Risk of fall-related injury in people with lower limb amputations: A prospective cohort study

Wong, Chi Song; Chihuri, Stanford; Li, Guohua

doi:10.2340/16501977-2042

Cited by 70 publications

(118 citation statements)

References 33 publications

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“…This finding may be related to the fact that individuals with bilateral transtibial amputations are more likely to use a wheelchair as their primary mobility aid during this time frame as they are nonambulatory. In contrast, and consistent with the literature, individuals with unilateral transtibial amputation are at an increased risk for falling. This may be related to their greater likelihood of using crutches or walkers for short distance ambulation and transfers.…”

Section: Discussionsupporting

confidence: 82%

Risk Factors for Falls in Individuals With Lower Extremity Amputations During the Pre‐Prosthetic Phase: A Retrospective Cohort Study

Payne

Hunter

et al. 2019

PM&R

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Background Falls in individuals with lower limb amputations (LLAs) pose significant health concerns. The literature is limited regarding falls during the preprosthetic phase of rehabilitation for persons with LLAs. Objective To determine the incidence of falls and identify factors associated with falls during the preprosthetic recovery phase. Design Retrospective chart audit. Setting Inpatient rehabilitation program. Participants Four hundred forty individuals with LLAs (age ± SD = 61.93 ± 14.53 years, 73.18% male) who attended inpatient rehabilitation from 26 July 2011 to 21 August 2017. Interventions Not applicable. Main Outcome Measurements The number of self‐reported falls was recorded from the time of surgery to admission for inpatient rehabilitation. Outcomes of interest were any fall (1+ fall) and recurrent falls (2+ falls). A retrospective chart audit was performed on consecutive admissions to an inpatient rehabilitation program. Results The incidence of falls was 8.37 per 1000 patient‐days. Falls were sustained by 60.9% of the sample. Unilateral transtibial amputation was independently associated with an increased risk of recurrent falls (relative risk [RR] 1.59, 95% confidence interval [CI] 1.13–2.23, P = .008). Diabetes mellitus was independently associated with an increased risk of any fall (RR 1.18, 95% CI 1.01–.38, P = .03). Finally, bilateral transtibial amputation was independently associated with a reduced risk of any fall (RR 0.59, 95% CI 0.39–0.90, P = .014). Conclusions Consistent with the current literature, diabetes mellitus and a unilateral transtibial amputation were risk factors for falling, whereas a bilateral transtibial amputation and increasing age presented new findings as factors associated with decreased falling. Level of Evidence III.

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Section: Discussionsupporting

confidence: 82%

Risk Factors for Falls in Individuals With Lower Extremity Amputations During the Pre‐Prosthetic Phase: A Retrospective Cohort Study

Payne

Hunter

et al. 2019

PM&R

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“…1) [39]. We identified only one study that reported fall-related injuries in lower limb amputees [39]. According to Wong et al [39], 26.8% of all falls had medical consequences.…”

Section: −Or <4y Vs 4+ymentioning

confidence: 99%

“…Falls may either require medical attention or they do not affect the health of the faller (Fig. 1) [39]. We identified only one study that reported fall-related injuries in lower limb amputees [39].…”

Section: −Or <4y Vs 4+ymentioning

confidence: 99%

Cost-effectiveness and budget impact of the microprocessor-controlled knee C-Leg in transfemoral amputees with and without diabetes mellitus

et al. 2020

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Background The safe use of a prosthesis in activities of daily living is key for transfemoral amputees. However, the number of falls varies significantly between different prosthetic device types. This study aims to compare medical and economic consequences of falls in transfemoral amputees who use the microprocessor-controlled knee joint C-Leg with patients who use non-microprocessor-controlled (mechanical) knee joints (NMPK). The main objectives of the analysis are to investigate the costeffectiveness and budget impact of C-Legs in transfemoral amputees with diabetes mellitus (DM) and without DM in Germany. Methods A decision-analytic model was developed that took into account the effects of prosthesis type on the risk of falling and fall-related medical events. Cost-effectiveness and budget impact analyses were performed separately for transfemoral amputees with and without DM. The study took the perspective of the statutory health insurance (SHI). Input parameters were derived from the published literature. Univariate and probabilistic sensitivity analyses (PSA) were performed to investigate the impact of changes in individual input parameter values on model outcomes and to explore parameter uncertainty. Results C-Legs reduced the rate of fall-related hospitalizations from 134 to 20 per 1000 person years (PY) in amputees without DM and from 146 to 23 per 1000 PY in amputees with DM. In addition, the C-Leg prevented 15 or 14 fall-related death per 1000 PY. Over a time horizon of 25 years, the incremental cost-effectiveness ratio (ICER) was 16,123 Euro per quality-adjusted life years gained (QALY) for amputees without DM and 20,332 Euro per QALY gained for amputees with DM. For the period of 2020-2024, the model predicted an increase in SHI expenditures of 98 Mio Euro (53 Mio Euro in prosthesis users without DM and 45 Mio Euro in prosthesis users with DM) when all new prosthesis users received C-Legs instead of NMPKs and 50% of NMPK user whose prosthesis wore out switched to C-Legs. Results of the PSA showed moderate uncertainty and a probability of 97-99% that C-Legs are cost-effective at an ICER threshold of 40,000 Euro (≈ German GDP per capita in 2018) per QALY gained. Conclusion Results of the study suggest that the C-Leg provides substantial additional health benefits compared with NMPKs and is likely to be cost-effective in transfemoral amputees with DM as well as in amputees without DM at an ICER threshold of 40,000 Euro per QALY gained.

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“…More than 50% of community-dwelling adults with lower-limb amputation (LLA) fall, based on studies largely conducted within 1 year of an amputation [1][2][3]. Within a given year, up to 56% of longer-term prosthetic users report a fall, 29% experience recurrent falls, and 26% sustain a fall-related injury [4]. Furthermore, evidence suggests that adults often reintegrate into their communities and return to work >1 year post-LLA, despite unresolved balance and mobility deficits [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Retracted: Test‐Retest Reliability of Dynamic Balance Performance‐Based Measures Among Adults With a Unilateral Lower‐Limb Amputation

Cardoso

Beisheim

Horne³

et al. 2019

PM&R

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Risk of fall-related injury in people with lower limb amputations: A prospective cohort study

Abstract: Risk of fall-related injury requiring medical care in people with lower limb amputation appears to be higher than in older adult inpatients. Intervention programs to prevent fall-related injury in people with lower limb amputation should target women and racial minorities.

Cited by 70 publications

References 33 publications

Risk Factors for Falls in Individuals With Lower Extremity Amputations During the Pre‐Prosthetic Phase: A Retrospective Cohort Study

Risk Factors for Falls in Individuals With Lower Extremity Amputations During the Pre‐Prosthetic Phase: A Retrospective Cohort Study

Cost-effectiveness and budget impact of the microprocessor-controlled knee C-Leg in transfemoral amputees with and without diabetes mellitus

Retracted: Test‐Retest Reliability of Dynamic Balance Performance‐Based Measures Among Adults With a Unilateral Lower‐Limb Amputation

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