Physiotherapy Interventions for Adults with Lower-Limb Amputation: Systematic Review of Effects on Quality of Life and Functional Outcomes

Abstract Background: Lower-limb amputation substantially affects mobility, functional independence, and quality of life (QoL) due to altered gait mechanics, pain, and psychosocial challenges. Physiotherapy interventions aim to restore function, improve gait, reduce falls, and manage pain. Objective: To systematically review randomized controlled trials (RCTs) evaluating the effectiveness of physiotherapy interventions on QoL and secondary functional outcomes in adults with lower-limb amputation. Methods: A systematic search was conducted in PubMed, Embase, Cochrane, and PEDro from 2015 to 2025, following PRISMA 2020 guidelines, yielding 302 records. Eligible RCTs involving physiotherapy interventions for adults with lower-limb amputation were included. Risk of bias was assessed using the PEDro scale and Cochrane tools, and the certainty of evidence for QoL outcomes was evaluated using GRADE methodology. The review was prospectively registered in PROSPERO (ID: 1128315). Due to heterogeneity in interventions, outcomes, and study designs, a narrative synthesis was performed. Results: Seven RCTs (n = 185) met inclusion criteria. Interventions included back school programs, Wii Fit exercises, personalized exercise programs, low-cost physiotherapy programs, Hull Early Walking Aid, phantom exercises, and prosthetic knee training. Evidence indicates that physiotherapy interventions improve QoL and secondary outcomes, including walking speed, balance, gait biomechanics, pain management, and prosthesis adaptation. Conclusion: Physiotherapy interventions are effective in enhancing QoL and functional outcomes in adults with lower-limb amputation. Implementation of individualized, multi-component rehabilitation programs is recommended. Further large-scale RCTs with standardized protocols and long-term follow-up are needed to strengthen the evidence base and guide clinical practice.