Minimising bone mineral density loss in traumatic amputees: a randomised controlled feasibility trial

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Recent conflicts in Iraq and Afghanistan have resulted in a large amount of traumatic or surgical lower limb amputations. Road traffic accidents also produce several extremity injuries (32%), including amputations. Hip bone mineral density (BMD) is reduced following amputation, increasing the risk of hip fractures on the amputated limb. This is compounded by a higher risk of falls in the amputee population. Previous interventions in parallel clinical populations have demonstrated the effectiveness of exercise interventions in recovering BMD loss. However, these types of exercise interventions have not been attempted in the amputee population. BMD loss in amputees appears to be local and mechanical in nature, requiring biomechanically informed interventions. Therefore, immediate investigation on the effectiveness of biomechanically informed interventions to minimise BMD loss in this population is required. To design an intervention where no direct evidence exists, a Delphi process, a consensus method involving experts in the area, would offer a systematic approach that has been applied in the literature extensively. Subsequently, this would inform a randomised controlled feasibility trial to assess the acceptability of an exercise intervention in this population to minimise BMD loss. Consequently, this study aims to design and implement a randomised controlled feasibility study to reduce bone mineral density loss in post-traumatic lower limb amputees.