Comparison of fear of falling in individuals with traumatic unilateral transtibial and transfemoral amputation

Year 2025, Volume: 16 Issue: 2, 309 - 314, 30.06.2025

Gizem Kılınç Kamacı , Merve Örücü Atar , Arzum Palaş , Nurdan Korkmaz , Yasin Demir , Koray Aydemir

https://doi.org/10.18663/tjcl.1636200

https://izlik.org/JA53CA26LJ

Abstract

Aim: Individuals with lower limb amputation are at risk of falling due to limb loss. Increased fear of falling in prosthesis users may negatively affect the rehabilitation process and quality of life. The aim of this study was to compare the fear of falling in individuals with traumatic unilateral transtibial amputation (TTA) and transfemoral amputation (TFA) and to determine the factors that may be associated with the fear of falling.

Material and Methods: This is a cross-sectional study. The study included 30 individuals with unilateral TTA and 30 individuals with TFA, aged 18–65 years. The Visual Analogue Scale (VAS) was used to determine the severity of intact limb, amputated limb, and low back pain. The Numeric Rating Scale (NRS) was used to assess satisfaction with the overall prosthesis, socket, prosthetic foot, and prosthetic knee joint. The number of falls in the past year was recorded. Fear of falling was assessed using the Falls Efficacy Scale International (FES-I).

Results: Among the individuals included in the study, 56.7% reported at least one fall in the last year. There was a statistically significant difference between TTA and TFA groups in terms of VAS intact and residual limb pain and number of falls in the last year (p = 0.011, p = 0.017, p = 0.024, respectively). A statistically significant relationship was found between VAS intact extremity pain and fear of falling in the TTA group (p = 0.004). A statistically significant relationship was found between VAS low back pain and fear of falling in both TTA and TFA groups (p = 0.039, p = 0.043, respectively). There was a significant relationship between the time since amputation and fear of falling in the TFA group (p = 0.027).

Conclusion: Fear of falling is associated with intact limb pain and low back pain in unilateral TTA individuals. In unilateral TFA individuals, fear of falling was associated with low back pain and time since amputation. In order to prevent fear of falling, which may negatively affect amputees, it is important to identify associated factors such as intact limb pain and low back pain. In order to prevent fear of falling, rehabilitation practices should be planned for these related factors.

Keywords

transtibial amputation , transfemoral amputation , falls , fear of falling.

Travmatik unilateral transtibial ve transfemoral amputasyonu olan bireylerde düşme korkusunun karşılaştırılması

https://izlik.org/JA53CA26LJ

Abstract

Amaç: Alt ekstremite amputasyonu olan bireyler uzuv kayıplarından dolayı düşme riski altındadır. Protez kullanan bireylerde düşme korkusunun artması, bireylerin rehabilitasyon sürecini ve yaşam kalitelerini olumsuz etkileyebilir. Travmatik unilateral transtibial amputasyonu (TTA) ile transfemoral amputasyonu (TFA) olan bireylerin düşme korkusunun karşılaştırılması ve düşme korkusu ile ilişkili olabilecek faktörlerin belirlenmesi amaçlanmıştır.

Gereç ve Yöntemler: Çalışma kesitsel olarak planlandı. Çalışmaya 18–65 yaş arası unilateral TTA olan 30 birey ve TFA olan 30 birey dahil edildi. Vizüel Analog Skala (VAS) ile sağlam ekstremite, ampute ekstremite ve bel ağrısının şiddeti belirlendi. Numerik Derecelendirme Ölçeği (NRS) kullanılarak genel protez, soket, protez ayak ve varsa protez diz eklemi memnuniyetleri sorgulandı. Son 1 yıl içerisinde düşme sayısı not edildi. Bireylerin düşme korkusu ise Uluslararası Düşme Etkinlik Ölçeği (FES-I) ile değerlendirildi.

Bulgular: Çalışmaya dahil edilen bireylerin son bir yıl içerisinde %56,7’si en az bir defa düşme yaşadığını belirtti. TTA ve TFA grupları arasında VAS sağlam ve rezidüel ekstremite ağrısı, son bir yıl içerisindeki düşme sayısı arasında istatistiksel olarak anlamlı fark saptandı (sırasıyla p = 0,011, p = 0,017, p = 0,024). VAS sağlam ekstremite ağrısı ile düşme korkusu arasında TTA grubunda istatistiksel olarak anlamlı bir ilişki saptandı (p = 0,004). VAS bel ağrısı ile düşme korkusu arasında ise hem TTA hem de TFA grubunda istatistiksel olarak anlamlı ilişki saptandı (sırasıyla p = 0,039, p = 0,043). Amputasyondan sonra geçen süre ile düşme korkusu arasında TFA grubunda anlamlı bir ilişki saptandı (p = 0,027).

Sonuçlar: TTA olan bireylerde düşme korkusu, sağlam ekstremite ağrısı ve bel ağrısı ile ilişkilidir. TFA olan bireylerde ise düşme korkusu bel ağrısı ve amputasyondan sonra geçen süre ile ilişkilidir. Ampute bireyleri olumsuz etkileyebilecek olan düşme korkusunun önlenmesi için sağlam ekstremite ağrısı ve bel ağrısı gibi ilişkili faktörlerin belirlenmesi önemlidir. Düşme korkusunu önlemek için ilişkili olabilecek bu faktörlere yönelik rehabilitasyon uygulamalarının planlanması gerekmektedir.

Keywords

transtibial amputasyon , trasfemoral amputasyon , düşme , düşme korkusu.

Ethical Statement

Araştırma için Ankara Bilkent Şehir Hastanesi Etik Kurulundan onay alındı (Tarih:13.12.2023 No: E1-23-4437).

Supporting Institution

Araştırmacıların herhangi bir çıkar ilişkisi bulunmamaktadır. Çalışmayı maddi olarak destekleyen kişi/kuruluş yoktur.

References

• Barnett CT, Vanicek N, Rusaw DF. Do Predictive Relationships Exist Between Postural Control and Falls Efficacy in Unilateral Transtibial Prosthesis Users? Arch Phys Med Rehabil 2018; 99: 2271-78.
• Steinberg N, Gottlieb A, Siev-Ner I, Plotnik M. Fall incidence and associated risk factors among people with a lower limb amputation during various stages of recovery - a systematic review. Disabil Rehabil 2019; 41: 1778-87.
• Miller WC, Deathe AB, Speechley M, Koval J. The influence of falling, fear of falling, and balance confidence on prosthetic mobility and social activity among individuals with a lower extremity amputation. Arch Phys Med Rehabil 2001; 82: 1238-44.
• Rosenblatt NJ, Major MJ, Manesh B, Schneider K, Miller SA. Validating a fear-of-falling-related activity avoidance scale in lower limb prosthesis users. PMR 2024; 16: 462-73.
• Engenheiro G, Pinheiro J, Costa JS, Cordeiro A, Ramos S. Falls in unilateral lower limb amputees living in the community. A Portuguese study. Acta Med Port 2020; 33: 675-79.
• Miller WC, Speechley M, Deathe B. The prevalence and risk factors of falling and fear of falling among lower extremity amputees. Arch Phys Med Rehabil 2001; 82: 1031-7.
• Hunter SW, Batchelor F, Hill KD, Hill AM, Mackintosh S, Payne M. Risk Factors for Falls in People With a Lower Limb Amputation: A Systematic Review. PMR 2017; 9: 170-80.
• Yardley L, Beyer N, Hauer K, Kempen G, Piot-Ziegler C, Todd C. Development and initial validation of the Falls Efficacy Scale-International (FES-I). Age Ageing 2005; 34: 614-9.
• Ulus Y, Durmus D, Akyol Y, Terzi Y, Bilgici A, Kuru O. Reliability and validity of the Turkish version of the Falls Efficacy Scale International (FES-I) in community-dwelling older persons. Arch Gerontol Geriatr 2012; 54: 429-33.
• Schafer ZA, Perry JL, Vanicek N. A personalised exercise programme for individuals with lower limb amputation reduces falls and improves gait biomechanics: A block randomised controlled trial. Gait Posture 2018; 63: 282-89.
• Anderson CB, Miller MJ, Murray AM, Fields TT, So NF, Christiansen CL. Falls After Dysvascular Transtibial Amputation: A Secondary Analysis of Falling Characteristics and Reduced Physical Performance. PMR 2021; 13: 19-29.
• Wilczyński J, Ścipniak M, Ścipniak K, Margiel K, Wilczyński I, Zieliński R, Sobolewski P. Assessment of Risk Factors for Falls among Patients with Parkinson's Disease. Biomed Res Int 2021: 5531331.
• Fuenzalida Squella SA, Kannenberg A, Brandão Benetti Â. Enhancement of a prosthetic knee with a microprocessor-controlled gait phase switch reduces falls and improves balance confidence and gait speed in community ambulators with unilateral transfemoral amputation. Prosthet Orthot Int 2018; 42: 228-35.
• Kahle JT, Klenow TD, Sampson WJ, Highsmith MJ. The effect of transfemoral interface design on gait speed and risk of falls. Technol Innov 2016; 18: 167-73.
• Kaufman KR, Miller EJ, Deml CM, Sheehan RC, Grabiner MD, Wyatt M et al. Fall Prevention Training for Service Members With an Amputation or Limb Salvage Following Lower Extremity Trauma. Mil Med 2024; 189: 980-87.
• Toumi A, Simoneau-Buessinger É, Bassement J, Barbier F, Gillet C, Allard P, Leteneur S. Standing posture and balance modalities in unilateral transfemoral and transtibial amputees. J Bodyw Mov Ther 2021; 27: 634-39.
• Yao Q, Jin W, Li Y. Associations between fear of falling and activity restriction and late life depression in the elderly population: Findings from the Irish longitudinal study on ageing (TILDA). J Psychosom Res 2021; 146: 110506.
• Pauley T, Devlin M, Heslin K. Falls sustained during inpatient rehabilitation after lower limb amputation: prevalence and predictors. Am J Phys Med Rehabil 2006; 85: 521-32.
• Seth M, Horne JR, Pohlig RT, Sions JM. Pain, Balance-Confidence, Functional Mobility, and Reach Are Associated With Risk of Recurrent Falls Among Adults With Lower-Limb Amputation. Arch Rehabil Res Clin Transl 2023; 5: 100309.