Samenvatting

Purpose: With this project the purpose is to promote the field of physiotherapeutic amputee rehabilitation. A physiotherapeutic treatment protocol of the lower extremity amputee including a simple guidance of prosthetic adjustments is made for the benefit of physiotherapy student's, physiotherapists, their patients and the physiotherapeutic profession itself. The project aims at enabling the physiotherapy students/physiotherapist to work within the field of amputation rehabilitation, providing them with sufficient information to problem solve within the clinical environment.
Method: A literature research was done through (computerised) databases and through contacting key figures (professionals). Literature containing information about the multidisciplinary, physiotherapeutic and prosthetic management of the amputee, including books, articles and protocols, was used. Only literature more recent than 1950, coming from industrial countries and written in Norwegian, English, Dutch or Swedish was used. The patients included in the literature were male or female, aged 16-99, with a right or left transtibial or transfemoral amputation. They were all first-time users of a prosthesis, in the rehabilitation phase and had no other physical complaints. In addition, only literature with amputees who were able to function in ADL was included. The protocol and guidance produced was based on the end product.
Results: In the end product report all the information obtained is explained in detail. To be able to understand the physiotherapeutic treatment of an amputee, the end product was divided into two parts. Part A contains all the background information, while part B is the part describing the physiotherapeutic treatment program of the transfemoral and transtibial amputee. This treatment program is divided into the observational phase, the treatment phase and the end phase, and it is based on the classification of the ICF (ICIDH). From the end product report a physiotherapeutic treatment protocol for the transtibial and transfemoral amputee including a simple guidance of prosthetic adjustments was made.
Discussion: Although a considerable amount of literature was found the quality of these literature sources was difficult to judge. Before carrying out the project it was assumed that much evidence-based literature would be found, unfortunately this was not the case2, 3,6,7,10,1. Even the literature of more recent date did not have any new developments when it came to the rehabilitation of the transtibial and the transfemoral amputee7, 10,1. Because not a lot of evidence based literature could be found, the literature sources used were mostly books and key-figures (professionals or patients). A direct comparison of the results of the different studies was difficult to make. The literature did not make a difference between the rehabilitation of the young (usually traumatic) and the older (usually vascular) amputee, and made hardly any difference between transtibial and transfemoral amputee rehabilitation process2, 3,6,7,10,1. The project group could, however, agree on not making a difference between the physiotherapeutic rehabilitation of the transtibial and the transfemoral amputee, as the rehabilitation of the two is more or less the same2,6.
Conclusion: From the end product it was possible to make a physiotherapeutic treatment program for the trenstibial and the transfemoral amputee including a simple guidance of prosthetic adjustments. The treatment of these two amputees is almost identical, also when compared between different countries. The year of publication of the found literature varied, which made clear that the progress in rehabilitation of the lower limb amputee has not advanced much the latest 50 years.