Fatores associados à adaptação protética em pessoas com amputação transtibial e transfemoral: uma revisão de escopo

Abstract

Lower limb amputations cause major functional limitations and reduced quality of life. Prosthetic adaptation is one of the main goals of rehabilitation after amputation, as it is associated with higher levels of functionality. Different aspects can have an impact on prosthetic adaptation and understanding them is essential for successful rehabilitation. The aim of the study was to identify in the existing literature the factors associated with adaptation to prosthesis use in adult transtibial and transfemoral amputee patients, and how these aspects relate to the components of the International Classification of Functioning, Disability and Health (ICF). A scoping review was carried out by searching the BVS, Pubmed, Web of Science, Scopus and Embase databases. We included experimental or observational studies that addressed aspects associated with the rehabilitation and prosthetic adaptation of patients with transtibial and transfemoral amputations. The studies were independently assessed by two authors using Rayyan software and a third reviewer resolved any discrepancies. The aspects associated with prosthetic adaptation were then classified according to the ICF components. A total of 1,256 articles were found, of which 49 met the inclusion criteria. A total of 38 factors were associated with prosthetic adaptation. Most of them were related to the domains of body function and structure (36.8%) and environmental factors (28,9%). Lower amputation level, advanced age, presence of diabetes, amputation of vascular etiology and comorbidities are non-modifiable factors associated with the prosthetic adaptation process. Among the modifiable factors, rehabilitation programs with emphasis on muscle strengthening of the hip segment, fall prevention, postural and evidence-based control, longer time using the prosthesis, higher levels of physical activity, use of suspension systems with liners and their variations and use of suction sockets stand out. Several modifiable and non-modifiable factors are associated with prosthetic adaptation, with most being linked to the components of body function and structure and environmental factors. Rehabilitation professionals must consider these different aspects when developing strategies aimed at better prosthetic adaptation.