In e na ional Jou nal o Rehabili a ion Resea ch
Unde s anding he mul idimensionali y o a conce n o alling in people wi h unila e al
ans- ibial ampu a ion: A c oss-sec ional s udy
--Manusc ip D a --
Manusc ip Numbe : IJRR-D-24-00275R3
Full Ti le: Unde s anding he mul idimensionali y o a conce n o alling in people wi h unila e al
ans- ibial ampu a ion: A c oss-sec ional s udy
A icle Type: O iginal S udy
Keywo ds: ampu a ion; conce n o alling; alls; p os hesis
Co esponding Au ho : K is in Nugen , M.Sc.
Uni e si y o Wes e n On a io Facul y o Heal h Sciences: Wes e n Uni e si y Facul y
o Heal h Sciences
London, On a io CANADA
Co esponding Au ho Seconda y
In o ma ion:
Co esponding Au ho 's Ins i u ion: Uni e si y o Wes e n On a io Facul y o Heal h Sciences: Wes e n Uni e si y Facul y
o Heal h Sciences
Co esponding Au ho 's Seconda y
Ins i u ion:
Fi s Au ho : K is in Nugen , MSc
Fi s Au ho Seconda y In o ma ion:
O de o Au ho s: K is in Nugen , MSc
Rica do Viana, MScOT MD
Michael W Payne, MSc MD
Janelle Unge , PT PhD
Susan W Hun e , PT PhD
O de o Au ho s Seconda y In o ma ion:
Manusc ip Region o O igin: CANADA
Abs ac : People wi h lowe limb loss ha e a high isk o alling and o en expe ience
psychological conce ns ela ed o alling. A conce n o alling is a mul idimensional
e m ha includes ou subdomains: a ea o alling, sel -e icacy, consequences o
alling and pe cep ions o alls. The e is limi ed knowledge in he li e a u e abou he
delinea ion and associa ion be ween subdomains in he conce n o alling amewo k,
and i is unknown i clinical ac o s and his o y o alls is associa ed wi h he conce n o
alling subdomains. This c oss-sec ional online su ey e alua ed he: 1) associa ions
among di e en ou come measu es o a conce n o alling; 2) ela ionships be ween
alls his o y wi h he di e en measu es; and 3) clinical and demog aphic ac o s ela ed
wi h each ou come measu e. Inclusion c i e ia:≥18 yea s old, unila e al ans- ibial
ampu a ion and cu en ly using a p os hesis o ambula ion. Exclusion c i e ia: unable
o p o ide in o med consen . Eigh s anda dized scales assessed a conce n o alling:
isual analog scale ea o alling, Modi ied Su ey o Ac i i ies and Fea o Falling in
he Elde ly, Ac i i ies-speci ic Balance Con idence scale, Falls E icacy Scale
In e na ional, P os he ic Limb Use s Su ey – Mobili y, Locomo o Capabili ies Index,
Consequences o Falling Scale and Pe cei ed Abili y o Manage Falls. The associa ion
among he eigh conce n o alling scales was pe o med using Pea son bi a ia e
co ela ion analysis. The associa ion o alls s a us on he sco es was pe o med wi h -
es s. Mul iple linea eg ession modelled he clinical and demog aphic ac o s ela ed
o each ou come measu e. Six y-eigh adul s (mean 61.8±12.0) wi h unila e al ans-
ibial ampu a ion pa icipa ed. Mode a e s a is ically signi ican co ela ions we e ound
ac oss mos ou come measu es, wi h he s onges co ela ions ound be ween he
PLUS-M and mSAFFE ( =-0.841, p<0.001), ABC and FES-I ( =-10.821, p<0.001) and
Powe ed by Edi o ial Manage ® and P oduXion Manage ® om A ies Sys ems Co po a ion
PLUS-M and ABC ( =0.819, p<0.001). Falle s a us was no associa ed wi h any
ou come measu e (p>0.05). The R2 o models examining he associa ion o quali y o
li e wi h ea o alling, a oidance o ac i i ies, sel -e icacy and ce ain y o managing
alls anged be ween 0.27 and 0.47. Conce n o alling should be e alua ed
independen ly o his o y o alls among PWLLL.
Powe ed by Edi o ial Manage ® and P oduXion Manage ® om A ies Sys ems Co po a ion
1
Unde s anding he mul idimensionali y o a conce n o alling in people wi h unila e al
1
ans- ibial ampu a ion: A c oss-sec ional s udy
2
Running head: Conce n o alling in ans ibial ampu ees
3
4
K is in Nugen 1, Rica do Viana2, Michael W Payne2, Janelle Unge 1, Susan W Hun e 1
5
1. School o Physical The apy, Uni e si y o Wes e n On a io, London, ON, Canada
6
2. Depa men o Physical Medicine & Rehabili a ion, Schulich School o Medicine &
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Den is y, Uni e si y o Wes e n On a io
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Co esponding au ho :
10
K is in Nugen MSc
11
School o Physical The apy, Uni e si y o Wes e n On a io, 1201 Wes e n Road, London, ON
12
N6G 1H1, Email: [email p o ec ed]
13
14
Au ho disclosu es: No hing o disclose.
15
Con lic s o in e es : The au ho s ha e no hing o disclose.
16
Sou ce o unding: This wo k was suppo ed by a On a io G adua e Schola ship o K is in
17
Nugen . The unding body had no in ol emen in he conduc o he s udy.
18
19
20
Manusc ip (All Manusc ip Tex Pages in MS Wo d o ma ,
including Ti le Page, Re e ences and Figu e Legends)
2
Wo d coun o abs ac : 328
21
Wo d coun o main ex , abs ac , and igu e and able cap ions: 4237
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Numbe o ables: 4
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Numbe o igu es: 1
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3
ABSTRACT
25
People wi h lowe limb loss ha e a high isk o alling and o en expe ience psychological
26
conce ns ela ed o alling. A conce n o alling is a mul idimensional e m ha includes ou
27
subdomains: a ea o alling, sel -e icacy, consequences o alling and pe cep ions o alls.
28
The e is limi ed knowledge in he li e a u e abou he delinea ion and associa ion be ween
29
subdomains in he conce n o alling amewo k, and i is unknown i clinical ac o s and his o y
30
o alls is associa ed wi h he conce n o alling subdomains. This c oss-sec ional online su ey
31
e alua ed he: 1) associa ions among di e en ou come measu es o a conce n o alling; 2)
32
ela ionships be ween alls his o y wi h he di e en measu es; and 3) clinical and demog aphic
33
ac o s ela ed wi h each ou come measu e. Inclusion c i e ia: 18 yea s old, unila e al ans-
34
ibial ampu a ion and cu en ly using a p os hesis o ambula ion. Exclusion c i e ia: unable o
35
p o ide in o med consen . Eigh s anda dized scales assessed a conce n o alling: isual analog
36
scale ea o alling, Modi ied Su ey o Ac i i ies and Fea o Falling in he Elde ly, Ac i i ies-
37
speci ic Balance Con idence scale, Falls E icacy Scale In e na ional, P os he ic Limb Use s
38
Su ey – Mobili y, Locomo o Capabili ies Index, Consequences o Falling Scale and Pe cei ed
39
Abili y o Manage Falls. The associa ion among he eigh conce n o alling scales was
40
pe o med using Pea son bi a ia e co ela ion analysis. The associa ion o alls s a us on he
41
sco es was pe o med wi h - es s. Mul iple linea eg ession modelled he clinical and
42
demog aphic ac o s ela ed o each ou come measu e. Six y-eigh adul s (mean 61.8±12.0) wi h
43
unila e al ans- ibial ampu a ion pa icipa ed. Mode a e s a is ically signi ican co ela ions we e
44
ound ac oss mos ou come measu es, wi h he s onges co ela ions ound be ween he PLUS-
45
M and mSAFFE ( =-0.841, p<0.001), ABC and FES-I ( =-10.821, p<0.001) and PLUS-M and
46
ABC ( =0.819, p<0.001). Falle s a us was no associa ed wi h any ou come measu e (p>0.05).
47
4
The R2 o models examining he associa ion o quali y o li e wi h ea o alling, a oidance o
48
ac i i ies, sel -e icacy and ce ain y o managing alls anged be ween 0.27 and 0.47. Conce n
49
o alling should be e alua ed independen ly o his o y o alls among PWLLL.
50
51
Key wo ds: ampu a ion, conce n o alling, alls, p os hesis
52
5
INTRODUCTION
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People wi h lowe limb loss (PWLLL) ha e a high isk o alling, e en o hose who
54
ha e success ully comple ed a p os he ic ehabili a ion p og am.[1] O e 50% o PWLLL sus ain
55
a leas one all a yea [2,3] and mos alls occu while he pe son is walking wi h hei
56
p os hesis[4]. The majo i y o PWLLL in Canada ha e a ans- ibial le el ampu a ion due o a
57
dys ascula e iology.[5] Risk ac o s o alls among PWLLL include inc easing age, balance o
58
gai impai men s, a highe le el o ampu a ion (e.g., ans- ibial compa ed o Symes o below
59
ankle) and a dys ascula ampu a ion e iology.[1] Addi ionally, ecalled numbe o alls, balance
60
con idence and pe cei ed mobili y a e also associa ed wi h u u e alls in PWLLL.[6,7]
61
Falls o PWLLL can esul in long- e m ad e se sequelae ha a ec bo h physical and
62
psychological unc ion.[8,9] While he physical consequences o alls may be eadily appa en o
63
he ou side obse e [10] (e.g., ac u es, lace a ion, dehiscence o he s ump wound), he
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psychological e ec s equi e a ho ough subjec i e his o y along wi h s anda dized
65
ques ionnai es o de ine and quan i y he issue.[11] Ampu ee ehabili a ion clinicians ha e
66
epo ed anecdo al conce ns abou he misma ch be ween pa ien s’ pe cei ed conce ns abou
67
alling and hei epo ed his o y o alls. To add ess his conce n and educe alls among
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PWLLL, quan i ying bo h conce n o alling and alls his o y, and demons a ing he misma ch
69
o he pa ien , may be he mos comp ehensi e app oach. The e o e, assessing a conce n o
70
alling bo h in ela ion o and independen ly o alls his o y is necessa y o be e unde s and his
71
issue in PWLLL.
72
Moo e and Ellis[12] desc ibed a conce n o alling as a mul idimensional, o e a ching
73
e m ha includes mul iple complex psychological e ec s, which a e ela ed bu ha e dis inc
74
elemen s ha di e en ia es hem om one ano he . The conce n o alling amewo k was
75
6
adap ed and applied o PWLLL by Nugen e al.[13] delinea ing i e dis inc subdomains: 1) ea
76
o alling (las ing conce n abou alling ha leads an indi idual o a oid ac i i ies ha hey a e
77
physically capable o pe o ming); 2) alls e icacy (con idence in one’s abili y o pe o m
78
ac i i ies o daily li ing wi hou alling); 3) mobili y e icacy (con idence in one’s abili y o
79
pe o m no mal daily ac i i ies wi hou di icul y); 4) consequences o alling ( ea ed ou comes
80
as a esul o alling); and 5) pe cep ion o alls (an indi idual’s knowledge o and belie in hei
81
abili y o ha e con ol o e alling). Associa ions indica e ela ionships be ween wo cons uc s.
82
A pe ec associa ion would sugges ha one cons uc be used in e changeably wi h he o he , as
83
bo h would add ess he same aspec s.[14] Howe e , when associa ions a e no pe ec , i
84
p o ides e idence ha he cons uc s while ela ed, cap u e dis inc aspec s.[14] This implies ha
85
al hough he e may be o e lap, each cons uc has speci ic di e ence ha a e e lec ed in one
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ou come measu e bu no he o he .[14] Despi e clea de ini ions o each o he conce n o
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alling subdomains, he e ms ha e been used in e changeably in he li e a u e.[15] Ou p e ious
88
publica ions used he p elimina y esul s o his la ge da abase, which demons a ed he
89
s a is ically signi ican associa ion wi h a conce n o alling has on o e all quali y o li e o
90
PWLLL, bu did no ully explain he a iance in he ela ionship.[13] P e ious esea ch has
91
shown ha wi hin each subdomain o a conce n o alling, di e en ou come measu es e alua e
92
dis inc cons uc s, making i necessa y o use mul iple ou come measu es o ully e alua e each
93
subdomain.[13]
94
The lack o di e en ia ion in his e minology limi s clinicians o accu a ely de ine a
95
conce n o alling among PWLLL and he iden i ica ion and implemen a ion o in e en ion
96
s a egies.[16] The exis ing li e a u e ela ed o a conce n o alling in PWLLL has ocused on
97
balance con idence, ea o alling and alls knowledge. Hun e e al.[17] ound balance
98
7
con idence o be low among PWLLL a e comple ing p os he ic ehabili a ion and did no
99
imp o e a h ee mon hs a e discha ge. Falls- ela ed sel -e icacy, he belie ha a pe son can
100
pe o m an ac i i y wi hou alling, has been ound o emain unchanged in he i s 6 o 12
101
mon hs a e p os he ic ehabili a ion despi e a signi ican imp o emen in unc ional
102
mobili y.[8,16] Mille e al.[9] ound 49.2% o PWLLL li ing in he communi y epo ed a ea
103
o alling. Fea o alling con ibu es o a dec eased alls- ela ed sel -e icacy ha con ibu es o
104
he o e all psychological conce ns ela ed o alls and dec eased communi y pa icipa ion.[16]
105
The li e a u e on a conce n o alling among PWLLL lacks comp ehensi e e alua ion,
106
de ined as assessing a leas one ou come measu e wi hin each subdomain o he conce n o
107
alling amewo k, o how hese subdomains may be in luenced by a his o y o alls. To add ess
108
his gap, an e alua ion o he ela ionships be ween di e en subdomains o a conce n o alling
109
among PWLLL is indica ed. The objec i es o he s udy we e o e alua e he associa ions among
110
di e en ou come measu es ela ed o a conce n o alling, o assess he ela ionship be ween
111
alls his o y and a conce n o alling, and o examine he in luence o clinical and demog aphic
112
ac o s on each o he ou come measu es o a conce n o alling.
113
I was hypo hesized ha he eigh conce n o alling ou come measu es will ha e
114
mode a e o s ong s a is ically signi ican co ela ions wi h one ano he . Second, i was
115
hypo hesized ha his o y o alls will no be s a is ically signi ican ly associa ed wi h each
116
conce n o alling ou come measu e. Finally, i was hypo hesized ha clinical and demog aphic
117
ac o s would be associa ed wi h ou come measu es ela ed o a conce n o alling.
118
METHODS
119
S udy pa icipan s
120
14
medica ions was associa ed wi h educed mobili y e icacy and educed ce ain y abou
258
managing any alls. The use o a mobili y aid was associa ed wi h inc eased balance con idence.
259
DISCUSSION
260
This s udy e alua ed a comp ehensi e se o ou come measu es o a conce n o alling
261
in a sample o people wi h unila e al ans- ibial limb loss. The ou come measu es we e
262
consis en ly aligned ac oss he subdomains; low ea o alling was associa ed wi h high balance
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con idence, lowe ac i i y a oidance, s onge alls e icacy, be e mobili y e icacy, inc eased
264
agency o p e en alls and ewe conce ns ega ding ad e se consequences. While he o al
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sco es o he eigh ou come measu es we e mode a ely co ela ed, he i ems wi hin each
266
measu es we e mode a ely co ela ed, he indi idual i ems wi hin each measu e we e no
267
uni o mly epea ed ac oss all he scales.
268
While he o al sco es o he eigh ou come measu es we e mode a ely co ela ed, he
269
i ems wi hin each measu e we e no uni o mly epea ed ac oss all he scales. Recu en alle
270
s a us in he las 12 mon hs was no s a is ically signi ican o any o he ou come measu e o al
271
sco es. Howe e , quali y o li e was associa ed wi h o al sco es o all ou come measu es in he
272
linea eg ession modelling. Speci ically, inc easing quali y o li e was associa ed wi h less ea
273
o alling, less a oidance o ac i i ies, be e sel -e icacy and be e ce ain y in managing any
274
alls he pe son migh expe ience.
275
Consis en wi h Moo e and Ellis[12] e iew o psychological cons uc s in alls, we
276
ound mode a e co ela ions among he o al eigh ou come measu es co e ing i e subdomains
277
o a conce n o alling. While he cons uc s a e ela ed wi hin he conce n o alling
278
amewo k, hey a e dis inc om one ano he , and e minology o each cons uc is no
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in e changeable[11] no pe ec ly co ela ed[12]. I is c ucial o esea che s o ensu e ha he
280
15
ins umen s hey use align wi h he speci ic cons uc s hey aim o assess. To ensu e consis ency
281
ac oss esea ch and clinical p ac ice, he cons uc being measu ed, and he ins umen being
282
used o measu e, a e aligned wi h he cons uc o in e es .[15] Clinicians e alua ing a conce n
283
o alling in PWLLL should inco po a e mul iple ou comes measu es o comp ehensi ely
284
e alua e he cons uc s o each subdomain. Using a a ie y o ools cap u es unique elemen s o a
285
conce n o alling, which may be missed by a single scale, and p o ides a mo e holis ic iew o
286
he pa ien ’s needs.
287
Impo an ly, he e was no associa ion be ween alle s a us and sco es on he conce n o
288
alling ou come measu es in ou s udy, sugges ing ha alls his o y may no be he sole o mos
289
accu a e p edic o o alls isk in PWLLL. Consis en wi h alls p e en ion and managemen
290
guidelines in olde adul s,[30] i is impo an o ask abou a conce n o alling in combina ion
291
wi h physical unc ion assessmen and his o y o alls.
292
Falls in PWLLL ha e well-documen ed physical and psychological consequences.[31]
293
The psychological impac o alls, including sel -imposed ac i i y es ic ions, can lead o a
294
dec ease in muscle s eng h, balance and gai p oblems, educed endu ance, social isola ion and
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dec eased quali y o li e.[8] These psychological e ec s can bo h esul om and con ibu e o
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u u e alls. Ba ne e al.[32] demons a ed ha lowe objec i e measu es o pos u al s abili y
297
was associa ed wi h lowe u u e alls e icacy measu ed a 6 mon hs om baseline.
298
Addi ionally, ecen esea ch by Tobaigy e al.[6,7] has epo ed a ela ionships be ween physical
299
unc ion, balance con idence, and mobili y e icacy in p edic ing u u e alls in PWLLL.
300
P e ious esea ch has demons a ed ha PWLLL who ha e comple ed a p os he ic
301
ehabili a ion p og am exhibi ed a gap be ween hei knowledge o alls and how o p e en
302
alls.[33] The ela ionship be ween he iden i ica ion o ba ie s and acili a o s o he
303
16
implemen a ion o alls p e en ion s a egies on a conce n o alling wa an s esea ch o de ine
304
e ec i e s a egies o use in ehabili a ion o PWLLL.
305
Highe quali y o li e was associa ed wi h posi i e shi s ac oss all subdomains o a
306
conce n o alling, highligh ing he impo ance o iewing ehabili a ion and communi y
307
in eg a ion ha ocuses on bo h physical and psychological needs o PWLLL. P e ious esea ch
308
has shown ha despi e PWLLL comple ing a comp ehensi e p os he ic ehabili a ion p og am,
309
hey o en exhibi gaps in hei knowledge o alls p e en ion s a egies.[33] Add essing hese
310
gaps h ough a ge ed in e en ions could enhance alls p e en ion and p omo e g ea e social
311
engagemen , as high balance con idence has been shown o inc ease pa icipa ion in social
312
ac i i ies.[13]
313
Se e al limi a ions should be no ed. This was a con enience sample o people who
314
a ended ou acili y’s ou pa ien ampu ee ehabili a ion p og am and does no ep esen all
315
people who a end ou acili y o all PWLLL. The s udy ocused on people wi h a ans- ibial
316
ampu a ion o limi he e ogenei y, as bila e al and ans- emo al ampu a ions a e associa ed wi h
317
di e en capabili ies o gai , balance, alls isk and p os hesis use.[34] Fu u e s udies should
318
adop a mul i-cen e app oach o ec ui pa icipan s wi h a ious le els o limb loss ha allow
319
o subg oup analyses based on he le el o ampu a ion. Finally, a limi a ion o his s udy is he
320
lack o p ecision in he pa icipan clinical ac o esponses, as i did no accoun o mo e
321
de ailed epo ing on p os hesis i ing and ime since discha ge om p os he ic ehabili a ion,
322
which wa an s u he explo a ion. Despi e hese limi a ions, his s udy has se e al s eng hs.
323
The ou come measu es used in his s udy ep esen measu es ha a e used in clinical and
324
esea ch p ac ice in his popula ion. Two measu es we e included among he complemen o es s
325
ha we e de eloped speci ically o PWLLL. Fu u e esea ch should e alua e he alidi y o
326
17
con en among he emaining measu es. The ou come measu es used in his s udy ha e
327
psychome ic p ope ies accep able o use in PWLLL and ha e eliabili y alues o use in an
328
online o ma . This s udy con ibu es o he g owing body o li e a u e by p o iding an in-dep h
329
assessmen o he psychological and physical cons uc s associa ed wi h conce n o alling in
330
PWLLL which will in o m u u e in e en ions and clinical p ac ice.
331
CONCLUSION
332
This s udy e alua ed a comp ehensi e se o ou comes measu es o a conce n o alling
333
in people wi h unila e al ans- ibial limb loss. Many o he conce n o alling ou come measu es
334
demons a ed mode a e and s a is ically signi ican associa ions o one ano he bu we e no
335
pe ec ly aligned in e ms o hei co ela ion o i em con en . The e o e, hey should no be used
336
in e changeably o e alua e he same cons uc . The e was an alignmen o sco es ac oss he
337
scales, such ha a low ea o alling was co ela ed wi h a high balance con idence, low ac i i y
338
a oidance, good alls e icacy, good mobili y e icacy, high agency o p e en alls and a low
339
conce n o ad e se consequences. Recu en alle s a us in he las 12 mon hs was no associa ed
340
o any o he ou come measu e o al sco es. Highe quali y o li e was associa ed wi h less ea o
341
alling, less a oidance o ac i i ies, be e sel -e icacy and be e ce ain y in managing any alls
342
he pe son migh expe ience.
343
344
345
346
347
348
349
18
REFERENCES
350
1. Hun e SW, Ba chelo F, Hill KD, Hill AM, Mackin osh S, Payne M. Risk Fac o s o
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Falls in People Wi h a Lowe Limb Ampu a ion: A Sys ema ic Re iew. PM R.
352
2017;9(2):170-180.e1. doi:10.1016/j.pm j.2016.07.531
353
2. Kim J, Majo MJ, Ha ne B, Sawe s A. F equency and Ci cums ances o Falls Repo ed
354
by Ambula o y Unila e al Lowe Limb P os hesis Use s: A Seconda y Analysis. PM R.
355
2019;11(4):344-353. doi:10.1016/j.pm j.2018.08.385
356
3. Mille WC, Speechley M, Dea he B. The p e alence and isk ac o s o alling and ea o
357
alling among lowe ex emi y ampu ees. A ch Phys Med Rehabil. 2001;82(8):1031-1037.
358
doi:10.1053/apm .2001.24295
359
4. Kulka ni J, Toole C, Hi ons R, W igh S, Mo is J. Falls in pa ien s wi h lowe limb
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ampu a ions: P e alence and con ibu ing ac o s. Physio he apy. 1996;82(2):130-136.
361
doi:10.1016/S0031-9406(05)66968-4
362
5. Imam B, Mille WC, Finlayson HC, Eng JJ, Ja us T. Incidence o lowe limb ampu a ion
363
in Canada. Can J Public Heal. 2017;108(4):e374-e380. doi:10.17269/cjph.108.6093
364
6. Tobaigy M, Ha ne BJ, Sawe s A. Recalled Numbe o Falls in he Pas Yea -Combined
365
wi h Pe cei ed Mobili y-P edic s he Incidence o Fu u e Falls in Unila e al Lowe Limb
366
P os hesis Use s. Phys The . 2022;102(2). doi:10.1093/p j/pzab267
367
7. Tobaigy M, Ha ne BJ, Sawe s A. The numbe o alls ecalled in he pas yea and
368
balance con idence p edic he equency o inju ious alls by unila e al lowe limb
369
p os hesis use s. PM R. 2023;15(4). doi:10.1002/pm j.12936
370
8. Mille WC, Dea he AB. The in luence o balance con idence on social ac i i y a e
371
discha ge om p os he ic ehabili a ion o i s lowe limb ampu a ion. P os he O ho
372
19
In . 2011;35(4):379-385. doi:10.1177/0309364611418874
373
9. Mille WC, Dea he AB, Speechley M, Ko al J. The in luence o alling, ea o alling,
374
and balance con idence on p os he ic mobili y and social ac i i y among indi iduals wi h
375
a lowe ex emi y ampu a ion. A ch Phys Med Rehabil. 2001;82(9):1238-1244.
376
doi:10.1053/apm .2001.25079
377
10. Wong CK, Chihu i ST, San o EG, Whi e RA. Rele ance o medical como bidi ies o
378
unc ional mobili y in people wi h limb loss: e ospec i e explana o y models o a
379
clinical walking measu e and a pa ien - epo ed unc ional ou come. Physio he (Uni ed
380
Kingdom). 2020;107:133-141. doi:10.1016/j.physio.2020.01.002
381
11. Hadjis a opoulos T, Delbae e K, Fi zge ald TD. Reconcep ualizing he ole o ea o
382
alling and balance con idence in all isk. J Aging Heal h. 2011;23(1):3-23.
383
doi:10.1177/0898264310378039
384
12. Moo e DS, Ellis R. Measu emen o all- ela ed psychological cons uc s among
385
independen -li ing olde adul s: A e iew o he esea ch li e a u e. Aging Men Heal.
386
2008;12(6):684-699. doi:10.1080/13607860802148855
387
13. Nugen K, Payne MW, Viana R, Unge J, Hun e SW. A conce n o alling impac s
388
quali y o li e o people wi h a lowe limb ampu a ion. In J Rehabil Res. 2022;45(3):253-
389
259. doi:10.1097/MRR.0000000000000537
390
14. S eine DL, No man GR, Cai ney J. Heal h Measu emen Scales: A P ac ical Guide o
391
Thei De elopmen and Use. 5 h ed.; 2015.
392
doi:10.1093/acp o :oso/9780199231881.001.0001
393
15. Jø s ad EC, Haue K, Becke C, Lamb SE. Measu ing he psychological ou comes o
394
alling: A sys ema ic e iew. J Am Ge ia Soc. 2005;53(3):501-510. doi:10.1111/j.1532-
395
20
5415.2005.53172.x
396
16. Mille WC, Dea he AB. A p ospec i e s udy examining balance con idence among
397
indi iduals wi h lowe limb ampu a ion. Disabil Rehabil. 2004;26(14-15):875-881.
398
doi:10.1080/09638280410001708887
399
17. F engopoulos C, Bu ley J, Viana R, Payne M, Hun e S. Associa ion be ween ea o
400
alling and unc ional ou comes a e inpa ien ehabili a ion o majo lowe ex emi y
401
ampu a ion: A es ospec i e cha audi . J Rehabil Med. 2016;48(1).
402
doi:10.2340/16501977-2032
403
18. Eysenbach G. Imp o ing he quali y o web su eys: The Checklis o Repo ing Resul s
404
o In e ne E-Su eys (CHERRIES). J Med In e ne Res. 2004;6(3):1-6.
405
doi:10.2196/jmi .6.3.e34
406
19. Lamb SE, Jø s ad-S ein EC, Haue K, Becke C. De elopmen o a common ou come da a
407
se o all inju y p e en ion ials: The P e en ion o Falls Ne wo k Eu ope consensus. J
408
Am Ge ia Soc. 2005;53:1618-1622. doi:10.1111/j.1532-5415.2005.53455.x
409
20. Bonomi AE, Pa ick DL, Bushnell DM, Ma in M. Valida ion o he Uni ed S a es’
410
e sion o he Wo ld Heal h O ganiza ion Quali y o Li e (WHOQOL) ins umen . J Clin
411
Epidemiol. 2000;53(1):1-12. doi:10.1016/S0895-4356(99)00123-7
412
21. Nugen K, Payne MW, Viana R, Hun e SW. The eliabili y o ou s anda dized conce n
413
o alling scales among adul s wi h a majo lowe ex emi y ampu a ion. PM&R.
414
2022;15(4):437-444. doi:10.1002/pm j.12785
415
22. Ya dley L, Smi h H. A p ospec i e s udy o he ela ionship be ween ea ed consequences
416
o alling and a oidance o ac i i y in communi y-li ing olde people. Ge on ologis .
417
2002;42(1):17-23. doi:10.1093/ge on /42.1.17
418
21
23. Ya dley L, Beye N, Haue K, Kempen G, Pio -Ziegle C, Todd C. De elopmen and
419
ini ial alida ion o he Falls E icacy Scale-In e na ional (FES-I). Age Ageing.
420
2005;34(6):614-619. doi:10.1093/ageing/a i196
421
24. Powell LE, Mye s AM. The Ac i i ies-speci ic Balance Con idence (ABC) Scale.
422
Jou nals Ge on ol Se A Biol Sci Med Sci. 1995;50A(1):M28-M34.
423
doi:10.1093/ge ona/50A.1.M28
424
25. Mille WC, Dea he AB, Speechley M. Psychome ic p ope ies o he ac i i ies-speci ic
425
balance con idence scale among indi iduals wi h a lowe -limb ampu a ion. A ch Phys
426
Med Rehabil. 2003;84(5):656-661. doi:10.1016/s0003-9993(03)04807-4
427
26. Ha ne BJ, Gaunau d IA, Mo gan SJ, Am mann D, Salem R, Gailey RS. Cons uc
428
Validi y o he P os he ic Limb Use s Su ey o Mobili y (PLUS-M) in Adul s Wi h
429
Lowe Limb Ampu a ion. A ch Phys Med Rehabil. 2017;98(2):277-285.
430
doi:10.1016/j.apm .2016.07.026
431
27. Gau hie -Gagnon C, G isé MC. P os he ic p o ile o he ampu ee ques ionnai e: Validi y
432
and eliabili y. A ch Phys Med Rehabil. 1994;75(12):1309-1214. doi:10.1016/0003-
433
9993(94)90278-x
434
28. Law ence RH, Tenns ed SL, Kas en LE, Shih J, Howland J, Je e AM. In ensi y and
435
Co ela es o Fea o Falling and Hu ing Onsel in he Nex Yea . Aging Heal.
436
1998;10(3):267-286. doi:10.1177/089826439801000301
437
29. Chan YH. Bios a is ics 104: Co ela ion Analysis. Singapo e Med J. 2003;44(12):614-
438
619. PMID: 14770254
439
30. Mon e o-Odasso M, an de Velde N, Ma in FC, e al. Wo ld guidelines o alls
440
p e en ion and managemen o olde adul s: a global ini ia i e. Age Ageing.
441
22
2022;51(9):1-36. doi:10.1093/ageing/a ac205
442
31. Wong CK, Chihu i ST, Li G. Risk o all- ela ed inju y in people wi h lowe limb
443
ampu a ions: A p ospec i e coho s udy. J Rehabil Med. 2016;48(1):80-85.
444
doi:10.2340/16501977-2042
445
32. Ba ne CT, Vanicek N, Rusaw DF. Do P edic i e Rela ionships Exis Be ween Pos u al
446
Con ol and Falls E icacy in Unila e al T ans ibial P os hesis Use s? A ch Phys Med
447
Rehabil. 2018;99(11):2271-2278. doi:10.1016/j.apm .2018.05.016
448
33. Hun e SW, Higa J, F engopoulos C, Viana R, Payne MWC. E alua ing knowledge o
449
alls isk ac o s and alls p e en ion s a egies among lowe ex emi y ampu ees a e
450
inpa ien p os he ic ehabili a ion: a p ospec i e s udy. Disabil Rehabil. 2020;42(16).
451
doi:10.1080/09638288.2018.1555721
452
34. Gau hie -Gagnon C, G isé MC, Po in D. Enabling ac o s ela ed o p os he ic use by
453
people wi h ans ibial and ans emo al ampu a ion. A ch Phys Med Rehabil.
454
1999;80(6):706-713. doi:10.1016/S0003-9993(99)90177-6
455
456
457
458
459
460
461
462
463
464
23
Table and Figu e Legend:
465
Table 1. Demog aphic and clinical cha ac e is ics o a sample o communi y-dwelling adul s
466
wi h unila e al ans- ibial ampu a ion. (n=68)
467
Table 2. Resul s o bi a ia e Pea son co ela ion analysis o eigh ou come measu es o a
468
conce n o alling in unila e al ans- ibial ampu ees.
469
Table 3. Conce n o alling ou come measu e o al sco es epo ed o whole sample and
470
s a i ied by alls his o y in pas 12 mon hs among people wi h unila e al ans- ibial
471
ampu a ions. (n=68)
472
Table 4. Resul s o s ep-wise linea eg ession modelling o iden i y ac o s associa ed wi h o al
473
sco es on measu es o a conce n o alling in unila e al ans- ibial ampu ees. (n=68)
474
Figu e 1. Rada plo o o al a e age sco es as a pe cen o he maximum sco e on eigh
475
measu es o a conce n o alling in people wi h a unila e al ans- ibial ampu a ion. (n=68)
476
477
478
479
480
481
482
483
484
485
486
487
LCI
44.3 (13.5)
46.8 (12.1)
40.7 (14.8)
0.066
Consequences
CoF
24.8 (7.0)
23.9 (6.1)
25.9 (8.1)
0.249
Con ol o e Falling
PAMF
15.6 (2.9)
15.7 (3.1)
15.5 (2.7)
0.782
No e: ABC, Ac i i ies-speci ic Balance Con idence Scale; CoF, Consequences o Falls Scale; FES-I, Falls E icacy Scale
In e na ional; mSAFFE, modi ied Su ey o Ac i i ies and Fea o Falling in he Elde ly; LCI, Locomo o Capabili ies Index; PCOF,
Pe cei ed Con ol o e Falling Scale; PAMF, Pe cei ed Abili y o Manage Falls Scale; Fea o Falling VAS, isual analogue scale
om 0 (no ea ) o 100 (wo s ea ). High sco es o mSAFFE, FES-I, CoF indica e wo se ou comes. High sco es on VAS, ABC,
PLUS-M, LCI and PAMF indica e good ou comes.
Table 4.
Reg ession
Model
Ou come Measu e
Explana o y Va iables
Uns anda dized ß Coe icien
(95% CI)
p- alue
R2 o
Model
Fea o Falling
1
Visual analog scale
Falls his o y
21.5 (2.46, 40.46)
0.028
0.44
Quali y o Li e
-0.80 (-1.15, -0.45)
<0.001
2
mSAFFE
Quali y o Li e
-0.14 (-0.22, -0.06)
0.001
0.30
Sel -E icacy
3
ABC
Quali y o Li e
0.37 (0.13, 0.61)
0.004
0.34
Gai aid use
15.08 (1.09, 29.07)
0.036
4
FES-I
Quali y o Li e
-0.29 (-0.40, -0.17)
<0.001
0.47
Mobili y E icacy
5
PLUS-M
Quali y o li e
0.14 (0.01, 0.28)
0.041
0.44
Numbe o medica ions
-0.68 (-1.42, 0.07)
0.073
6
LCI
Quali y o li e
0.14 (-0.02, 0.29)
0.085
0.32
Numbe o medica ions
-1.16 (-2.02, -0.29)
0.011
Table 4
Consequences
7
CoF
Quali y o li e
-0.20 (-0.28, -0.12)
<0.001
0.47
Con ol o e alling
8
PAMF
Quali y o li e
0.08 (0.05, 0.11)
<0.001
0.27
Numbe o medica ions
-0.17 (-0.34, 0.01)
0.057
No e: ABC, Ac i i ies-speci ic Balance Con idence Scale; CoF, Consequences o Falls Scale; FES-I, Falls E icacy Scale
In e na ional; mSAFFE, modi ied Su ey o Ac i i ies and Fea o Falling in he Elde ly; PLUS-M, P os he ic Limb Use Su ey –
Mobili y; LCI, Locomo o Capabili ies Index; PCOF, Pe cei ed Con ol o e Falling Scale; PAMF, Pe cei ed Abili y o Manage Falls
Scale; Fea o Falling VAS, isual analogue scale om 0 (no ea ) o 100 (wo s ea ). High sco es o mSAFFE, FES-I, CoF indica e
wo se ou comes. High sco es on VAS, ABC, PLUS-M, LCI and PAMF indica e good ou comes. Va iables en e ed in o he s ep-wise
linea eg ession modelling we e age, gende , alls his o y in pas 12 mon hs (yes/no), gai aid use (yes/no), numbe o medica ions,
quali y o li e, ampu a ion e iology, Socke Com o Sco e.
Supplemen al Digi al Con en 1. Compa ison o ac i i ies e alua ed ac oss he mul i-i em scales use o assessmen subdomains o a
conce n o alling.
mSAFFE
ABC
FES-I
LCI
PLUS-M
Fea
a oidance
Balance
con idence
Falls
e icacy
Mobili y
e icacy
Mobili y
e icacy
Task
Ge d essed and und essed
x
Taking a ba h o showe
x
Taking a ba h
x
Taking a showe
x
Ge in and ou o chai
x
x
x
Ge up o he loo i ell
x
Walk a ound house
x
x
x
x
Go o answe he phone be o e i s ops inging
x
Walk up and down s ai s (use o hand ail no
s a ed)
x
x
x
Suppo ing documen
Walk up and down s ai s wi h use o hand ail
x
Walk up s ai s wi hou use o hand ail
x
Walk downs ai s wi hou use o hand ail
x
Bend o e o pick up some hing om loo
x
x
x
x
Reach o small can o shel a eye le el
x
P epa e simple meals
x
x
Reach o some hing o e head o on g ound
x
x
S and on ip oes and each o e head
x
S and on chai and each o some hing
x
Sweep he loo /cleaning he house
x
x
x
Walk ou side he house o ca in d i eway
x
Walk a ound he neighbou hood
x
x
x
Walk hal mile
x
Go o he shops
x
x
Ge in and ou o ca
x
Take public anspo
x
Walk ac oss pa king lo
x
Walk up and down amp/slope
x
x
S ep up cu b
x
S ep down cu b
x
S ep up and down cu bs
x
Visi a iend o ela i e
x
x
Go o doc o o den is
x
Walk ca ying an objec
x
x
Walk in c owded mall/busy place
x
x
x
Able o keep up wi h o he s while walking
x
Go o social e en
x
x
Walk in dimly li and un amilia place
x
x
In busy space whe e you a e bumped in o by
people
x
x
S ep on and o escala o holding on o ailing
x
S ep on and o escala o wi hou holding on o
ailing
x
Walk ou side on e en su ace
x
Walk on une en su ace
x
x
x
Walking on a slippe y su ace (we , ice, snow)
x
x
x
x
Walk ou side in inclemen wea he
x
Exe cising
x
Mo e a chai om one oom o ano he
x
Walk on s eep g a el pa h
x
Walk 2 miles on an e en su ace
x
No e: ABC, Ac i i ies-speci ic Balance Con idence Scale; FES-I, Falls E icacy Scale In e na ional; mSAFFE, modi ied Su ey o
Ac i i ies and Fea o Falling in he Elde ly; PLUS-M, P os he ic Limb Use Su ey – Mobili y; LCI, Locomo o Capabili ies Index.
