Balance-confidence is associated with community participation, perceived physical mobility, and performance-based function among individuals with a unilateral amputation.

This was a cross-sectional association study, so it cannot show that low balance-confidence caused poorer participation or function, or that improving confidence would improve outcomes. The analysis used 45 of 101 clinically evaluated patients and 80 consented participants; exclusions were due to no prosthesis, incomplete data, or disarticulation or bilateral amputation. Examiners were trained, but inter-examiner reliability for performance testing was not assessed. Participation was measured only by questionnaire, not by objective tracking such as GPS or accelerometers. Small sample size prevented control for time since amputation, residual limb pain, comorbidities and physical activity level. Participants had unilateral transfemoral or transtibial amputation at least 1 year earlier and were using a prosthesis, so results may not apply to bilateral amputations, non-prosthetic users, very recent amputations, or other amputation levels. The median time since amputation was 6.0 years, so this reflects post-acute community reintegration rather than acute rehabilitation.

The authors report no conflict of interest.

Do not conclude that improving balance-confidence will improve walking or participation. This study measured associations only; it did not test an intervention or show cause.