Eight studies were included in the review, with 219 participants (range 10 to 100). According to the table of study designs (Table 1), there were two RCTs, one case-control study, three before-and-after studies, and two observational cross-over studies. Scores for internal validity ranged from 5 to 8 points. Seven of eight studies scored 3 or 4 points for external validity. Only two studies scored highly for both internal and external validity. Follow-up was under four months in all except one study (range four weeks to two years, where reported).
Five of seven studies that reported activity or participation found a significant difference between the groups for at least one measure. Two of three relevant studies reported benefit from a microprocessor-controlled (compared with a non-microprocessor-controlled) knee; the third study found no significant difference between them. Single studies reported benefits from a neoprene-suspension sleeve (compared to an elastomeric-suspension liner), a silicon (compared with non-silicon) cover prosthesis, and an osseo-integrated transfemoral amputation prosthesis (compared with a conventional prosthesis). One study found no significant difference between a shock-absorbing versus a rigid-pylon prosthesis.
Four of five studies reported that there was a significant difference between the groups in quality of life for at least one measure. Interventions associated with benefits (relative to their comparator) were the osseo-integrated transfemoral amputation prosthesis (one study) and the microprocessor-controlled knee (three studies). No significant difference was found between a silicon and non-silicon cover prosthesis for quality of life outcomes.
Findings for secondary outcomes were also reported in the review.