Falls After Dysvascular Transtibial Amputation: A Secondary Analysis of Falling Characteristics and Reduced Physical Performance

Abstract

Introduction Over half of all people with lower limb amputation (LLA) experience at least one fall annually. Furthermore, the majority of LLAs result from dysvascular health complications, contributing to balance deficits. However, fall‐related research specific to dysvascular LLA remains limited. Objective To characterize falls among adults with dysvascular LLA, using an existing Fall‐Type Classification Framework and to describe the functional characteristics of participants across the framework categories. Design Secondary data analysis from two randomized controlled trials. Setting Outpatient setting. Participants People (n = 69) 6 months to 5 years from dysvascular lower extremity amputation, who were ≥50 years of age and independently ambulatory using a prosthesis. Intervention None. Outcome Descriptions of self‐reported falls were collected on a weekly basis for 12 weeks, and analyzed using an existing Fall‐Type Classification Framework. Fall frequencies, estimated count, and estimated proportions were compared across all framework categories, with 95% confidence intervals. Functional measures (Timed Up and Go, Two Minute Walk, Five Meter Walk, and average step count) were collected, and averages for each participant who experienced a fall were calculated. Results Thirty participants (43.5%) reported 42 falls within 12 weeks. A variety of fall types were described. Incidence of falls was highest for intrinsic destabilization sources, from incorrect weight shift patterns during transfer activities. Conclusion Patients with dysvascular LLAs experience a variety of fall types. The high frequency of intrinsically sourced, incorrect weight‐shift falls during transfer activities emphasizes the need to focus rehabilitation efforts on improving postural control in patients with dysvascular LLAs during activities such as reaching, turning, and transferring.

Quantifying the risk of falls and injuries for amputees beyond annual fall rates—A longitudinal cohort analysis based on person-step exposure over time

“…Not all falls caused injury; and not all injuries were caused by falls. Falls occurred both indoors and outdoors, but most falls occurred indoors consistent with research that found more falls occurred in the home than in community ( Anderson et al, 2021 ). The results suggest that PLL are exposed to falls whether or not they access the outdoor settings that present attentional and cognitive challenges identified as risks for falls ( Coffey et al, 2012 ).…”

Reported Outcome Measures in Studies of Real-World Ambulation in People with a Lower Limb Amputation: A Scoping Review

“…ActiGraph (ActiGraph, Pensacola, USA) [29,31,32,39,41,43,45,47,53,70,75,[80][81][82][83]92,105,109], FitBit (FitBit, San Francisco, USA) [34,40,52,76,108,117], and activPAL (PAL Technologies, Glasgow, Scotland) [26,36,37,68,91,103,104].…”

“…The most frequently used wearable technologies were the StepWatch (Modus Health, Edmonds, Santa Monica, CA, USA) [4,21,25,27,28,30,42,44,46,[48][49][50][51]54,57,58,61,64,65,69,73,[77][78][79]84,[86][87][88][89][90][94][95][96]98,100,101,110,[114][115][116], ActiGraph (ActiGraph, Pensacola, FL, USA) [29,31,32,39,41,43,45,47,53,70,...…”

“…Step Count Seventy-two articles reported on step count. The majority reported the number of steps taken per day [4,[24][25][26][27][28][29][30][31][32]36,37,39,40,42,44,46,47,[49][50][51]53,55,56,58,59,61,62,64,65,[68][69][70][71][72][73]75,[77][78][79]81,82,84,86,[89][90][91]93,[95][96][97]…”

“…Step counts were also reported to demonstrate a difference between participant groups [4,26,29,31,32,37,40,46,47,49,51,52,[54][55][56]64,65,68,75,77,81,84,105,110], between different types of activity monitors [115], or between baseline and follow-up measurements [24,40,50,68,77,81,84,89,93,96,97].…”