Balance confidence can affect outcomes for lower limb amputees

SAN ANTONIO — Improvements in the balance confidence of patients with lower limb amputation could lead to improved mobility and community participation, according to a speaker in the Thranhardt Lecture Series at the American Orthotic and Prosthetic Association National Assembly, here.

J. Megan Sions, PhD, DPT, PT, OCS, and colleagues at the University of Delaware studied 35 adults with unilateral transtibial or transfemoral amputation to explore the relationship between balance confidence, physical function and social integration among this patient population. Sions is a physical therapist, research scientist and clinical instructor at the University of Delaware.

J. Megan Sions

“We thought those individuals with lower balance confidence would have worse self-reported function than their peers with higher balance confidence, as well as [lower scores on] performance-based measures, and be less involved in the community,” Sions said.

The researchers collected demographic information and body anthropometrics. Patients completed four different self-reported questionnaires — the Activities-Specific Balance Confidence Scale, the Prosthetic Evaluation Questionnaire-Mobility Section, the Locomotor Capabilities Index and the Community Integration Questionnaire — and underwent a 6-minute walk test, in which participants must walk as quickly as possible, with an assistive device if needed.

Sions said participants with higher balance confidence had higher self-reported function and higher performance-based measures, and were more involved in their communities. She said previous studies have shown improvements in walking ability do not lead to higher balance confidence; therefore, it needs to be addressed separately from physical rehabilitation.

“We believe confidence balance is a modifiable factor that could be addressed through a longitudinal clinical trial to improve outcomes among individuals with lower limb loss,” Sions said. “Providers should consider addressing balance confidence among patients with unilateral lower limb amputations using these targeted or specialized interventions that may include cognitive behavioral approaches as well as positive reinforcement.” – by Amanda Alexander

Reference: Sions JM. Balance-confidence may help explain physical function and community-integration among individuals with unilateral transfemoral and transtibial amputations. Presented at: American Orthotic and Prosthetic Association National Assembly; Oct. 7-10, 2015; San Antonio.

Disclosure: Sions reports the research received funding from Independence Prosthetics-Orthotics Inc.; the National Institute on Aging grant #1R01AG041202-01; the Foundation for Physical Therapy; and the Academy of Geriatric Physical Therapy.

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