Igor

Hyperbaric oxygen therapy may improve mobility, reduce complications and return circulation in post-amputation patients have rehabilitation for prosthesis fitting.

Clinical bottom line:

1. Evidence of a number of benefits in mobility and return of peripheral circulation in patients undergoing a rehabilitation program for prosthesis fitting

 

Citation/s: 1, Igor S, Mirka T, Dalibor P, Milutin R, Dusica D, Vladimir Z, Vladimir J. Hyperbaric oxygenation accelerates prosthetic rehabilitation of lower limb amputees. Undersea and Hyperbaric Medicine 2013;40(3):289-287.

Lead author's name and fax: J Vladimir drvladakgbg@yahoo.com

Three-part Clinical Question:' For patients undergoing rehabilitation and the fitting of prosthetic limbs after amputation, does the addition of hyperbaric oxygen therapy improve rehabilitation?

Search Terms: amputation; rehabilitation; prosthesis

The Study: Non-blinded randomised controlled trial with intention-to-treat.

The Study Patients: Patients with unilateral lower limb amputation and where a rehabilitation program for fitting of a prosthetic limb is planned.

Control group (N = 30; 30 analysed): A standard prosthetic assessment and rehabilitation program including orthopaedic assessment, physiotherapy, laser therapy, magnetotherapy, electrotherapy, thermotherapy and electrical stimulation.

Experimental group (N = 30; 30 analysed): As above plus 15 sessions of HBOT at 1.7 ATA for 60 minutes

 

The Evidence:

Outcome	Time to Outcome	Control Group	Hyperbaric Group	Relative risk reduction	Absolute risk reduction	NNT
Complications (e.g. dehiscence, phantom pain, haematoma)	Discharge	1.00	0.87	13%	0.13	8
			95% CIs:	1% to 25%	0.01 to 0.26	4 to 87
Stump contracture	Discharge	0.20	0.13	34%	0.07	15
			95% CIs:	-60% to 100%	-0.12 to 0.26	NNT 4 to INF; NNH8 to INF
Return of palpable peripheral pulses	Discharge	0	0.27	INF	0.27	4
			95% CIs:		0.11 to 0.43	2 to 9

 

Measure			Control Group		Hyperbaric Group	Difference	95% CI
	Mean	SD		Mean	SD
Locomotor capability index at discharge	34	9		38	11	4	1.2 to 9.2
Two minute walking test at discharge (feet)	74	21		90	32	16	2.0 to 30.0

Comments:

1. Functional outcome using an 'adapted Narang Scale' is not explained so omitted here.

2. Locomotor capability index and thigh girth have been read from a graph.

3. Other benefits stated in the paper not quantified - only p-values given.

4. It is difficult to understand how HBOT can return palpable peripheral pulses as suggested here. Authors suggest "we can assume that HBO2 significantly affected peripheral vascularization of our patients". This is an extraordinary claim.

5. Many findings in this study have a high chance of bias due to the unblinded nature of the study.

Appraised by: Mike Bennett m.bennett@unsw.edu.au ; Sunday, 1 October 2017

Kill or Update By: July 2021

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