Understanding the multidimensionality of a concern for falling in people with unilateral transtibial amputation: a cross-sectional study.

Abstract

People with lower limb loss often experience psychological concerns related to falling. A concern for falling (CFF) includes four subdomains: fear of falling, self-efficacy, consequences of falling, and perceptions of falls. Limited research exists on how these subdomains are influenced by clinical factors and falls history. This cross-sectional online survey evaluated: (1) associations among CFF outcome measures; (2) relationships between falls history and outcome measures; and (3) clinical and demographic factors related with outcome measures. Inclusion criteria: ≥18 years old, unilateral transtibial amputation and ambulating with a prosthesis. Eight measures assessed CFF: visual analog scale fear of falling, Modified Survey of Activities and Fear of Falling in the Elderly (mSAFFE), Activities-specific Balance Confidence (ABC), Falls Efficacy Scale International (FES-I), Prosthetic Limb Users Survey - Mobility (PLUS-M), Locomotor Capabilities Index, Consequences of Falling Scale, and Perceived Ability to Manage Falls. Pearson bivariate correlation analysis assessed associations among outcome measures. T tests evaluated the association of falls status on outcome scores. Multiple linear regression modelled the clinical and demographic factors related to each measure. Sixty-eight adults (mean 61.8 ± 12.0) participated. Moderate statistically significant (P < 0.001) correlations were found across most outcome measures, with the strongest between PLUS-M and mSAFFE (r = -0.841), and ABC and FES-I (r = -0.821). Faller status was not associated with any measure (P > 0.05). Quality of life was associated with fear of falling, activity avoidance, self-efficacy, and certainty to managing falls (R2 ranged from 0.27 to 0.47). CFF should be evaluated independently of falls history.