Current and Emerging Trends in the Management of Fall Risk in People with Lower Limb Amputation

Clemens, Sheila; Doerger, C; Lee, Szu‐Ping

doi:10.1007/s13670-020-00328-4

Cited by 4 publications

(8 citation statements)

References 63 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Since the fear of falling and lack of confidence was apparent, it is important to inform prosthesis users on the higher risk of falling and teach them how to decrease the chance of injury when they fall [ 48 ]. Therefore, rehabilitation training should also include fall training in different circumstances and different surfaces.…”

Section: Discussionmentioning

confidence: 99%

User-relevant factors influencing the prosthesis use of persons with a transfemoral amputation or knee-disarticulation: A meta-synthesis of qualitative literature and focus group results

et al. 2023

View full text Add to dashboard Cite

Objective Persons with a transfemoral amputation or knee-disarticulation are heavily reliant on an adequate set of components for their prosthesis. To improve the process of adjusting the specific prosthetic properties to the expectations of the prosthesis users, it is of importance to first identify which factors have an influence on prosthesis use. Therefore, we aimed to identify factors that influence prosthesis use in adults with a transfemoral amputation or knee-disarticulation. Methods A qualitative meta-synthesis was conducted by searching five databases (last update January 20th 2022). Studies were considered eligible if they contained qualitative data about adult persons with a transfemoral amputation or knee-disarticulation with experience in using a prosthesis and focused on the users’ opinions. All eligible studies were independently screened by two reviewers. The results sections of the included studies were entered in Atlas.ti software (v8) and coded using the framework approach. The quality of the included studies was assessed using the Critical Appraisal Skills Program (CASP) qualitative research checklist. Results of the meta-synthesis were validated with prosthesis users (n = 8) in a focus group. Results Out of 5757 articles, 14 studies were included. An overview of seven themes (‘prosthesis related’; ‘rehabilitation, costs and prosthetist’; ‘mental’; ‘physical’; ‘social’; ‘activities and participation’ and ‘walking’) containing 84 factors was created. Ten factors were added during the focus group, resulting in an overview of 94 factors that may influence the prosthesis use of lower-limb prosthesis users. Participants would like more user-involvement from the rehabilitation team. The development of a patient decision aid could help this process in the future. Conclusion The large number of factors demonstrates that there is a great variety between prosthesis users and the factors that influence their prosthesis use. Therefore, it is important to take individual preferences into account for the selection of a new prosthesis.

show abstract

Section: Discussionmentioning

confidence: 99%

User-relevant factors influencing the prosthesis use of persons with a transfemoral amputation or knee-disarticulation: A meta-synthesis of qualitative literature and focus group results

et al. 2023

View full text Add to dashboard Cite

show abstract

“…Established evidence‐based clinical protocols exist to evaluate fall risk in older adults in the general population 13–16 . However, no evidence‐based clinical protocol exists to effectively evaluate fall risk in older adults or adults at any age who use lower‐limb prostheses 11,17–19 . For older adults who use a lower‐limb prosthesis, falls are one of the most prevalent and costly concerns in this population 20–22 .…”

Section: Introductionmentioning

confidence: 99%

“…1,[5][6][7][8][9] Combined fall risk factors of older age and prosthesis use may make older adults who use prostheses more vulnerable to falls than either risk factor alone. 11 Further, older adults are estimated to be 42% of the amputee population, and numbers are expected to increase with the prevalence of peripheral vascular disease and type 2 diabetes. 12 As the prevalence of older adults who rely on lower-limb prostheses increases, the need for effective fall risk screening in this population increases.…”

Section: Introductionmentioning

confidence: 99%

“…[13][14][15][16] However, no evidence-based clinical protocol exists to effectively evaluate fall risk in older adults or adults at any age who use lower-limb prostheses. 11,[17][18][19] For older adults who use a lower-limb prosthesis, falls are one of the most prevalent and costly concerns in this population. [20][21][22] While several studies have associated poor balance with older age in adults who use lower-limb prostheses, 23,24 older adults are typically underrepresented in amputation and prosthesis user literature surrounding musculoskeletal and biomechanical adaptations.…”

Section: Introductionmentioning

confidence: 99%

“…In both of these populations, falls have been associated with a wide variety of negative secondary health effects, such as diminished mobility, decreased social activity, and increased fall‐related injury 1,5–9 . Combined fall risk factors of older age and prosthesis use may make older adults who use prostheses more vulnerable to falls than either risk factor alone 11 . Further, older adults are estimated to be 42% of the amputee population, and numbers are expected to increase with the prevalence of peripheral vascular disease and type 2 diabetes 12 .…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Clinical evaluation of fall risk in older adults who use lower‐limb prostheses: A scoping review

Finco

Sumien

Moudy

2023

J American Geriatrics Society

View full text Add to dashboard Cite

Background No reviews or evidence‐based clinical protocols exist to evaluate fall risk in older adults who use lower‐limb prostheses, despite falls being prevalent and costly in this population. This scoping review sought to determine assessments, defined as clinical outcome measures and gait parameters, associated with fall risk in this population to determine if a systematic review is warranted and help inform an evidence‐based clinical protocol. Methods Google Scholar, PubMed, and Scopus were searched on April 19th, 2022 to include peer‐reviewed original research. Included articles reported relationships between falls and clinical outcome measures or gait parameters in older adults who use transtibial or transfemoral prostheses. Clinical outcome measures included self‐reported questionnaires and functional mobility tests. Gait parameters included spatiotemporal, kinematic, and kinetic data during walking and stair negotiation. Results Nineteen articles were included. Clinical outcome measure scores, gait parameter data, and cutoff scores by fall status (nonfallers, single fallers, recurrent fallers) were summarized. Six articles determined clinical outcome measures that had statistically significant associations with falls, and two articles determined gait parameters that had statistically significant associations with falls. Conclusions The majority of articles found no clinical outcome measure or gait parameter alone was effective at identifying fall risks in this population. Future research should evaluate a combination of assessments and collect prospective fall data to move towards establishing an evidence‐based protocol to evaluate fall risk in older adults using lower‐limb prostheses.

show abstract

Indications of musculoskeletal health in deceased male individuals with lower-limb amputations: comparison to non-amputee and diabetic controls

Finco

Finnerty

Ngo

et al. 2023

Sci Rep

View full text Add to dashboard Cite

Individuals with lower-limb amputations, many of whom have type 2 diabetes, experience impaired musculoskeletal health. This study: (1) compared residual and intact limbs of diabetic and non-diabetic post-mortem individuals with amputation to identify structures vulnerable to injury, and (2) compared findings to diabetic and healthy control groups to differentiate influences of amputation and diabetes on musculoskeletal health. Postmortem CT scans of three groups, ten individuals each, were included: (1) individuals with transtibial or transfemoral amputations, half with diabetes (2) diabetic controls, and (3) healthy controls. Hip and knee joint spaces, cross-sectional thigh muscle and fat areas, and cross-sectional bone properties (e.g. area, thickness, geometry) were measured. Wilcoxon Signed-Rank and Kruskal–Wallis tests assessed statistical significance. Asymmetry percentages between limbs assessed clinical significance. Residual limbs of individuals with amputation, particularly those with diabetes, had significantly less thigh muscle area and thinner distal femoral cortical bone compared to intact limbs. Compared to control groups, individuals with amputation had significantly narrower joint spaces, less thigh muscle area bilaterally, and thinner proximal femoral cortical bone in the residual limb. Diabetic individuals with amputation had the most clinically significant asymmetry. Findings tended to align with those of living individuals. However, lack of available medical information and small sample sizes reduced the anticipated clinical utility. Larger sample sizes of living individuals are needed to assess generalizability of findings. Quantifying musculoskeletal properties and differentiating influences of amputation and diabetes could eventually help direct rehabilitation techniques.

show abstract

Current and Emerging Trends in the Management of Fall Risk in People with Lower Limb Amputation

Cited by 4 publications

References 63 publications

User-relevant factors influencing the prosthesis use of persons with a transfemoral amputation or knee-disarticulation: A meta-synthesis of qualitative literature and focus group results

User-relevant factors influencing the prosthesis use of persons with a transfemoral amputation or knee-disarticulation: A meta-synthesis of qualitative literature and focus group results

Clinical evaluation of fall risk in older adults who use lower‐limb prostheses: A scoping review

Indications of musculoskeletal health in deceased male individuals with lower-limb amputations: comparison to non-amputee and diabetic controls

Contact Info

Product

Resources

About