Frequency and Circumstances of Falls Reported by Ambulatory Unilateral Lower Limb Prosthesis Users: A Secondary Analysis
Frequency and Circumstances of Falls Reported by Ambulatory Unilateral Lower Limb Prosthesis Users: A Secondary Analysis
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DOI：
10.1016/j.pmrj.2018.08.385
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发表时间：
2019-04-01
期刊：
影响因子：
2.1
通讯作者：
Sawers, Andrew
中科院分区：
文献类型：
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作者：
Kim, Janis;Major, Matthew J.;Sawers, Andrew
背景：超过50%的下肢假体（LLP）使用者报告每年至少跌倒一次，使他们处于不良健康结果的高风险中，如活动能力下降和生活质量下降。传统上，减少LLP用户跌倒的努力主要集中在开发临床试验来评估跌倒风险，设计假肢组件以提高患者安全性，以及识别风险因素以识别潜在的跌倒。很少有人关注记录、报告和描述LLP用户跌倒的情况。确定最常见的跌倒类型可以帮助指导和优先考虑临床和研究需求。目的：描述单侧LLP使用者报告的跌倒频率和情况。设计：对2个横断面研究的数据进行二次分析。环境：门诊和研究实验室。参与者：动态单侧经胫骨和经股骨LLP使用者（N = 66）。干预:没有。结果：基于生物力学理论和已发表的跌倒术语，建立了跌倒类型分类框架。使用该框架分析了过去12个月内LLP用户的自我报告跌倒和伴随的叙述描述。频率、估计比例和估计计数在不同情况下使用95%置信区间进行比较。结果：38名参与者（57.6%）在过去一年中报告了90次跌倒。使用提议的框架，所有报告的下降都成功分类。大多数下跌是由于支撑基础的破坏、内在的不稳定因素和多种下跌模式造成的。在平地上行走是跌倒时最常见的活动。结论：这一次要分析表明，在流动LLP使用者中，跌倒仍然很频繁，临床医生和研究人员可能希望优先考虑由于行走时发生的支撑基础中断而导致的跌倒。需要更大样本的额外研究来证实和扩展这些结果。
Background: More than 50% of lower limb prosthesis (LLP) users report falling at least once a year, placing them at high risk for adverse health outcomes such as decreased mobility and diminished quality of life. Efforts to decrease falls in LLP users have traditionally focused on developing clinical tests to assess fall risk, designing prosthetic components to improve patient safety, and identifying risk factors to recognize potential falters. Little attention has been directed toward recording, reporting, and characterizing the circumstances of falls in LLP users. Identifying the most common types of falls could help guide and prioritize clinical and research needs.Objective: To characterize the frequency and circumstances of falls reported by unilateral LLP users.Design: Secondary analysis of data from 2 cross-sectional studies.Setting: Outpatient clinic and research laboratory.Participants: Ambulatory unilateral transtibial and transfemoral LLP users (N = 66).Intervention: None.Outcome: A fall-type classification framework was developed based on biomechanical theory and published falls terminology. Self-reported falls and accompanying narrative descriptions of LLP users' falls in the previous 12 months were analyzed with the framework. Frequencies, estimated proportions, and estimated counts were compared across fall circumstances using 95% confidence intervals.Results: Thirty-eight participants (57.6%) reported 90 falls during the previous year. All reported falls were successfully categorized using the proposed framework. Most falls occurred from disruptions to the base of support, intrinsic destabilizing factors, and a diverse set of fall patterns. Walking on level terrain was the most common activity at the time of a fall.Conclusion: This secondary analysis showed that falls remain frequent in ambulatory LLP users and that clinicians and researchers might wish to prioritize falls owing to disruptions of the base of support that occur while walking. Additional research with a larger sample is required to confirm and expand these results.