Temporal adaptations in generic and population-specific quality of life and falls efficacy in men with recent lower-limb amputations

Abstract

Abstract-This study examined the longitudinal changes in generic health-related quality of life (QOL), prosthesis-related QOL, falls efficacy, and walking speed in men with lower-limb amputations up to 6 months following discharge from rehabilitation. Seven male unilateral transtibial amputees completed the Medical Outcomes Study 36-Item Short Form Health Survey, the Prosthesis Evaluation Questionnaire, and the Modified Falls Efficacy Scale at 1, 3, and 6 months postdischarge from rehabilitation. Walking speed was also recorded to objectively assess participants' mobility. Health-related QOL measures displayed increases, resulting in large effect sizes though not reaching statistical significance. Prosthesis-related QOL measures indicated that scales relating to the participants' prostheses improved and the support of significant others was the most positively scored variable. Walking speed increased by 0.12 m/ s, although it was not significantly related to indices of QOL or falls efficacy. Falls efficacy did not improve significantly during the study period, although it was strongly related to QOL (p < 0.05). These results provide a novel insight into how QOL and falls efficacy develop in people with lower-limb amputations, alongside changes in mobility, after discharge from rehabilitation. Further improvements in physical health following discharge may be required to elicit subsequent increases in overall QOL and concurrent improvements in falls efficacy.

Do Predictive Relationships Exist Between Postural Control and Falls Efficacy in Unilateral Transtibial Prosthesis Users?

“…This was a surprising result given that both an increased fear of falling and falls reported by prosthesis users is frequently and widely cited in literature 2,3 . Prosthesis users' falls efficacy reported in the current study was higher when compared to that from prosthesis users with less (<1 year) prosthetic experience, who were of mixed vascular/traumatic etiology 23 . One explanation for this could be that, having been screened against the stated inclusion and exclusion criteria, the prosthesis users of traumatic etiology in the current study could be considered relatively active and mobile.…”

“…Balance ability and postural control have also been shown to improve with prosthetic experience . Therefore, it seems important to consider patient characteristics such as different etiologies 2, or different levels of prosthetic experience 23 when investigating the relationships between, falls efficacy and postural control and when comparing falls efficacy data to previous reports. This would also allow for improved interpretation of the falls efficacy between sub-groups of prosthesis users.…”

“…The total number of falls that satisfied the definition of 'an unexpected event in which the participant comes to rest on the ground, floor or lower level' were included for each individual in statistical analyses 26 . Secondly, participants completed the FES-I, which is an assessment of falls efficacy under different circumstances, 21,22 designed and validated for use in older adults, but has been used with unilateral transtibial prosthesis users previously in the form of the modified Falls Efficacy Scale 23 . The FES-I is validated in English and Swedish languages, as used in the current study 22,27 .…”

“…It is yet to be ascertained whether the relationships explored in the current study could be generalized more broadly to such a group, or indeed a more homogenous group, regardless of group characteristics. Finally, similar instruments to the FES-I and a modified version of the FES-I have been used previously to assess falls efficacy and/or confidence in prosthesis users 23 . However, the FES-I specifically, has not been fully validated in this population and it is not conclusive whether total FES-I scores should be treated as ordinal data or not.…”

Barriers to outcome measure administration and completion at discharge from inpatient rehabilitation of people with amputation

“…Amputee rehabilitation proceeds in a progressive pattern as the user becomes more comfortable with prosthetic ambulation and as the supports needed for walking are advanced [13]. Improvements in gait speed have been seen 6 mo after discharge from an amputee rehabilitation program, and the likelihood of falling continues to diminish even years later [14][15]; this suggests that the ambulatory limitations present at discharge are not fixed and are likely to improve even after the patient transitions into the community. Early identification of performancelimiting factors can be used to direct rehabilitation efforts across the continuum for both inpatient and outpatient programs.…”