Postoperative rehabilitation after lower limb amputation due to peripheral arterial disease: scoping review

No.	Study (author, year)	Title	Country	Type of study
S1	MarzenGroller et al. (2008)³⁶	“Testing the effectiveness of the AMP: a pilot study”	USA	Observational: pre and post program implementation
S2	Sheikh et al. (2024)³⁸	“Tailored physiotherapy combined with exercises for enhanced recovery post-below-knee amputation in a diabetic patient with PAD: a case report”	India	Case report
S3	O’Banion et al. (2020)³⁹	“Outcomes of major lower extremity amputations in dysvascular patients: room for improvement”	USA	Observational, retrospective study
S4	Hermodsson & Ekdahl (1999)⁴⁰	“Early planning of care and rehabilitation after amputation for vascular disease by means of Katz index of activities of daily living”	Sweden	Observational, predictive study
S5	Wong et al. (2024)³⁵	“A scoping review of postoperative early rehabilitation programs after dysvascular - related amputations”	USA	Scoping Review: 8 studies: 2 retrospective cohort studies, 3 case-control studies, 2 single-group interventional studies, and 1 case study

Table 2.

Rehabilitation interventions.

Study	Main components of interventions or programs
S1	AMP with divergent interventions between people with BKA or AKA amputation: - Day 1: exercises in bed - Second day: transfer to chair - Third day: beginning of the march to discharge - Control of postoperative edema - Gradual gait patterns - Assessment of emotions through therapeutic communication and direct observation - Consistent reinforcement and immediate positive feedback
S2	Components of the Rehabilitation process: - Education of the person about the effects of rehabilitation focused on the person’s goals and necessary care - Pain relief: TENS waves and cryotherapy - Positioning and edema control: elevation, prone position, compression - Prevention of respiratory complications: breathing exercises - Prevention of muscle atrophy: range of motion exercises - Promote stump healing: infrared radiation therapy - Promote muscle strengthening: strengthening exercises for the lower limbs, core and upper limbs - Promote mobility in bed: rolling and transfer exercises - Promote balance and coordination: sitting and standing - Promote mobility: gait training started with a walker - Promotion of pre-prosthetic education: pre-prosthetic preparation, compressive bandage, soft tissue mobilization, weight distribution and limb care
S3	Rehabilitation interventions in surgery or vascular services: - Transfer from bed to chair as early as possible - Non-weight-bearing exercises - Strengthening of the upper limbs Rehabilitation Unit Rehabilitation Program: Not described
S4	- Circular dressing for 3 weeks - Stitches removed after 3 weeks if healed, after which elastic modulating stockings are placed - On the third day: - Strengthening exercises - Verticalization training - Transfer training - The person and caregiver begin interacting with other amputees in the group - Physical and psychosocial interventions are coordinated by the multidisciplinary team in the initial phase of rehabilitation, functional capacity exams and prosthesis.
S5	postoperative mobilization in the first 3 postoperative days.

[i] Note: AKA, amputation above the knee; AMP, amputee mobility protocol; BKA, amputation below the knee; FIM, functional independence measure; TENS, transcutaneous electrical nerve stimulation; TMA, tansmetatarsal amputation.

Table 3.

Assessment of rehabilitation interventions.

Study	Start phase	Assessment moments	Indicators/instruments
S1	- Post-operative - Early post-operative period: first post-operative day	Assessment with the modified FIM Scale in the preoperative period Assessment throughout hospitalization after amputation.	- Functional mobility: FIM modified - Length of hospital stay
S2	- Acute postoperative: second postoperative day	Second postoperative day Fourth week	- Numerical Pain Rating Scale Beck Depression Inventory Scale, - Manual muscle strength tests - Range of motion tests
S3	Between the day of surgery and the fourth postoperative day	One day before surgery or between the first and fourth postoperative day After completing rehabilitation (in units or at home)	- Postoperative–Length of hospital stay - Disposition for discharge - Time until ambulation
S4	Early post-operative period–starting on the third day	- Upon admission to the orthopedic service - 5–7 d after amputation - 1 month post-operatively - 6 months post-operatively	- Katz index - Duration of hospital stay - Discharge home - Mortality at 1 month
S5	Early postoperative period	Not applicable	- Various results reported in the 8 studies

[i] Note: FIM, Functional Independence Measure.

Table 4.

Characteristics of inventions.

Study	Frequency (sessions/week)	Duration, intensity, periodicity
S1	Interventions carried out daily	5-month program Hospitalization with an average duration of approximately 18.3 d
S2	Exercises performed daily - Exercises with sets of 10 repetitions - Cryotherapy applied 2–3 times a day	Duration per session: Cryotherapy for 15–20 min; infrared radiation for 10–15 min per week for healing and 20 min in the fourth week for scar management; gait training for 10–15 min 4-week intervention
S3	Daily	Upper limb strengthening exercises and non-weight-bearing exercises can be initiated preoperatively In the first intervention, the person is transferred from the bed to the chair during hospitalization
S4	No information	Does not specify duration, intensity, and periodicity Program can be continued at home
S5	No information	Variable in different studies with and without prosthesis

Table 5.

Health professionals implementing the intervention.

Study	Context	Professionals involved
S1	Acute care unit (vascular medical-surgical unit in an academic community hospital)	Multidisciplinary team (nurses, physiotherapists, researchers, and vascular surgeon)
S2	Phase - in hospitalization	Physiotherapist Nursing team
S3	Regional hospital	Multidisciplinary team (surgeons, physiotherapists)
S4	Orthopedic service	Multidisciplinary team (nursing, therapists, surgeons)
S5	Acute postoperative care	Multidisciplinary team

Table 6.

Results related to functional independence.

Study	Length of hospital stay	Walking ability/mobility	Level of independence
S1	- Pre protocol (AMP): 15.3 d - Pos protocol (AMP): 18.3 d	- Improved functional mobility (FIM): the TMA group had a significant increase in walking distance - Reduction in hospital stay: 0.7 d in TMA; 7.1 d in BKA and 2.7 d in AKA	- 64% of post-AMP patients were able to return home or go to a rehabilitation center, compared to 44% of the pre-AMP group
S2	- Pre-operative: 5 d - Post-operative: approximately 4 weeks	- Increased mobility: walking with a walker - Increased muscle strength - Increased joint range of motion	- Ability to walk with a walker - Pain control
S3	Average length of stay in the surgical unit: - 4 d ± 3 d for transfers to acute rehabilitation units - 5 d ± 3 d for home transfers - 8 d ± 8 d for transfers to specialized nursing institutions Total rehabilitation time (in institution or at home): 224 d (95–567 d)	- Faster ambulation with physical therapy after transfer to a rehabilitation unit	Functional independence on day 5–7 (Katz index): - 2 people level A and B - 92% (47/51) level E to G (unable to stand on one leg)
S4	- 20% home discharge ≤1 month - 62% (32/52) discharged ≤6 months - 7 people high >6 months	No information	No information
S5	- Variable (not reported by all studies)	Safe early mobilization - People without temporary prosthesis have a higher risk of falling	- The review indicated that early mobilization led to functional gains and benefits in FIM mobility score

[i] Note: AKA, amputation above the knee; AMP, amputee mobility protocol; BKA, amputation below the knee; FIM, functional independence measure; TMA, tansmetatarsal amputation.

Table 7.

Complications and adaptation to the prosthesis.

Study	Complications	Adaptation to the prosthesis
S1	- After the protocol (AMP): no thrombotic events - Pre-protocol (AMP) group with 10% thrombotic events	No information
S2	- Pain - Decreased muscle strength - Decreased body alignment and balance	Pre-prosthetic training for future adaptation to the prosthesis: pre-prosthetic teachings carried out
S3	- 15% - surgical wound infection - 15% - readmission - 7% - mortality - 1 case of reamputation (BKA to AKA)	Received prosthesis: 44% Rehabilitation brought forward delivery by about 1 month
S4	- 4% mortality in the first month (2/52 people) - 25% mortality at 6 months (13 users) - 90% malnourished at the time of amputation	After 1 month of surgery: 0 people with prosthesis
S5	- Reamputation surgeries - Falls - Wound healing problems	Temporary prostheses in 5/8 studies (132 patients) associated with faster prosthetic fitting (2–2.4 months versus 5.1 months for those without temporary prosthesis)

[i] Note: AKA, amputation above the knee; AMP, amputee mobility protocol; BKA, amputation below the knee.

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DOI: https://doi.org/10.2478/fon-2026-0032 | Journal eISSN: 2544-8994 | Journal ISSN: 2097-5368

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Language: English

Page range: 227 - 290

Submitted on: Nov 11, 2025

Accepted on: Dec 8, 2025

Published on: Sep 25, 2026

Published by: Shanxi Medical Periodical Press

In partnership with: Paradigm Publishing Services

Keywords:

peripheral arterial disease,

Related subjects:

Assistive professions, nursing

© 2026 Isabel Margarida Silva Costa dos Santos, Isabel de Jesus Oliveira, Vitor Sérgio de Oliveira Parola, published by Shanxi Medical Periodical Press
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 13 (2026): Issue 3 (September 2026)

Postoperative rehabilitation after lower limb amputation due to peripheral arterial disease: scoping review

Figures & Tables

Figure 1.

Table 1.