Do rigid dressings reduce the time from amputation to prosthetic fitting? A systematic review and meta-analysis.

OBJECTIVE To investigate whether application of a rigid dressing (RD) to the residual limb soon after transtibial amputation reduces the time from amputation to the first prosthetic casting/fitting compared with the residual limb managed with a soft dressing (SD). DATA SOURCES Studies in humans were identified by a systematic search of MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials to December 2013. Search terms were based on appropriate medical subject headings and other free-text headings combining the following key words: "amputation," "amputation stumps," "transtibial," "lower limb," "post operative dressing," "removable rigid dressing," "rigid dressing," "wound healing," "rehabilitation," and "prosthetic." Reference lists of the relevant retrieved studies were checked for further studies. Papers could be published in English or other languages. STUDY SELECTION Randomized controlled trials (RCT) and cross-sectional studies that included adults who had an amputation of the lower limb were included. Initial literature search identified 356 potentially relevant articles. Review of abstracts and subsequently full text identified 6 studies included in the meta-analysis. Of these studies, 2 were RCT and 4 were retrospective cross-sectional studies. DATA EXTRACTION Data were extracted by one reviewer and then checked by another reviewer. DATA SYNTHESIS The use of RD resulted in significantly shorter time from amputation to casting or fitting of the prosthesis. Pooled standardized mean difference (SMD) from meta-analysis using DerSimonian and Laird random effect model was 0.46 (95% confidence interval: 0.19-0.73; P = 0.001), with 54% variation in SMD attributable to heterogeneity (I(2) = 0.539, P = 0.06). No evidence of small study effect has been found. The quality of reporting of the results varied, with some important elements omitted in the publications. CONCLUSIONS Patients who are fitted with RD post transtibial amputation commence prosthetic management sooner than those managed with SD.