Impact of Sports Prostheses on Sports Participation for Children with Lower Limb Loss/Difference

Clinical Question

Does receiving sports specific prostheses increase sports participation for children with lower limb loss/difference compared to those with only everyday prostheses?

Background

Participation in sports offers psychosocial benefits for children with physical disabilities, including increased health-related quality of life, athletic competence, social acceptance, and self-efficacy.¹ Children with limb differences specifically have reported feelings of accomplishment, satisfaction, confidence, and fulfillment when involved in sports.² Despite these benefits, participation in sports among individuals with lower limb amputation remains relatively low, ranging from just 11-60% in comparison to 58.4% of able-bodied children participating in sports.^{3 4}

Sports-specific prostheses are designed to meet the functional demands of an individual’s chosen sport, often featuring increased energy storage and return, increased shock absorption, and greater propulsion.^5,6 However, only an estimated 13.5% of lower limb prosthesis users utilize a secondary sports prosthesis.⁷  To evaluate medical necessity and support children with limb differences, it is important to determine whether receiving a sports specific prosthesis increases the extent of sports participation in this population.

Search Strategy

Databases Searched: PubMed, Google Scholar, CINAHL

Search Terms: "Artificial Limbs"[Mesh] AND “Pediatrics”[Mesh] AND (sport OR activity OR recreation OR run)

Inclusion Criteria: Published within the last 10 years, peer-reviewed, participants under age 18 using a lower limb sports prosthesis, available in English, primary evidence

Synthesis of Results

Three descriptive qualitative studies evaluated the use and experience of children with limb differences who use sports prostheses.^2,8,9 All three studies utilized convenience sampling,^2,8,9 with sample sizes ranging between 8⁸ and 19² children and/or their parents. Study populations included both upper^2,9 and lower limb^2,8,9 involvement at varying levels. All studies used semi-structured interviews to gather data,^2,8,9 and one included an online survey.⁸

Conclusions are limited by small sample sizes,^2,8,9 lack of member checking of identified themes,^2,8 restricted geographical diversity,^2,8 lack of control groups,^2,8,9 recency bias,⁸ and a failure to differentiate results between upper and lower limb prosthesis users.^2,9

The studies explored child and parental perceived facilitators and barriers to sports participation,² perception of running specific prostheses,⁸ and lived experiences.⁹ Across studies, 77% to 100% of children utilized a sports prosthesis in a variety of activities.^2,8,9 Sports prostheses were perceived to improve participation quality by enabling better posture, increased strength, stability, balance, weight distribution, prevention of contralateral limb overuse,² faster running, higher jumping, and keeping up with peers.⁸ Conversely, some participants felt any prosthesis could hinder participation.² Preferences varied by activity, with children identifying tasks best suited for sports versus everyday prostheses.⁸ Notably, no study directly compared sports participation before and after receiving a sports specific prosthesis.

Clinical Message

This medium-to-low-quality body of evidence indicates mixed results of the effect of sports prostheses on sports participation in children with lower limb differences. While some studies demonstrate improved participation quality,^{2, 8} perceptions vary, and some children report that any prosthesis can be limiting during sports.² Clinically, these data can inform discussions with patients and families inquiring about sports prostheses, offering insight into lived experiences and potential benefits and challenges. Future research should include control groups of age- and condition- matched children who do not utilize a sports prosthesis to better assess comparative sports participation. With 11 U.S. states now mandating insurance coverage for activity specific prostheses,¹⁰ there is growing opportunity for longitudinal studies comparing sports participation before and after receiving a sports prosthesis- offering valuable data to guide both clinical practice and policy.