Pain, Balance-Confidence, Functional Mobility, and Reach Are Associated With Risk of Recurrent Falls Among Adults With Lower-Limb Amputation.

The study is cross-sectional, so it cannot show whether pain, low balance confidence, poor mobility, or short reach caused falls or were consequences of falls. Falls and pain were self-reported, and participants rated only current pain, not average pain over time. The sample was limited to community-dwelling adults with unilateral transtibial or transfemoral amputation who could walk at least 25 feet and use a traditional socket prosthesis; it does not apply to minors, bilateral amputation, osseointegrated prostheses, or people unable to complete testing. The sample size limited the number of covariates; comorbidities, medications, strength, prosthetic components, and physical activity were not adjusted for. Most participants reported mild pain; only 8.4% reported moderate pain, so findings may not apply to people with severe pain. Some analyses had fewer valid cases (82 for reach, 69 for the step test).

Do not conclude that treating pain, improving balance confidence, or increasing reach will reduce falls. This was a cross-sectional study of self-reported falls, and the identified factors were associated with recurrent falls, not proven causes. Also, average pain intensity was not independently associated after adjustment.