The Influence of Falling, Fear of Falling, and Balance Confidence on Prosthetic Mobility and Social Activity Among Individuals with a Lower Extremity Amputation

Objective: To assess in amputee patients the relationship between having fallen in the past 12 months, fear of falling, and balance confidence on mobility capability, mobility performance, and social activity.

Design: Population-based survey and chart review.

Setting: Two university-affiliated outpatient amputee programs in southwestern Ontario.

Participants: Community-living individuals (n = 435) with a unilateral lower limb amputation.

Interventions: Patient chart review and a survey questionnaire.

Main Outcome Measures: Self-report assessment of prosthetic capability and performance and social activity participation was assessed with the Prosthetic Evaluation Questionnaire mobility subscale, the Houghton Scale, and the Frenchay Activities Index.

Results: Falling experiences in the past 12 months were not significantly associated with any outcomes. Fear of falling was important in univariate relationships in all 3 outcomes, but not when balance confidence was included in multivariable modeling. Balance confidence was statistically significant with each of the outcomes and remained significant with inclusion of the covariates. There was statistical interaction (balance confidence x automatism; balance confidence x medication count) in modeling mobility capability and in modeling mobility performance (balance confidence x pain + balance confidence x amputation level). The final models accounted for 70%, 60%, and 55% of the variation in mobility capability, mobility performance, and social activity, respectively.

Conclusion: Balance confidence was the only factor associated with mobility capability and performance and social activity in the final adjusted models. Clinicians and researchers should consider this variable in the rehabilitation of amputee patients.