Assessment of pain and functional outcomes after lower limb amputation: a scoping review

TL;DR

This review examines how pain and mobility are assessed after lower limb amputation and finds that pain is often linked to reduced function, but inconsistent methods limit comparisons.

Contribution

The study provides a comprehensive overview of assessment methods and associations between postamputation pain and functional outcomes.

Findings

Phantom limb pain is linked to gait and balance issues.

Residual limb pain correlates with limited walking and community participation.

Low back pain is associated with gait asymmetry and increased energy cost.

Abstract

Pain, including phantom limb pain (PLP), residual limb pain (RLP) and low back pain (LBP), is highly prevalent after lower limb amputation (LLA) and compromises quality of life. Although both pain and function have been studied extensively, methods of assessment and reporting vary, limiting comparability. A clearer overview of how these domains are measured and interrelated is needed to guide research and practice.

To synthesise evidence on how postamputation pain and functional outcomes have been assessed and reported in adults with LLA, and to examine reported relationships between pain and mobility/function.

Scoping review guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews.

MEDLINE, Embase and PsycINFO (inception to 15 August 2025).

Quantitative studies that measured pain and functional outcome in adults with LLA.

Two reviewers independently extracted study characteristics, pain measures and functional outcomes in Covidence; findings were narratively synthesised.

Eighty-four studies were included. RLP (n=46), LBP (n=32) and PLP (n=28) were most frequently examined. Pain was mainly assessed by self-report scales; mobility was typically assessed by clinical tests and less often by biomechanical instrumentation. PLP was associated with altered gait and balance deficits; RLP with limited walking distance, asymmetric weight-bearing and reduced community participation; LBP with gait asymmetry, trunk–pelvis discoordination and increased energy cost of walking.

Postamputation pain is often linked to reduced mobility and functional limitations. However, heterogeneous definitions and inconsistent methodology hinder synthesis across studies. Future research should combine validated pain scales with objective analysis, wearable sensors and musculoskeletal modelling to clarify mechanisms and inform rehabilitation.

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