From the Department of Rehabilitative and Regenerative Medicine, Physical Therapy Program, Columbia University Medical Center, New York, New York (CKW); and Center for Injury Epidemiology and Prevention, Columbia University Medical Center, New York, New York (STC).
Am J Phys Med Rehabil. 2019 Feb;98(2):130-135. doi: 10.1097/PHM.0000000000001034.
The aim of the study was to investigate the impact of balance ability, activities-specific balance confidence, and other self-reported and clinical factors on incidence of falls among people with lower limb loss.
This is a cross-sectional study (N = 305) with multivariable logistic regression analysis.
Participants included 68.3% men with an age of 55.5 ± 14.9, with 50% dysvascular and 56.8% transtibial amputations. The mean ± SD activities-specific balance confidence is 2.1/4 ± 1.1, balance ability is 2.9/4 ± 1.3, and walking speed is 0.766 ± 0.387 m/sec. The final model showed fall risk was heightened for people with vascular comorbidities (odds ratio = 3.46, 95% confidence interval = 1.40-8.54) and better balance (odds ratio = 23.29, confidence interval = 3.19-170.23), but attenuated for people with transfemoral (odds ratio = 0.08, confidence interval = 0.01-0.82) and vascular amputations (odds ratio = 0.38, confidence interval = 0.15-0.95). Significant interactions existed between age and amputation level (odds ratio = 1.06, confidence interval = 1.02-1.11) and between balance confidence and balance ability (odds ratio = 0.27, confidence interval = 0.13-0.57).
Although people with vascular amputations were less likely to fall than those with nonvascular amputations, people with concurrent vascular comorbidities were more likely to fall than those without. People with transfemoral amputations were less likely to fall; however, fall risk increased with each year of age compared with people with transtibial amputations. People with balance ability of 3.5 or greater fell more often than those with lower ability, but people with lower balance ability and mismatched confidence in their balance ability had 3.7 times greater fall risk.
本研究旨在调查平衡能力、特定活动平衡信心以及其他自我报告和临床因素对下肢缺失者跌倒发生率的影响。
这是一项横断面研究（N=305），采用多变量逻辑回归分析。
参与者包括 68.3%的男性，年龄为 55.5±14.9 岁，50%为血管性病变，56.8%为胫骨截肢。平均（±SD）活动特异性平衡信心为 2.1/4±1.1，平衡能力为 2.9/4±1.3，行走速度为 0.766±0.387m/sec。最终模型显示，血管合并症患者的跌倒风险较高（比值比=3.46，95%置信区间=1.40-8.54），平衡能力较好（比值比=23.29，置信区间=3.19-170.23），但股骨截肢（比值比=0.08，置信区间=0.01-0.82）和血管截肢（比值比=0.38，置信区间=0.15-0.95）患者的跌倒风险较低。年龄和截肢水平之间存在显著的交互作用（比值比=1.06，置信区间=1.02-1.11），平衡信心和平衡能力之间存在显著的交互作用（比值比=0.27，置信区间=0.13-0.57）。
尽管血管性截肢者跌倒的可能性低于非血管性截肢者，但合并血管合并症的患者跌倒的可能性高于无血管合并症的患者。股骨截肢者跌倒的可能性较小；然而，与胫骨截肢者相比，随着年龄的增长，跌倒风险增加。平衡能力为 3.5 或更高的患者跌倒的频率高于平衡能力较低的患者，但平衡能力较低且平衡能力信心不匹配的患者跌倒的风险增加了 3.7 倍。
