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: The aim of the study was to investigate the impact of balance ability, activities-specific balance confidence, and other self-reported and clinical factors on incidence of falls among people with lower limb loss.

Design: This is a cross-sectional study (N = 305) with multivariable logistic regression analysis.

Results: Participants included 68.3% men with an age of 55.5 ± 14.9, with 50% dysvascular and 56.8% transtibial amputations. The mean ± SD activities-specific balance confidence is 2.1/4 ± 1.1, balance ability is 2.9/4 ± 1.3, and walking speed is 0.766 ± 0.387 m/sec. The final model showed fall risk was heightened for people with vascular comorbidities (odds ratio = 3.46, 95% confidence interval = 1.40-8.54) and better balance (odds ratio = 23.29, confidence interval = 3.19-170.23), but attenuated for people with transfemoral (odds ratio = 0.08, confidence interval = 0.01-0.82) and vascular amputations (odds ratio = 0.38, confidence interval = 0.15-0.95). Significant interactions existed between age and amputation level (odds ratio = 1.06, confidence interval = 1.02-1.11) and between balance confidence and balance ability (odds ratio = 0.27, confidence interval = 0.13-0.57).

Conclusions: Although 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 with people with transtibial amputations. People with balance ability of 3.5 or greater 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.