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 January 1988 to January 2016. Noninterventional 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 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 also were common, with an 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, transtibial level of amputation in the postoperative period and transfemoral level postrehabilitation, and reduced sense of vibration. 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, which has implications for safety and fall-prevention strategies. Level of Evidence: III