Reliability and Validity of Measurement Tools for Residual Limb Volume in People With Limb Amputations: A Systematic Review.

Background: Measurements of residual limb volume often guide decisions on the type and timing of prosthetic prescription. To help inform these decisions, it is important that clinicians use measurement tools that are reliable and valid.

Purpose: The aim of this systematic review was to investigate the reliability and validity of measurement tools for residual limb volume in people with limb amputations.

Data Sources: A comprehensive search on MEDLINE, Embase, CINAHL, SCOPUS, and Web of Science was performed on July 11, 2016.

Study Selection: Studies were included if they examined the reliability or validity of measurement tools for residual limb volume, were conducted on humans, and were published in English.

Data Extraction: Data were extracted from 11 reliability and 4 validity studies and included study characteristics, volumetric estimates, and reliability and validity estimates. The quality of the studies was also rated.

Data Synthesis: Data from 2 studies (38 participants) indicated good to excellent intrarater (ICC of ≥ 0.88) and interrater (ICC of ≥ 0.88) reliability and high between-session reliability (coefficient of variation [CV] = 10%) for water displacement volumetry. One study (28 participants) reported excellent intrarater and interrater reliability (ICC of ≥ 0.93) for the circumferential method, and data from 2 studies (19 participants) indicated high between-session reliability for the optical surface scanner (CV of ≤ 9.8%). Three studies (26 participants) indicated good to excellent between-session reliability results for computed tomography (CV = 9.2%-10.9%). One study (7 participants) showed moderate within-session reliability (CV = 50%). Using water displacement volumetry as the gold standard, 2 studies (79 participants) indicated excellent validity for the circumferential method (r of ≥ 0.92; ICC of ≥ 0.92). All studies reporting measures of reliability or validity were performed with people who had transtibial amputations.

Limitations: Only studies published in English and in which water displacement volumetry was used as the gold standard were included in this review. The reliability and validity of the quality rating scale used in this review have not been tested.

Conclusions: On the basis of a limited number of moderate- to high-quality studies with small sample sizes, circumferential and water displacement methods were found to be reliable, and the circumferential method was found to be valid in people with transtibial amputations. There are inadequate data for drawing conclusions about volume measurement methods in people with other types of limb amputations.