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Introduction: Several personal characteristics have been associated with an increased risk of injurious falls by lower limb prosthesis (LLP) users. To date, however, none have been used to effectively predict the occurrence of injurious falls. Objective: To develop a model that could predict the number of injurious falls over the next 6 months and identify fall‐related circumstances that may increase the odds of a fall being injurious in unilateral LLP users. Design: A secondary analysis of a prospective observational study. Setting: Research laboratory. Participants: Sixty unilateral LLP users with a transtibial or transfemoral amputation. Intervention: Not applicable. Main outcome measure(s): Participants' characteristics were recorded at baseline. Falls and their circumstances and consequences were collected prospectively over 6 months via monthly telephone calls. Multivariate negative binomial regression was used to predict the number of injurious falls over the next 6 months in LLP users. Incidence rate ratios (IRRs) were derived to determine the risk of an injurious fall. Bivariate logistic regression was used to identify the associations between injurious falls and fall‐related circumstances. Odds ratios (ORs) were derived to characterize the odds that a fall would be injurious. Results: The final multivariate model, which included the number of falls recalled in the past year (IRR = 1.31, 95% confidence interval [CI]: 1.01–1.71, p =.045) and balance confidence (p =.120), predicted the number of injurious falls in the next 6 months (χ2 (2) = 8.15, p =.017). Two fall‐related circumstances were found to increase the odds that a fall would be injurious, fatigue due to activity (OR = 13.5, 95% CI: 3.50–52.3, p =.001), and tiredness from a lack of sleep (OR = 5.36, 95% CI: 1.22–23.6, p =.026). Conclusion: The results suggest that the number of falls recalled in the past year and balance confidence scores predict the number of injurious falls an LLP user will experience in the next 6 months. [ABSTRACT FROM AUTHOR]

To explore lived experiences, and identify common themes as well as vocabulary associated with fall-related events in lower limb prosthesis (LLP) users. Five focus groups of LLP users from across the United States were conducted remotely via video or tele-conferencing. Focus group transcripts were coded and analyzed using methods adapted from a grounded theory approach to identify themes. Focus group participants (n = 25) described experiences associated with fall-related events that resulted in the identification of six themes: (1) memories of fall-related events are shaped by time and context, (2) location and ground conditions influence whether falls occur, (3) some activities come with more risk, (4) fall-related situations are multi-faceted, and often involve the prosthesis, (5) how LLP users land, but not the way they go down, tends to vary, and (6) not all falls affect LLP users, but some near-falls do. Consideration for where LLP users fall, what they are doing when they fall, how they fall, what occurs as a result of a fall, and how well memory of a fall persists may enhance recording and reporting of falls, contribute to development of improved fall risk assessment tools, and inspire the design and function of prosthetic componentry for patient safety. Falls are a common problem in lower limb prosthesis (LLP) users that can lead to adverse health outcomes. Concerns over near falls, not just falls, may merit greater attention from rehabilitation professionals. Elements of the lived experience that appear unique to LLP users include the role of prosthetic fit, function, and comfort in losing and/or recovering balance; as well as the tendency of LLP users to modify rather than stop or avoid activities associated with falls. [ABSTRACT FROM AUTHOR]

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Background: Performance‐based tests are viewed as a gold standard for measuring physical capability. Practice effects, however, may threaten their predictive, discriminative, and evaluative applications. Despite these potential consequences, practice effects have received limited attention in users of lower limb prostheses (LLP). Objective: To perform an initial characterization of the occurrence, time‐course, and magnitude of practice effects in three performance‐based tests administered to users of LLP. Design: Secondary analysis of data from a multisite repeated‐measures study. Setting: Outpatient clinic and research laboratory. Participants: Convenience sample of established ambulatory users of unilateral transtibial and transfemoral prostheses (n = 60). Intervention: Not applicable. Main Outcome Measures: Practice effects were identified as significant changes in slope of participants' cumulative trial‐by‐trial records. The occurrence, time‐course, and magnitude of practice effects were computed for the Timed Up and Go (TUG), Four Square Step Test (FSST), and the 10‐m Walk Test (10mWT). Results: Across tests, practice effects were observed in 45% to 76% of participants. The proportion of participants with practice effects (ie, occurrence) was significantly greater for the FSST than the 10mWT (P =.008). The median number of trials (ie, time‐course) required for participants to reach a consistent level of performance was not significantly different between tests (FSST: 4 trials, TUG: 4 trials; 10mWT: 3.5 trials; P =.481). Practice effect magnitude (ie, difference between the mean of trials during the plateau and best performance over the first two trials) was significantly greater than zero for the FSST (1.6 s; 16%) and TUG (1.4 s; 13%) (P <.05). Conclusion: Results indicate that the FSST, TUG, and 10mWT were susceptible to practice effects in this sample of users of LLP. Practice effects may obscure significant differences in walking and balance ability, and thereby, in the absence of modifications, limit the use of these tests for making individual patient clinical decisions and analyzing group‐level data. [ABSTRACT FROM AUTHOR]

Background: Clinicians are routinely required to make decisions about fall risk among lower limb prosthesis (LLP) users. These decisions can be guided by standardized clinical balance tests but require population- and test-specific cutoff scores and validity indices to categorize individuals as probable fallers or nonfallers on the basis of test performance. Despite the importance of cutoff scores and validity indices to clinical interpretation of clinical balance test scores, they are rarely reported for LLP users. In their absence, clinicians cannot use results from clinical balance tests to assess the likelihood of a fall by any one patient.Objective: Derive cutoff scores, and associated validity indices, for clinical balance tests administered to established unilateral LLP users.Design: Cross-sectional study.Setting: Outpatient clinic and research laboratory.Participants: Established ambulatory unilateral transtibial and transfemoral prosthesis users (n = 40).Intervention: Not applicable.Main Outcome Measure(s): Optimal cutoff scores and related validity indices (ie, area under the curve, sensitivity, specificity, likelihood ratios) were computed for five balance tests, the activities-specific balance confidence scale (ABC), timed up and go (TUG), four square step test (FSST), Berg balance scale (BBS), and narrowing-beam walking test (NBWT).Results: Cutoff scores were identified for the NBWT (≤.43/1.0), TUG (≥8.17 seconds], FSST (≥8.49 seconds), BBS (≤50.5/56), and ABC (≤80.2/100). Validity indices (ie, area under the curve, sensitivity, specificity, and likelihood ratios) for the NBWT, TUG, and FSST had greater diagnostic accuracy and provided more information about the probability of a fall than those for the BBS or ABC.Conclusion: Performance above or below identified cutoff scores for the NBWT, FSST, and TUG provides information about potentially important shifts in the probability of falling among established unilateral LLP users. These results can serve as initial benchmarks to reduce uncertainty surrounding fall risk assessment in established unilateral LLP users but require future prospective evaluation.Level Of Evidence: III. [ABSTRACT FROM AUTHOR]

AbstractPurposeMethodsResultsConclusions\nIMPLICATIONS FOR REHABILITATIONEvaluate specific elements of previously proposed fall and near-fall definitions to determine whether they fully capture lower limb prosthesis (LLP) users’ lived experiences.Semi-structured interviews were conducted with 24 LLP users. Interview transcripts were reviewed, coded, and analyzed using deductive thematic analysis to identify shared experiences and inform revisions to previously reported definitions.Four major themes emerged: a fall can be initiated by more than just a loss of balance, loss of balance and losing balance are considered similar, falls are not limited to landing on the ground or floor, and catching yourself and recovering your balance are distinct responses to a loss of balance.Two revisions were made to previous definitions to better align with LLP users’ experiences and historically overlooked fall circumstances. A fall is defined as a loss of balance or sudden loss of support where your body lands on the ground, floor, or another object. A near-fall was defined as a loss of balance where you caught yourself or recovered your balance without landing on the ground, floor, or another object. Implementation of these new definitions will aid the collection of accurate, consistent, and meaningful fall data, enhancing aggregation and comparison across studies.Falls are a top health concern for lower limb prosthesis users.Understanding how lower limb prosthesis users experience falls helps build meaningful fall definitions.Standardized definitions allow clinicians to document fall events with greater consistency and justify fall prevention interventions.Falls are a top health concern for lower limb prosthesis users.Understanding how lower limb prosthesis users experience falls helps build meaningful fall definitions.Standardized definitions allow clinicians to document fall events with greater consistency and justify fall prevention interventions. [ABSTRACT FROM AUTHOR]