Impact of vascular disease, amputation level, and the mismatch between balance ability and balance confidence in a cross sectional study of the likelihood of falls among people with limb loss: perception versus reality

Objective Investigate impact of balance ability, Activities-specific Balance Confidence (ABC), and other self-reported and clinical factors on incidence of falls among people with lower-limb loss. Design Cross-sectional study (N=305) with multivariable logistic regression analysis Results Participants included 68.3% males with age 55.5±14.9; with 50% dysvascular and 56.8% transtibial amputations. Average ABC=2.1/4 ±1.1, balance ability=2.9/4 ±1.3 and walking speed=0.766±0.387 m/s. The final model showed fall risk was heightened for people with vascular comorbidities (odds ratio [OR]=3.46, 95% confidence interval [CI]=1.40-8.54) and better balance (OR=23.29, CI=3.19-170.23); but attenuated for people with transfemoral (OR=0.08, CI=0.01-0.82) and vascular amputations (OR=0.38, CI=0.15-0.95). Significant interactions existed between age and amputation level (OR=1.06, CI=1.02-1.11) and between balance confidence and balance ability (OR=0.27, CI=0.13-0.57). Conclusions While people with vascular amputations were less likely to fall than those with nonvascular amputations, people with concurrent vascular comorbidities were more likely to fall than those without. People with transfemoral amputations were less likely to fall—however, fall risk increased with each year of age compared to people with transtibial amputations. People with balance ability ≥3.5 fell more often than those with lower ability, but people with lower balance ability and mismatched confidence in their balance ability had 3.7 times greater fall risk. CORRESPONDING AUTHOR CONTACT INFORMATION: Christopher Kevin Wong, PT, PhD, OCS, Associate Professor, Department of Rehabilitation and Regenerative Medicine, Associate Director, Program in Physical Therapy, Columbia University Medical Center, 617 West 168th Street, The Georgian 3rd Floor, New York, NY 10032, Tel: 212-305-3781 Fax: 212-305-4569 Email: ckw7@cumc.columbia.edu DISCLOSURES: a. The authors have no conflicts of interest to report. c. Funding: Supported in part by the National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (grant no. 1 R49 CE002096). Its contents are solely the responsibility of the authors and do not represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services. c. The authors have no potential financial benefits to report. d. Prior presentations: This work has not been presented. Related work focused on injury was presented at the International Society of Prosthetics and Orthotics, 2017 World Conference, Capetown, South Africa. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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