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Identifying Fallers Using Clinical Balance Measures in Community-Dwelling Adults with Lower Extremity Amputation: A Cross-Sectional Study

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Abstract

The purpose of this study was to administer clinical balance measures in community-dwelling adults with unilateral lower extremity (LE) amputations and determine optimal cut-off scores for identifying fallers. A cross-sectional study was conducted on a convenience sample of 40 independently ambulatory participants with unilateral LE amputations and a prosthetic device (20 fallers and 20 nonfallers) who were tested during a single session using: the Amputee Mobility Predictor with Prosthesis (AMP PRO), Functional Reach (FR), Single Limb Stance (SLS) and the Timed-Up-and-GO (TUG). There was a statistically significant difference on the AMP PRO (4.75 points.; 95% CI 1.10–8.40) for fallers (36.95 out of 47, SD 7.43) compared with nonfallers (41.70 out of 47, SD 3.13) and on the TUG (4.17 s., 95% CI 0.65–7.69) for fallers (14.84 s, SD 7.33) versus nonfallers (10.67 s, SD 2.64). The AMP PRO had a moderate Area Under the Curve (AUC) predictive value of 0.70 with an optimal cut-off score of 39.5 out of 47 total points (sensitivity 80%, specificity 60%) for identification of fallers. For the TUG, there was a moderate AUC value of 0.68 (sensitivity 70%, specificity 60%) when using a cut-off score of 10.03 s. There was a moderate to high correlation between the AMP PRO and TUG both between (r = −0.77) and within (r = −0.68) groups indicating that they measure similar constructs. Limitations included a heterogeneous sample and self-report of fall history. Both the AMP PRO and the TUG provide acceptable sensitivity and specificity for identifying fallers among community-dwelling adults with LE amputation.

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Acknowledgements

We would like to thank the secretarial staff of Keystone Prosthetics and Orthotics for assisting with the recruitment and scheduling of our participants. We also appreciate the help of Dr. Tom Hogan with the statistical analyses of the data.

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Authors and Affiliations

  1. Department of Physical Therapy, University of Scranton, 800 Linden Street, Scranton, PA, 18510, USA

    Renée M. Hakim

  2. NYU Langone Medical Center - Rusk Rehabilitation, 240 East 38th Street, New York, NY, 10016, USA

    Caroline M. Frey

  3. ProCare Physical Therapy, 208 S. Main Street, Moscow, PA, 18444, USA

    Karen E. Spadoni

  4. Center for Orhotic and Prosthetic Care, 1500 Main Street, Dickson City, PA, 18519, USA

    Keith Meyer

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  1. Renée M. Hakim
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Correspondence to Renée M. Hakim.

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All procedures performed involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was provided by all participants in writing as per protocol approved by the University of Scranton OT/PT Departmental Review Board.

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The authors declare that they have no conflict of interest.

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Hakim, R.M., Frey, C.M., Spadoni, K.E. et al. Identifying Fallers Using Clinical Balance Measures in Community-Dwelling Adults with Lower Extremity Amputation: A Cross-Sectional Study. J Dev Phys Disabil 30, 677–688 (2018). https://doi.org/10.1007/s10882-018-9612-2

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