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Amputee-Reduces risk of falls

Reduces risk of falls

Evidence summary

Balance is known to deteriorate following an amputation [1], and fear of falling is a common barrier to physical activity in amputees [2,3]. RCTs have demonstrated that exercise programmes incorporating balance activities result in a reduced risk of falls in in the short-term [4], and a reduced incidence of falls in the longer-term [5]. Balance and balance confidence, clearly linked to a risk of falling, have also been shown to improve when dedicated balance exercises are incorporated into these programmes [6].

Quality of evidence

Moderate

Strength of recommendation

Strong

Conclusion

Targeted balance exercises can improve the risk of falls in lower limb amputees and, while the evidence provided relates to exercise programme interventions, lower limb amputees should be encouraged to incorporate balance exercises into their activity routine. Exercise programmes incorporating exercises to improve balance which are available to amputees during their rehabilitation should be utilised.

Lower limb amputations are performed for a number of clinical indications. Although most evidence around physical activity relates to prosthetic users and for dysvascular amputees, the benefits of physical activity are not exclusive to these groups and should be shared with all lower limb amputees. Lower limb amputees wishing to increase their physical activity levels should be encouraged to do so.

References

  1. van Velzen JM, van Bennekom CAM, Polomski W, et al. Physical capacity and walking ability after lower limb amputation: a systematic review. Clinical Rehabilitation 2006;20(11):999-1016. doi: 10.1177/0269215506070700
  2. Littman AJ, Boyko EJ, Thompson ML, et al. Physical activity barriers and enablers in older Veterans with lower-limb amputation. Journal of Rehabilitation Research and Development 2014;51(6):895-906. doi: 10.1682/jrrd.2013.06.0152
  3. Littman AJ, Bouldin ED, Haselkorn JK. This is your new normal: A qualitative study of barriers and facilitators to physical activity in Veterans with lower extremity loss. Disability and Health Journal 2017;10(4):600-06. doi: 10.1016/j.dhjo.2017.03.004
  4. Godlwana LL, Stewart A, Musenge E. Mobility during the intermediate stage of rehabilitation after lower limb amputation from an under resourced community: a randomized controlled trial. Physiotherapy 2015;101:e458. doi: 10.1016/j.physio.2015.03.3243
  5. Schafer ZA, Perry JL, Vanicek N. A personalised exercise programme for individuals with lower limb amputation reduces falls and improves gait biomechanics: A block randomised controlled trial. Gait & Posture 2018;63:282-89. doi: 10.1016/j.gaitpost.2018.04.030
  6. Miller CA, Williams JE, Durham KL, et al. The effect of a supervised community-based exercise program on balance, balance confidence, and gait in individuals with lower limb amputation. Prosthetics and Orthotics International 2017;41(5):446-54. doi: 10.1177/0309364616683818

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