Using Clinical Balance Tests to Assess Fall Risk among Established Unilateral Lower Limb Prosthesis Users: Cutoff Scores and Associated Validity Indices

Sawers, Andrew; Hafner, Brian J.

doi:10.1002/pmrj.12160

Cited by 25 publications

(63 citation statements)

References 73 publications

(218 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…For example, falls from intrinsic destabilizing forces were associated with lower average FMW test (0.74 m/s) and higher TUG test outcomes (25.6 seconds). Existing research has established thresholds for identifying patients with LLA at risk for multiple falls (TUG test thresholds ranging from 9.25 to 19 seconds) 9,27 . The results from this study suggest a potential relationship between poor functional outcomes after dysvascular LLA and fall types.…”

Section: Discussionmentioning

confidence: 69%

“…The TUG test 37,38 is an assessment of basic mobility, and is measured as the time (in seconds) required for the participant to rise from a chair, walk 3 meters, return to the chair, and sit back down as quickly and safely as possible, using a handheld stopwatch and a 46‐cm seat 43 . The TUG has established cut‐off scores to indicate fall risk for people with LLA 9,27 . Each participant was provided one practice trial, and the average of two subsequent trials was reported.…”

Section: Methodsmentioning

confidence: 99%

“…Although older adults with dysvascular etiologies represent up to 80% of people with LLA, 24,25 fall‐related research specific to dysvascular amputation remains limited. Current evidence for targeting interventions and clinical tests for identifying falls after LLA are generalized to all ages and etiologies for LLA 9,10,12,17,26,27 . In order to appropriately design interventions for patients at high risk for falls, it is important to classify the characteristics of falls among older adults with dysvascular LLAs, and to examine fall types using common clinical evaluation tools.…”

Section: Introductionmentioning

confidence: 99%

“…Lower limb amputation (LLA) is associated with poor health outcomes, such as reduced strength, balance, proprioception, 1‐4 low physical function, 5,6 and increased adverse events 7‐9 . Over half the population living with LLAs experience at least one fall annually, compared to 26% of the community‐dwelling population without amputation 10‐12 .…”

Section: Introductionmentioning

confidence: 99%

“…Lower limb amputation (LLA) is associated with poor health outcomes, such as reduced strength, balance, proprioception, [1][2][3][4] low physical function, 5,6 and increased adverse events. [7][8][9] Over half the population living with LLAs experience at least one fall annually, compared to 26% of the community-dwelling population without amputation. [10][11][12] Falls often lead to adverse health outcomes, such as injury, 3,13 activity avoidance, 10,14 increased medical costs, 15 and increased incidence of death.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

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

Anderson¹,

Miller

Murray

et al. 2020

PM&R

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 69%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

Anderson¹,

Miller

Murray

et al. 2020

PM&R

View full text Add to dashboard Cite

show abstract

Performance‐based balance tests, combined with the number of falls recalled in the past year, predicts the incidence of future falls in established unilateral transtibial prosthesis users

Sawers

Hafner

2021

PM&R

Self Cite

View full text Add to dashboard Cite

Background: Falls are common and consequential events for lower limb prosthesis (LLP) users. Currently, there are no models based on prospective falls data that clinicians can use to predict the incidence of future falls in LLP users. Assessing who is at risk for falls, and thus most likely to need and benefit from intervention, remains a challenge. Objective: To determine whether select performance-based balance tests predict future falls in established, unilateral transtibial prosthesis users (TTPU). Design: Multisite prospective observational study. Setting: Research laboratory and prosthetics clinic. Participants: Forty-five established, unilateral TTPU. Intervention: Not applicable. Main Outcome Measures: The number of falls reported over a prospective 6-month period. Timed Up-and-Go (TUG) and Four-Square Step Test (FSST) times, as well as Narrowing Beam Walking Test scores were recorded at baseline, along with the number of falls recalled over the past 12 months and additional potential fall-risk factors. Results: The final negative binomial regression model, which included TUG (P = .044) and FSST (P = .159) times, as well as the number of recalled falls (P = .009), was significantly better than a null model at predicting the number of falls over the next 6 months (X 2 [3] = 11.6, P = .009) and fit the observed fall count data (X 2 [41] = 36.12, P = .20). The final model provided a significant improvement in fit to the prospective fall count data over a model with fall recall alone X 2 (1) = 4.342, P < .05. Conclusion:No combination of performance-based balance tests alone predicted the incidence of future falls in our sample of established, unilateral TTPU. Rather, a combination of the number of falls recalled over the past 12 months, along with TUG and FSST times, but not NBWT scores, was required to predict the number of "all-cause" falls over the next 6 months. The resulting predictive model may serve as a suitable method for clinicians to predict the incidence of falls in established, unilateral TTPU.

show abstract

The number of falls recalled in the past year and balance confidence predict the frequency of injurious falls by unilateral lower limb prosthesis users

Tobaigy

Hafner

Sawers

2023

PM&R

Self Cite

View full text Add to dashboard Cite

Introduction Several personal characteristics have been associated with an increased risk of injurious falls by lower limb prosthesis (LLP) users. To date, however, none have been used to effectively predict the occurrence of injurious falls. Objective To develop a model that could predict the number of injurious falls over the next 6 months and identify fall‐related circumstances that may increase the odds of a fall being injurious in unilateral LLP users. Design A secondary analysis of a prospective observational study. Setting Research laboratory. Participants Sixty unilateral LLP users with a transtibial or transfemoral amputation. Intervention Not applicable. Main outcome measure(s) Participants' characteristics were recorded at baseline. Falls and their circumstances and consequences were collected prospectively over 6 months via monthly telephone calls. Multivariate negative binomial regression was used to predict the number of injurious falls over the next 6 months in LLP users. Incidence rate ratios (IRRs) were derived to determine the risk of an injurious fall. Bivariate logistic regression was used to identify the associations between injurious falls and fall‐related circumstances. Odds ratios (ORs) were derived to characterize the odds that a fall would be injurious. Results The final multivariate model, which included the number of falls recalled in the past year (IRR = 1.31, 95% confidence interval [CI]: 1.01–1.71, p = .045) and balance confidence (p = .120), predicted the number of injurious falls in the next 6 months (χ2 (2) = 8.15, p = .017). Two fall‐related circumstances were found to increase the odds that a fall would be injurious, fatigue due to activity (OR = 13.5, 95% CI: 3.50–52.3, p = .001), and tiredness from a lack of sleep (OR = 5.36, 95% CI: 1.22–23.6, p = .026). Conclusion The results suggest that the number of falls recalled in the past year and balance confidence scores predict the number of injurious falls an LLP user will experience in the next 6 months.

show abstract

Using Clinical Balance Tests to Assess Fall Risk among Established Unilateral Lower Limb Prosthesis Users: Cutoff Scores and Associated Validity Indices

Abstract: This is the author manuscript accepted for publication and has undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as

Cited by 25 publications

References 73 publications

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

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

Performance‐based balance tests, combined with the number of falls recalled in the past year, predicts the incidence of future falls in established unilateral transtibial prosthesis users

The number of falls recalled in the past year and balance confidence predict the frequency of injurious falls by unilateral lower limb prosthesis users

Contact Info

Product

Resources

About