A Systematic Review of Cognitive Functioning and its Relationship to Outcomes Following Amputation Secondary to Vascular Etiology

Abstract

Amputation is a major life event, impacting on all aspects of daily living, and has the goal of achieving maximal patient mobility and independence. The level of cognitive function of those patients who are assigned a prosthesis is an important consideration in the rehabilitation process. Therefore we set out to understand the relationship between cognitive functioning and functional and/or health outcomes following amputation secondary to a vascular condition. This systematic review searched five databases: PsycINFO, Cumulative index to nursing and allied health literature (CINAHL), Scopus, MEDLINE, and Web of Science for peer-reviewed English language articles that met the inclusion criteria. Two authors independently assessed suitability for inclusion, determined biases (Cochrane risk of bias assessment) and extracted data. Results are presented as associations determined on the balance of probabilities. A total of 14 studies were included, with a total of 6891 participants across six domains. Evidence of an association between cognitive function and prosthetic use, mobility and activities of daily living (ADLs) were found. Evidence revealed 83.3% association for cognition and mobility, 66.7% for cognition and ADL, and 62.5% for cognition and prosthetic use. The evidence was indeterminate for an association between cognitive function and living/discharge destination. There was insufficient weight of evidence to determine an association between cognitive function and general health or social participation. The associations found between cognitive function and prosthetic use, mobility and ADL highlight the need for cognitive assessment to form part of the postoperative pathway for vascular amputees.