Effects of prosthetic mass and mass distribution on kinematics and energetics of prosthetic gait: a systematic review.

OBJECTIVE To introduce the theoretical models used in literature that describe the relation between prosthetic inertial loading and amputee gait and to derive specific predictions from these models: to systematically review experimental studies on the relation between prosthetic inertial loading and energetics and kinematics of lower-limb prosthetic gait; and to compare the review outcomes with predictions derived from theoretical models. DATA SOURCES Studies selected from Medline and from examining references in the selected Medline publications. STUDY SELECTION Theoretical models were selected that are used in the present literature to predict the effects of prosthetic mass and mass distribution on kinematics and energetics of prosthetic gait. Experimental studies were selected that investigated the effects of prosthetic mass or center of mass location on the economy, self-selected walking speed, stride length, or stride frequency of lower limb amputee patients. DATA EXTRACTION The design and methodologic quality was assessed using a checklist of nine criteria. Data on economy, self-selected walking speed, stride frequency, and stride length were extracted from the studies selected. DATA SYNTHESIS The predictions of the theoretical models suggest that inertial loading of the present lightweight prostheses need not be decreased and sometimes may need to be increased to improve the gait of amputee patients. The methodologic quality of most of the experimental studies was limited. Review of the experimental studies suggests that the inertial loading of the present lightweight prostheses need not be further reduced. The discrepancy between theoretical models and experimental findings may be related to both the poor methodologic quality of the experiments as well as to the limited predictive value of the existing models.