Factors associated with the likelihood of fall-related injury among people with lower limb loss

Abstract

BackgroundPeople with lower limb loss that live in the community fall at a rate that exceeds that of other vulnerable populations such as hospitalized elderly people. Past research in a small single state study has identified factors associated with fall-related injury. The purpose of this study was to use a larger multistate sample of people with lower limb loss living in community settings to evaluate factors associated with fall-related injury in a multivariable model.MethodThis retrospective cohort study included community-dwelling people with lower limb loss participating in wellness-walking programs in 6 states within the United States. Fall-related injury was considered injury sustained during a fall to the ground that required medical care. Pearson’s Chi-squared test and student’s t-test were used for descriptive statistics. Odds ratios and 95% confidence intervals from multivariable logistic regression modelling were used to estimate the likelihood of fall-related injuries.ResultsOf the 303 subjects recruited, 257 (84.8%) were included in the analyses. Overall, 45 subjects (17.5%) reported at least a single fall-related injury. Most subjects reported two or more falls within the previous 12 months (N = 161, 63.1%), were male (N = 177, 68.9%), and were White (N = 212, 83.8%). Most falls were associated with gait (44.5%), activities of daily living (ADL, 15.7%), or ramps and/or stairs (12%). The likelihood of fall-related injury was elevated among females versus males (OR = 2.90, 95% CI 1.35, 6.24), people of non-White versus White race (OR = 4.79, 95% CI 1.06, 21.76), people with vascular amputations due to peripheral artery disease or diabetes versus non-vascular amputations (OR = 2.22, 95% CI 1.04, 4.73) and people with transtibial versus transfemoral amputations (OR = 2.32, 95% CI 1.01, 4.89).DiscussionResults of this study show that the likelihood of fall-related injury was significantly higher among women, non-White race, people with vascular and transtibial amputations. The results from this study were largely consistent with results from the prior multivariable fall-related injury model.ConclusionThe results highlight the association of female sex, non-White race, vascular and transtibial amputations with the likelihood of fall-related injury. Future studies may use the study findings to develop educational fall prevention programs for women, minorities, and people with vascular etiology and transtibial amputations.

The Role of Earlier Receipt of a Lower Limb Prosthesis on Emergency Department Utilization

“…However, it was found that no change in risk occurred for those with or without a prosthesis 23 . It is interesting to highlight that we found no effect of sex, as a few studies have found that women with limb loss have worse function or increased adverse events compared to men with limb loss 22,24,25 . Yet, the current study differed from previous studies in that this study utilized claims of those with commercial insurance as opposed to relying on self‐report, which may have recall bias influencing the report of injurious falls.…”

“… 23 It is interesting to highlight that we found no effect of sex, as a few studies have found that women with limb loss have worse function or increased adverse events compared to men with limb loss. 22 , 24 , 25 Yet, the current study differed from previous studies in that this study utilized claims of those with commercial insurance as opposed to relying on self‐report, which may have recall bias influencing the report of injurious falls. It is likely that other factors besides sex may be driving increased health care utilization within 12 months after LLA.…”

Using Clinical Balance Tests to Assess Fall Risk among Established Unilateral Lower Limb Prosthesis Users: Cutoff Scores and Associated Validity Indices

“…Over 50% of LLP users report falling at least once a year, with up to 39% reporting multiple falls a year [4][5][6][7][8] . Falls among LLP users frequently lead to adverse health outcomes including injury 3,5,7,9,10 , financial costs 11 , reduced mobility 12,13 , and diminished quality of life 14 . A major barrier to reducing falls among LLP users has been effective screening of those at risk 15,16 .…”

Comparison of electromyographic activity of quadriceps muscle in persons with unilateral traumatic transtibial amputation using patellar tendon bearing supracondylar endoskeletal prosthesis with the unaffected limb in weight bearing positions.

“…During different positions in our study, it was found that there is increased weight distribution on the unaffected limb. Asymmetrical lower limb loading can be explained by listing the following reasons -devoid of ankle movement and due to prosthesis socket [11] Persons with unilateral transtibial amputation have strength discrepancies between limbs, with their uninvolved limb being more substantial than the prosthetic limb. This leads to asymmetrical bodyweight distribution with their center of pressure (COP) shifted anterolaterally towards the uninvolved limb.…”