Risk factors for falls in people with a lower limb amputation: a systematic review

OBJECTIVE: To review the evidence connecting risk factors to falls in adults with a lower limb amputation (LLA) across the continuum of care settings. DESIGN: Systematic review. LITERATURE SURVEY: Electronic database searches were conducted in MEDLINE, Pubmed, CINAHL and EMBASE covering 01/1988 and 01/2016. Non-interventional studies, including cohort and cross-sectional studies were included. Two reviewers independently completed data extraction and quality evaluation. METHODOLOGY: Twelve studies met the inclusion criteria and quality of reporting of reporting was evaluated using the criteria by Tooth et al.. SYNTHESIS: The average quality of reporting score was 19.8, scores ranged from 16 to 29. Studies covered the acute hospital stay after the amputation, inpatient rehabilitation and community living. Falls were a common occurrence, with the cohort studies reporting 20.8% for acute hospital stay to 58% in the community years after the amputation. Injurious falls were also common, occurrence ranging from 40% to 60%. Risk factors that increase falls, and are shared with the general population of older adults, include lower extremity muscle weakness, increasing age, comorbidities and number of prescription medications. Risk factors for falls that are unique to adults with LLA are dysvascular etiology of the amputation, trans-tibial level of amputation in the post-operative period and trans-femoral level post-rehabilitation, and reduced vibration sense. CONCLUSIONS: Falls in adults with an LLA are common from the time of the amputation to years later living in the community. Risk factors vary across care settings after the amputation and this has implications for safety and fall prevention strategies