Abstract
PURPOSE: While some studies report improved outcomes following exercise-based interventions, the overall findings regarding their impact on individuals with lower limb amputation (LLA) remain inconsistent. Therefore, there is a need to synthesize the available evidence. In this regard, this systematic review and meta-analysis aimed to clarify the effects of organized physical activity on quality of life (QoL) and phantom limb pain (PLP) in adults with LLA. METHODS: This review was conducted in accordance with PRISMA 2020 guidelines and registered in PROSPERO (CRD42024582703). Eight databases were searched in November 2024, including PubMed, Embase, Cochrane Library, Web of Science, PsycINFO, SPORTDiscus, ICI World of Papers, and ClinicalTrials.gov. Search terms combined concepts related to amputation, physical activity, quality of life, and phantom limb pain. Studies were included if they examined adults aged 18-60 with lower limb amputation and reported outcomes on quality of life or phantom limb pain following structured physical activity interventions. Only studies using validated outcome measures were considered. RESULTS: Six studies met the inclusion criteria for the systematic review. Three studies (reporting four independent effect sizes) were included in the meta-analysis of QoL outcomes. The pooled effect size was small and not statistically significant (SMD = -0.06, 95% CI: -0.29 to 0.16; p = 0.58), with no observed heterogeneity (I(2) = 0%). Narrative synthesis indicated that most studies found either non-significant or short-term improvements in QoL. Only one study reported a reduction in phantom limb pain (PLP; NPRS: 9 to 2), precluding a meta-analysis for this outcome due to insufficient data. CONCLUSIONS: Current evidence does not provide statistically significant support for improvements in QoL following organized physical activity among adults with lower-limb amputation, while effects on PLP remain unclear due to limited and heterogeneous data. Further high-quality research using standardized, context-sensitive outcome measures and well-defined intervention protocols is needed. A more person-centered and contextually grounded understanding of QoL may help capture meaningful recovery outcomes in this population.