Proposed recommendations for the minimum impairment criteria for limb deficiency for wheelchair tennis according to amputation type
| Amputation type | Recommendation | Level of evidence | Grade of recommendation | Rationale |
| Toe amputation(s) (excluding great toe) | Exclude | 5 | D | It is unlikely that running speed and acceleration/deceleration will be highly affected, but more research is needed |
| Great toe amputation | Unclear | 5 | D | Loss of power on pushing off, lateral movements, and serving. More research is needed on the extent that fundamental tennis activities are affected. |
| Ray amputation (excluding first ray) | Unclear | 5 | D | Acceleration/deceleration and running speed may be affected. More research is needed.* |
| First Ray amputation | Include | 5 | D | Loss of power on pushing off, lateral movements and serving. Acceleration/deceleration and running speed may be reduced. |
| Metatarsophalangeal amputation | Unclear | 5 | D | Minor limitations on acceleration/deceleration. More research is needed.† |
| Transmetatarsal amputation | Include | 4 | C | Major limitations on acceleration/deceleration. |
| Lisfranc amputation | Include | 5 | D | Major limitations on acceleration/deceleration. |
| Chopart amputation | Include | 5 | D | Major limitations on acceleration/deceleration. |
Grade of recommendation for the minimum impairment criteria rated according to the Centre of Evidence-Based Medicine (CEBM)25:
A = consistent level 1 studies. B = consistent level 2 or 3 studies or extrapolations from level 1 studies. C = level 4 studies or extrapolations from level 2 or 3 studies. D = level 5 evidence or troublingly inconsistent or inconclusive studies at any level.
*Based on three patients.
†Based on two patients.