Abstract
Objective
To assess whether variables from a postural control test relate to and predict falls
efficacy in prosthesis users.
Design
Twelve-month within- and between-participants repeated measures design. Participants
performed the limits of stability (LOS) test protocol at study baseline and at 6-month
follow-up. Participants also completed the Falls Efficacy Scale-International (FES-I)
questionnaire, reflecting the fear of falling, and reported the number of falls monthly
between study baseline and 6-month follow-up, and additionally at 9- and 12-month
follow-ups.
Setting
University biomechanics laboratories.
Participants
Participants (N=24) included a group of active unilateral transtibial prosthesis users
of primarily traumatic etiology (n=12) with at least 1 year of prosthetic experience
and age- and sex-matched control participants (n=12).
Interventions
Not applicable.
Main Outcome Measures
Postural control variables derived from center of pressure data obtained during the
LOS test, which was performed on and reported by the Neurocom Pro Balance Master,
namely reaction time, movement velocity (MVL), endpoint excursion (EPE), maximum excursion
(MXE), and directional control (DCL). Number of falls and total FES-I scores.
Results
During the study period, the prosthesis users group had higher FES-I scores (U=33.5, P=.02), but experienced a similar number of falls, compared to the control group. Increased
FES-I scores were associated with decreased EPE (r= −0.73, P=.02), MXE (r= −0.83, P<.01) and MVL (r= −0.7, P=.03) in the prosthesis users group, and DCL (r= −0.82, P<.01) in the control group, all in the backward direction.
Conclusions
Study baseline measures of postural control, in the backward direction only, are related
to and potentially predictive of subsequent 6-month FES-I scores in relatively mobile
and experienced prosthesis users.
Keywords
List of abbreviations:
CoM (center of mass), CoP (center of pressure), DCL (directional control), EPE (endpoint excursion), FDR (false discovery rate), FES-I (Falls Efficacy Scale-International), LOS (limits of stability), MVL (movement velocity), MXE (maximum excursion), RT (reaction time)To read this article in full you will need to make a payment
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References
- Physical capacity and walking ability after lower limb amputation: a systematic review.Clin Rehabil. 2006; 20: 999-1016
- The influence of falling, fear of falling, and balance confidence on prosthetic mobility and social activity among individuals with a lower extremity amputation.Arch Phys Med Rehabil. 2001; 82: 1238-1244
- The prevalence and risk factors of falling and fear of falling among lower extremity amputees.Arch Phys Med Rehabil. 2001; 82: 1031-1037
- A prospective study examining balance confidence among individuals with lower limb amputation.Disabil Rehabil. 2004; 26: 875-881
- Falls sustained during inpatient rehabilitation after lower limb amputation - prevalence and predictors.Am J Phys Med Rehabil. 2006; 85: 521-532
- Incidence and risk factors of falling in the postoperative lower limb amputee while on the surgical ward.Physical Med Rehabil. 2010; 2: 926-934
- How fear of falling can increase fall-risk in older adults: applying psychological theory to practical observations.Gait Posture. 2015; 41: 7-12
- Posturography and risk of recurrent falls in healthy non-institutionalized persons aged over 65.Gerontology. 2006; 52: 345-352
- Ability of static and statistical mechanics posturographic measures to distinguish between age and fall risk.J Biomech. 2005; 38: 1263-1272
- Force platform measurements as predictors of falls among older people - a review.Gerontology. 2006; 52: 1-16
- The assessment of body sway and the choice of the stability parameter(s).Gait Posture. 2005; 21: 48-58
- Physiological factors associated with falls in older community-dwelling women.J Am Geriatr Soc. 1994; 42: 1110-1117
- Postural sway and active balance performance in highly active lower-limb amputees.Am J Phys Med Rehabil. 2002; 81: 13-20
- Balance control on a moving platform in unilateral lower limb amputees.Gait Posture. 2008; 28: 222-228
- Clinical identification of multiple fall risk early after unilateral transtibial amputation.Arch Phys Med Rehabil. 2007; 88: 109-114
- Postural responses during volitional and perturbed dynamic balance tasks in new lower limb amputees: a longitudinal study.Gait Posture. 2013; 37: 319-325
- Can vibratory feedback be used to improve postural stability in persons with transtibial limb loss?.J Rehabil Res Dev. 2012; 49: 1239-1253
- The validity of forceplate data as a measure of rapid and targeted volitional movements of the centre of mass in transtibial prosthesis users.Disabil Rehabil Assist Technol. 2017; 12: 686-693
- Falls efficacy as a measure of fear of falling.J Gerontol. 1990; 45: P239-P243
- Clinical prescription and use of prosthetic foot and ankle mechanisms: a review of the literature.J Prosthet Orthot. 2005; 17: S5-S11
- Fear of falling revisited.Arch Phys Med Rehabil. 1996; 77: 1025-1029
- Development and initial validation of the falls efficacy scale-international (FES-I).Age Ageing. 2005; 34: 614-619
- Temporal adaptations in generic and population-specific quality of life and falls efficacy in men with recent lower-limb amputations.J Rehabil Res Dev. 2013; 50: 437-448
- Validation of the inverted pendulum model in standing for transtibial prosthesis users.Clin Biomech. 2016; 31: 100-106
- Development of a limits of stability protocol for use in transtibial prosthesis users: learning effects and reliability of outcome variables.Gait Posture. 2017; 58: 539-545
- Development of a common outcome data set for fall injury prevention trials: the prevention of falls network Europe consensus.J Am Geriatr Soc. 2005; 53: 1618-1622
- Evaluating the Swedish version of the Falls Efficacy Scale-International (FES-I).Adv Physiother. 2009; 11: 81-87
- Controlling the false discovery rate: a practical and powerful approach to multiple testing.J R Stat Soc Series B Stat Methodol. 1995; 57: 289-300
- Limits of stability in persons with transtibial amputation with respect to prosthetic alignment alterations.Arch Phys Med Rehabil. 2013; 94: 2234-2240
- Standing balance in people with trans-tibial amputation due to vascular causes: a literature review.Prosthet Orthot Int. 2017; 41: 345-355
Article info
Publication history
Published online: June 16, 2018
Footnotes
Disclosures: none.
Identification
Copyright
Crown Copyright © 2018 Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine
