Elevated Vacuum Suspension Systems for Adults with Amputation: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines

Details

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Project Status:
Completed
Project Line:
Health Technology Review
Project Sub Line:
Summary with Critical Appraisal
Project Number:
RC1224-000

Question

  1. What is the clinical effectiveness of elevated vacuum suspension systems versus standard prosthetic systems for adults with amputation?
  2. What is the cost-effectiveness of elevated vacuum suspension systems versus standard prosthetic systems for adults with amputation?
  3. What are the evidence-based guidelines regarding the use of elevated vacuum suspension systems?

Key Message

​Three relevant systematic reviews, five randomized controlled trials, and five non-randomized studies were identified regarding the clinical effectiveness of elevated vacuum suspension systems for adults (≥18 years of age) with amputation. Evidence of limited quality suggested that elevated vacuum suspension systems may improve balance, physical capability, prosthetic pistoning, fear and risk of falling, residual limb volume, and skin health compared to non-vacuum suspension systems in adults with amputation; however, there was inconsistency in these results (i.e., in several instances there were no statistically significant differences between vacuum suspension systems and standard prosthetic systems). Two evidence-based guidelines regarding the use of elevated vacuum suspension systems were identified. One guideline suggests that vacuum assisted suspension sockets permit the least amount of pistoning, followed by suction suspension and pin-lock suspension systems. The guideline also recommends that vacuum suspension systems may decrease daily limb volume fluctuations and facilitate favourable pressure distribution during gait compared to other suspension systems. Despite these positive recommendations, the authors of the guideline noted that vacuum assisted suspension sockets are not universally indicated and that awareness and compliance are required from the user of the device. The strength of these recommendations was not assessed. The second guideline stated that there was insufficient evidence to recommend for or against any particular prosthetic suspension system for adults with lower limb amputation (weak recommendation). No evidence regarding the cost-effectiveness of elevated vacuum suspension systems versus standard prosthetic systems for adults with amputation was identified. The limitations of the included studies (e.g., high risk of performance bias due to a lack of blinding, lack of long-term follow-up data) should be considered when interpreting the findings of this report.