfemoral compared with transtibial amputations, female compared with male sex, and Americans from racial and ethnic minority groups compared with White race.<h4>Conclusions</h4>Fewer than half receive prostheses after LEA worldwide. Differences among country health care models and income levels; lack of African, South American, and low-income country studies; and low prosthetic provision for people of female sex and Americans from racial and ethnic minority groups exposed evidence gaps for future research.<h4>Relevance</h4>Limited provision of prostheses that improve quality-of-life highlights the need to understand factors affecting prosthetic decisions and health care policies.