Category: Limb Restoration Rehabilitation; Clinical Practice (assessment, diagnosis, treatment, knowledge translation/EBP, implementation science, program development); Measurement
Characterize the frequency and circumstances of falls reported by unilateral lower limb prosthesis (LLP) users utilizing a novel fall classification framework.
Secondary analysis of retrospective data from two cross-sectional studies.
Setting : Hospital, outpatient clinic, and research laboratory
Participants (or Animals, Specimens, Cadavers) : Ambulatory adults with unilateral transtibial and transfemoral amputations (n=66; mean age=50.6±14.1)
Interventions : Not applicable
Main Outcome Measure(s) : Number of falls in previous 12-months and their narrative descriptions, including activities at the time of the fall(s), were collected and analyzed for frequency and estimated proportions ±95% confidence intervals. A 3-level hierarchical fall classification framework was developed to categorize falls based on the: i) anatomical location of disruption, ii) source of disruption, and iii) fall pattern.
Thirty-eight LLP users (57.6%) reported 90 falls during the previous year, with 36.3% reporting multiple falls. The estimated proportion of participants who reported falls attributed to base of support (BoS) disruptions (36.4%±26.4-48.4)was significantly greater than center of mass (CoM) disruptions (9.1%±1.9-16.3). Intrinsic sources of disruption (e.g., muscle weakness) were more commonly reported (39.4%±27.2-51.6) than extrinsic sources (e.g., crack in sidewalk) (27.3%±16.2-38.4), but the difference was not statistically significant. No significant differences were observed in the estimated proportion of LLP users reporting falls attributed to slips (18.2%±8.6-27.8), trips (16.7%±7.4-26.0), or prosthetic-related issues (15.2%±6.2-24.1). Walking on level terrain was the most commonly reported activity at the time of a fall (31.8%±20.2-43.4). The fall classification framework successfully categorized all reported falls.
Falls remain frequent among ambulatory unilateral LLP users. Clinicians and researchers may wish to prioritize falls owing to disruptions of the BoS that occur while walking. Future research with a larger sample and a structured data collection instrument is required to confirm and expand upon these results.
Janis Kim– Graduate student, University of Illinois at Chicago, Chicago, Illinois
Matthew Major– Assistant Professor / Research Health Scientist, Northwestern University / Jesse Brown VA Medical Center, Chicago, Illinois
Brian Hafner– Professor, University of Washington, Seattle, Washington
Andrew Sawers– Assistant Professor, University of Illinois at Chicago, Chicago, Illinois