The influence of falling, fear of falling, and balance confidence on prosthetic mobility and social activity among individuals with a lower extremityamputation

Objective: To assess in amputee patients the relationship between having fa llen in the past 12 months, fear of falling, and balance confidence on mobi lity capability, mobility performance, and social activity. Design: Population-based survey and chart review. Setting: Two university-affiliated outpatient amputee programs in southwest ern Ontario. Participants: Community-living individuals (n = 435) with a unilateral lowe r 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 Prosthe tic Evaluation Questionnaire mobility subscale, the Houghton Scale, and the Frenchay Activities Index. Results: Falling experiences in the past 12 months Were not significantly a ssociated with any outcomes. Fear of falling was important in univariate re lationships in all 3 outcomes, but not when balance confidence was included in multivariable modeling. Balance confidence was statistically significan t with each Of the outcomes and remained significant with inclusion of the covariates. There was statistical interaction (balance confidence X automat ism; 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%, an d 55% of the variation in mobility capability, mobility performance, and so cial activity, respectively. Conclusion: Balance confidence was the only factor associated with mobility capability and performance and social activity in the final adjusted model s. Clinicians and researchers should consider this variable in the rehabili tation of amputee patients.