Clinical evaluation of fall risk in older adults who use lower‐limb prostheses: A scoping review

Abstract

Background No reviews or evidence‐based clinical protocols exist to evaluate fall risk in older adults who use lower‐limb prostheses, despite falls being prevalent and costly in this population. This scoping review sought to determine assessments, defined as clinical outcome measures and gait parameters, associated with fall risk in this population to determine if a systematic review is warranted and help inform an evidence‐based clinical protocol. Methods Google Scholar, PubMed, and Scopus were searched on April 19th, 2022 to include peer‐reviewed original research. Included articles reported relationships between falls and clinical outcome measures or gait parameters in older adults who use transtibial or transfemoral prostheses. Clinical outcome measures included self‐reported questionnaires and functional mobility tests. Gait parameters included spatiotemporal, kinematic, and kinetic data during walking and stair negotiation. Results Nineteen articles were included. Clinical outcome measure scores, gait parameter data, and cutoff scores by fall status (nonfallers, single fallers, recurrent fallers) were summarized. Six articles determined clinical outcome measures that had statistically significant associations with falls, and two articles determined gait parameters that had statistically significant associations with falls. Conclusions The majority of articles found no clinical outcome measure or gait parameter alone was effective at identifying fall risks in this population. Future research should evaluate a combination of assessments and collect prospective fall data to move towards establishing an evidence‐based protocol to evaluate fall risk in older adults using lower‐limb prostheses.

Advances in prosthetic technology: a perspective on ethical considerations for development and clinical translation

“…However, current billing practices in prosthetics dictate that any follow-up care is bundled into a lump-sum payment for the device, and providers are not reimbursed for follow-up care outside of this base rate. Additionally, people who are older adults, belong to systematically marginalized groups, or live in rural communities are often underrepresented in prosthetics literature (57)(58)(59), including technology development. To elucidate health disparities, researchers must first collect and report detailed socioeconomic information, as a recent review determined 84% of the 420 manuscripts reviewed did not report race or ethnicity of the participants (60).…”

Foot characteristics of the daily-life gait in postmenopausal females with distal radius fractures: a cross-sectional study

“…More than half of DRFs are caused by a fall, which often occurs while walking; therefore, several studies have indicated that changes in gait patterns are related to falls [ 7 , 8 ]. Quantitative gait parameters such as slower gait speed, shorter stride length [ 9 ], and foot kinematics such as lower peak dorsiflexion angle of the foot [ 10 , 11 ], as well as larger variability of these parameters [ 12 ], have been reported to be associated with fall risk [ 13 , 14 ].…”