Journal CME, April 2022: Performance-based balance tests, combined with the number of falls recalled in the past year, predicts the incidence of future falls in established unilateral transtibial prosthesis users-Performance-based balance tests

Performance-based balance tests - article.pdf

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The study, authored by Andrew Sawers and Brian J. Hafner, investigates the predictive validity of performance-based balance tests in determining future falls among unilateral transtibial prosthesis users (TTPU). Employing a multisite prospective observational design, the study included 45 participants with established unilateral transtibial amputations. The primary objective was to evaluate if tests like Timed Up and Go (TUG), Four-Square Step Test (FSST), and Narrowing Beam Walking Test (NBWT) could predict future falls.<br /><br />The researchers collected baseline data, including TUG and FSST times, NBWT scores, the number of falls recalled over the past 12 months, and other potential fall-risk factors. Over a 6-month period, participants reported their falls through monthly telephone interviews. The final predictive model used negative binomial regression to analyze the data.<br /><br />Results indicated that no single performance-based balance test alone predicted the number of future falls. Instead, a combined model incorporating TUG, FSST times, and the number of falls recalled in the past year was effective. This combined model significantly improved fall prediction accuracy compared to using fall recall alone.<br /><br />The study concluded that pairing performance-based tests with fall recall provided a more robust method for predicting the incidence of future falls in this population. The findings suggest that clinicians should use a combination of TUG, FSST times, and fall history to assess fall risk in established unilateral TTPU.<br /><br />Limitations included the study's focus on younger, non-dysvascular TTPU who had been using a prosthesis for at least one year, potentially limiting generalizability to other amputee populations. The study's predictive model is aimed at forecasting falls over a 6-month period, with further research required to validate long-term predictions and applicability to varied prosthesis user groups. Despite these limitations, the combined predictive model offers a valuable tool for clinicians aiming to reduce fall risk in TTPU.

Keywords

predictive validity

balance tests

future falls

unilateral transtibial prosthesis

Timed Up and Go

Four-Square Step Test

Narrowing Beam Walking Test

fall prediction

negative binomial regression

fall risk assessment