Abstract
Objective
Design
Setting
Participants
Interventions
Main Outcome Measures
Results
Conclusions
Keywords
List of abbreviations:
ABC (Activities-specific Balance Confidence), BBS (Berg Balance Scale), FAI (Frenchay Activities Index), LLA (lower-limb amputation), PEQ-MS (Prosthesis Evaluation Questionnaire-Mobility Subscale), ROM (range of motion), 2MWT (2-minute walk test)Methods
Participants
Data collection
Outcome Measure | Measurement | Data | Description | Time Required for Administration (min) | Validity and Reliability in Persons With LLA (Reference) |
---|---|---|---|---|---|
ABC Scale | Perceived balance and confidence | Ordinal 0%–100% | 16 ADLs | 5–10 | Test-retest reliability: ICC=.91; Cronbach's α=.93 (Miller et al 79 ) |
PEQ-MS | Mobility ability | Ordinal 0–10 | 13 ADLs while wearing a prosthesis over the past 4wk | 5–10 | Test-retest reliability ICC=.77; Cronbach's α=.95 (Miller et al 81 ) |
FAI | Frequency of ADL | Ordinal 0–3 | 15 ADLs over the past 3 and 6mo | 5–10 | Test-retest reliability ICC=.79; Cronbach's α=.81 (Miller et al 84 ) |
BBS | Balance performance | Ordinal 0–4 | 14 tasks performed in chronological sequence: (1) sitting-to-standing; (2) standing unsupported; (3) sitting with back unsupported; (4) standing-to-sitting; (5) transfer between seats with and without armrests; (6) standing unsupported with eyes closed; (7) standing unsupported with feet together; (8) reaching forward while standing; (9) picking up an object from the floor; (10) turning to look over left and right shoulders; (11) turning 360°; (12) alternately stepping up on a stool while unsupported; (13) tandem standing while unsupported; (14) standing on one leg. | 15–20 | Not applicable |
L Test | Mobility/balance performance | Time (10th of a second) | Participants rise from a chair without armrests, walk 3m forward, turn right, walk 7m, walk around a floor marker, retrace their path to the chair, and sit down. The participants are timed from the moment their trunk leaves contact with the back of the chair until the trunk regains contact. | 1–2 including practice | Intrarater reliability ICC=.97; interrater reliability ICC=.96 (Deathe and Miller 85 ) |
2MWT | Mobility performance | Distance (10th of a meter) | Participants walk around 2 floor markers spaced 20m apart for 2min without sitting to rest. | 3–4 including practice | Intrarater reliability ICC=.90; interrater reliability ICC=.98 (Brooks et al 86 , 87 ) |
Data analysis
- 1.Fear of falling, due to hesitancy to challenge balance2,6,26;
- 2.Unilateral transfemoral amputation compared with transtibial amputation, due to reduced sensorimotor function2,73;
- 3.Dysvascular-related amputation, due to potentially reduced peripheral sensation12,13;
- 4.Daily use of a mobility aid, due to dependency on this aid for ambulation2,26,74;
- 5.Individuals who experienced multiple falls, due to a theoretical link with reduced postural control.12,16
Results
Characteristic | Mean ± SD (Range) |
---|---|
Age (y) | 54±12 (21–76) |
Height (cm) | 173±8 (159–186) |
Mass with prosthesis (kg) | 87±19 (52–121) |
Mass without prosthesis (kg) | 85±19 (50–118) |
Time since most recent major amputation (y) | 21±15 (0.5–55) |
Prosthesis usage (days/week×hours/day=hours/week) | 86±30 (15–126) |
Experience using a prosthesis (y) | 18±14 (0.3–52) |
Sex, n | |
Male | 20 |
Female | 10 |
Amputation etiology, n | |
Dysvascular | 7 |
Traumatic | 14 |
Infection | 6 |
Congenital | 3 |
Amputation level, n | |
Unilateral transtibial | 13 |
Unilateral transfemoral | 14 |
Bilateral transtibial | 2 |
Bilateral transtibial/transfemoral | 1 |
Mobility aids used for daily ambulation, n | |
Cane | 10 |
Walker | 5 |
Scooter | 4 |
Manual wheelchair | 4 |
Outcome Measure | Results, Mean ± SD (Range) | Literature Values (Mean ± SD) | Reference |
---|---|---|---|
ABC Scale (#/100%) | 79±20 (33–100) | 63±27 | Miller et al 5 |
PEQ-MS (#/10) | 8±2 (4–10) | 7±2 | Miller et al 5 |
FAI (#/45) | 33±7 (15–43) | 35±10 | Miller et al 84 |
2MWT (m) | 113.2±39.8 (26.1–196.5) | 99.2±15.1 | Miller et al 81 |
L Test (s) | 34.5±19.3 (17.5–113.9) | 32.9±16.8 | Deathe and Miller 85 |
BBS (#/56) | 51±5 (32–56) | 54±1 | Yazicioglu et al 67 |
Outcome Measure Correlated With the BBS | Spearman ρ | P |
---|---|---|
ABC Scale | .634 | <.001 |
PEQ-MS | .584 | .001 |
FAI | .607 | <.001 |
2MWT | .675 | <.001 |
L Test | −.802 | <.001 |
Descriptor | n | Median (Interquartile Range) | Mann-Whitney U, P |
---|---|---|---|
Fear of falling | |||
Yes | 10 | 49 (46–52) | 158.5, .008 |
No | 20 | 53 (50–55) | |
Unilateral amputation level | |||
Transtibial | 13 | 53 (49–55) | 112.0, .325 |
Transfemoral | 14 | 52 (49–54) | |
Amputation etiology | |||
Dysvascular | 7 | 48 (45–52) | 42.0, .061 |
Other | 23 | 53 (50–55) | |
Daily use of mobility aid | |||
Yes | 12 | 49 (45–50) | 192.0, <.001 |
No | 18 | 54 (52–55) | |
Two or more falls in previous 12 months | |||
Yes | 7 | 50 (49–43) | 94.5, .381 |
No | 22 | 53 (49–55) |


Discussion
Study limitations
Conclusions
Suppliers
- a.G*Power 3; Institut für Experimentelle Psychologie, Heinrich-Heine-Universität, Gebäude 23.02 und 23.03, Universitätsstr. 1, 40225 Düsseldorf, Germany.
- b.SPSS v20; IBM Corporation, 1 New Orchard Rd, Armonk, NY 10504.
Acknowledgments
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Article Info
Publication History
Footnotes
Supported by National Institutes of Health (grant no. 3UL1RR025741 ), National Institute on Disability and Rehabilitation Research (grant nos. H133P110013 and H133E080009 ), and the David Rubin, MD, Enrichment Fund. The opinions contained in this article are those of the authors and do not necessarily reflect those of the US Department of Education or Health and Human Services.
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.