Global Prosthetic Provision Rate After Major Lower Extremity Amputation for Dysvascular Populations From Four Continents: A Scoping Review

Importance Lower extremity amputation (LEA) is a worldwide public health problem leading to large disability burdens and health care costs. After LEA, prostheses improve functional mobility and quality-of-life. However, health care costs are high and prosthetic provision worldwide unknown. Objective The objective was to map the worldwide evidence for prosthetic provision rates after major dysvascular LEA to identify evidence gaps. Design This scoping review followed best practices and PRISMA-Sc guidelines. Of 609 abstracts screened and 28 full texts reviewed, 18 articles were included. Setting/Exposures Five databases were searched without language limits using MESH and keyword search terms. The Population-Concept-Context framework included people with major dysvascular LEA, prosthetic provision, and health care models. Participants Seventeen cohorts and 1 case-control study involved 31,982 people (7.7% female, 16.5% Americans from racial and ethnic minority groups), mean age 68.1 years, 85.0% after dysvascular LEA (61.4% transitibial). Main Outcomes The outcome of interest was prosthetic provision rates. Results Overall prosthetic provision rate from 10 countries was 48.5%: 48.6% high-income (16/18), 39.2% middle-income (2/18) countries. The 1 Bismark not-for-profit universal health care model country had the highest provision rate (73.7%); 4 studies from 3 Beveridge/Bismark model countries reported 59.3% provision. Most participants were from the hybrid USA system with 6 studies reporting 48.8% provision. Provision rate in 6 studies from 4 Beveridge government financed care model countries was 41.2%, and 32% in the fee-for-service country. Lower prosthetic provision rates were observed for transfemoral compared to transtibial amputations, female compared to male sex, and Americans from racial and ethnic minority groups compared to White race. Conclusions Fewer than half receive prostheses after LEA worldwide. Differences among country health care models and income levels; lack of African, South American, and low-income country studies, and low prosthetic provision for people of female sex and Americans from racial and ethnic minority groups exposed evidence gaps for future research. Relevance Limited provision of prostheses that improve quality-of-life highlights the need to understand factors affecting prosthetic decisions and health care policies.