Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi," Alma Mater Studiorum University of Bologna, Bologna, Italy.
Unità operativa di medicina fisica e riabilitazione, INAIL Centro Protesti, Vigoroso di Budrio, Emilia-Romagna, Italy.
Phys Ther. 2022 Apr 1;102(4). doi: 10.1093/ptj/pzab310.
People with transfemoral amputation have balance and mobility problems and are at high risk of falling. An adequate prosthetic prescription is essential to maximize their functional levels and enhance their quality of life. This study aimed to evaluate the degree of safety against falls offered by different prosthetic knees.
A retrospective study was conducted using data from a center for prosthetic fitting and rehabilitation. Eligible individuals were adults with unilateral transfemoral amputation or knee disarticulation. The prosthetic knee models were grouped into 4 categories: locked knees, articulating mechanical knees (AMKs), fluid-controlled knees (FK), and microprocessor-controlled knees (MPK). The outcome was the number of falls experienced during inpatient rehabilitation while wearing the prosthesis. Association analyses were performed with mixed-effect Poisson models. Propensity score weighting was used to adjust causal estimates for participant confounding factors.
Data on 1486 hospitalizations of 815 individuals were analyzed. Most hospitalizations (77.4%) were related to individuals with amputation due to trauma. After propensity score weighting, the knee category was significantly associated with falls. People with FK had the highest rate of falling (incidence rate = 2.81 falls per 1000 patient days, 95% CI = 1.96 to 4.02). FK significantly increased the risk of falling compared with MPK (incidence rate ratio [IRRFK-MPK] = 2.44, 95% CI = 1.20 to 4.96). No other comparison among knee categories was significant.
Fluid-controlled prosthetic knees expose inpatients with transfemoral amputation to higher incidence of falling than MPK during rehabilitation training.
These findings can guide clinicians in the selection of safe prostheses and reduction of falls in people with transfemoral amputation during inpatient rehabilitation.
股骨截肢者存在平衡和移动问题，且有较高的跌倒风险。适当的假肢处方对于最大限度地提高其功能水平和提高生活质量至关重要。本研究旨在评估不同假肢膝关节提供的防跌倒程度。
本回顾性研究使用来自假肢适配和康复中心的数据进行。合格的个体为单侧股骨截肢或膝关节离断的成年人。将假肢膝关节模型分为 4 类：锁定膝关节、机械关节膝关节（AMK）、液控膝关节（FK）和微处理器控制膝关节（MPK）。结果为佩戴假肢在住院康复期间经历的跌倒次数。采用混合效应泊松模型进行关联分析。采用倾向评分加权法调整参与者混杂因素的因果估计值。
分析了 815 名个体的 1486 次住院数据。大多数住院治疗（77.4%）与创伤导致的截肢个体有关。在进行倾向评分加权后，膝关节类别与跌倒显著相关。FK 的跌倒发生率最高（发生率=每 1000 患者天 2.81 次跌倒，95%CI=1.96 至 4.02）。与 MPK 相比，FK 显著增加了跌倒的风险（发生率比[IRRFK-MPK]=2.44，95%CI=1.20 至 4.96）。其他膝关节类别的比较均无统计学意义。
在康复训练期间，液控假肢膝关节使股骨截肢的住院患者跌倒发生率高于 MPK。
这些发现可以为临床医生在选择安全假肢和减少股骨截肢患者在住院康复期间跌倒方面提供指导。
