Risk Factors for Falls in Individuals With Lower Extremity Amputations During the Pre-Prosthetic Phase: A Retrospective Cohort Study

PM R. 2019 Aug;11(8):828-833. doi: 10.1002/pmrj.12046. Epub 2019 Apr 1.

Abstract

Background: Falls in individuals with lower limb amputations (LLAs) pose significant health concerns. The literature is limited regarding falls during the preprosthetic phase of rehabilitation for persons with LLAs.

Objective: To determine the incidence of falls and identify factors associated with falls during the preprosthetic recovery phase.

Design: Retrospective chart audit.

Setting: Inpatient rehabilitation program.

Participants: Four hundred forty individuals with LLAs (age ± SD = 61.93 ± 14.53 years, 73.18% male) who attended inpatient rehabilitation from 26 July 2011 to 21 August 2017.

Interventions: Not applicable.

Main outcome measurements: The number of self-reported falls was recorded from the time of surgery to admission for inpatient rehabilitation. Outcomes of interest were any fall (1+ fall) and recurrent falls (2+ falls). A retrospective chart audit was performed on consecutive admissions to an inpatient rehabilitation program.

Results: The incidence of falls was 8.37 per 1000 patient-days. Falls were sustained by 60.9% of the sample. Unilateral transtibial amputation was independently associated with an increased risk of recurrent falls (relative risk [RR] 1.59, 95% confidence interval [CI] 1.13-2.23, P = .008). Diabetes mellitus was independently associated with an increased risk of any fall (RR 1.18, 95% CI 1.01-.38, P = .03). Finally, bilateral transtibial amputation was independently associated with a reduced risk of any fall (RR 0.59, 95% CI 0.39-0.90, P = .014).

Conclusions: Consistent with the current literature, diabetes mellitus and a unilateral transtibial amputation were risk factors for falling, whereas a bilateral transtibial amputation and increasing age presented new findings as factors associated with decreased falling.

Level of evidence: III.

MeSH terms

  • Accidental Falls / prevention & control
  • Accidental Falls / statistics & numerical data*
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Amputation, Surgical / methods*
  • Amputees / rehabilitation*
  • Artificial Limbs*
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Inpatients / statistics & numerical data
  • Logistic Models
  • Lower Extremity / surgery
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Prognosis
  • Prosthesis Fitting / methods
  • Rehabilitation Centers
  • Retrospective Studies
  • Risk Assessment
  • Sex Factors
  • Tibia / surgery
  • Treatment Outcome