Performance‐based balance tests, combined with the number of falls recalled in the past year, predicts the incidence of future falls in established unilateral transtibial prosthesis users

Abstract

Background: Falls are common and consequential events for lower limb prosthesis (LLP) users. Currently, there are no models based on prospective falls data that clinicians can use to predict the incidence of future falls in LLP users. Assessing who is at risk for falls, and thus most likely to need and benefit from intervention, remains a challenge. Objective: To determine whether select performance-based balance tests predict future falls in established, unilateral transtibial prosthesis users (TTPU). Design: Multisite prospective observational study. Setting: Research laboratory and prosthetics clinic. Participants: Forty-five established, unilateral TTPU. Intervention: Not applicable. Main Outcome Measures: The number of falls reported over a prospective 6-month period. Timed Up-and-Go (TUG) and Four-Square Step Test (FSST) times, as well as Narrowing Beam Walking Test scores were recorded at baseline, along with the number of falls recalled over the past 12 months and additional potential fall-risk factors. Results: The final negative binomial regression model, which included TUG (P = .044) and FSST (P = .159) times, as well as the number of recalled falls (P = .009), was significantly better than a null model at predicting the number of falls over the next 6 months (X 2 [3] = 11.6, P = .009) and fit the observed fall count data (X 2 [41] = 36.12, P = .20). The final model provided a significant improvement in fit to the prospective fall count data over a model with fall recall alone X 2 (1) = 4.342, P < .05. Conclusion:No combination of performance-based balance tests alone predicted the incidence of future falls in our sample of established, unilateral TTPU. Rather, a combination of the number of falls recalled over the past 12 months, along with TUG and FSST times, but not NBWT scores, was required to predict the number of "all-cause" falls over the next 6 months. The resulting predictive model may serve as a suitable method for clinicians to predict the incidence of falls in established, unilateral TTPU.

A survey for characterizing details of fall events experienced by lower limb prosthesis users

“…When collecting retrospective fall data in a cross-sectional study, researchers should consider the length of the recall period and which fall event(s) to document, as both may influence fall recall decay. Given the level of detail within the survey, and our limited understanding of fall recall decay in LLP users [ 5 ], it may be prudent to focus on a single memorable fall event, particularly if a longer recall period is selected (e.g., one year). Concentrating on a single fall event is likely to maximize respondent recall and therefore data accuracy.…”

“…Falls in lower limb prosthesis (LLP) users remain as common and consequential today as they were over 20 years ago [1][2][3][4][5][6][7][8]. Between 1996 and2001, 50 to 58% of LLP users reported experiencing one or more falls in the previous year [1,2,6], while 21-29% of LLP users reported some form of injurious fall over the same time period [2,6].…”

“…Between 1996 and2001, 50 to 58% of LLP users reported experiencing one or more falls in the previous year [1,2,6], while 21-29% of LLP users reported some form of injurious fall over the same time period [2,6]. More than 20 years later, 48 to 60% of LLP users similarly report one or more falls a year [3][4][5]9]. Likewise, estimates of the proportion of LLP users experiencing one or more injurious falls a year remains between 18 and 26% [7,8].…”

“…Likewise, estimates of the proportion of LLP users experiencing one or more injurious falls a year remains between 18 and 26% [7,8]. Attempts to reduce the frequency of falls and their health-related consequences in LLP users over the past 20 years have generally focused on: i) developing and validating clinical tests to assess fall risk [4,5,[10][11][12], ii) designing and testing prosthetic components to improve patient safety [13][14][15][16], iii) quantifying biomechanical balance responses to identify deficits in key balance recovery strategies [17][18][19][20][21][22][23], and iv) identifying modifiable and non-modifiable risk factors [1,2,7,8,24,25]. Given that issues related to falls continue to plague LLP users, alternative approaches to reduce falls in LLP users may be needed.…”

Effects of Prosthetic Socket Design on Residual Femur Motion Using Dynamic Stereo X-Ray - A Preliminary Analysis

“…However, relative motion between a socket and the residual limb, such as distal translation, or pistoning, is a common problem for individuals with lower extremity amputation (LEA) and can lead to higher incidences of secondary consequences, such as residual limb pain, skin breakdown, gait deviations, and reduced comfort (Eshraghi et al, 2012). Furthermore, poorly fitting sockets can increase risk of falls (Sawers and Hafner, 2021) and prosthetic abandonment (Sprunger et al, 2012), which can lead to lower health-related quality of life (Sinha et al, 2011).…”