Date Presented 04/05/2025
A qualitative analysis of fall scenarios among veterans with amputation led to the identification of behavioral fall risk factors along a spectrum in each theme (self-efficacy, prosthesis perception, dual tasking, participation, and fall emotions).
Primary Author and Speaker: Laura A. Swink
Contributing Authors: Laura A. Swink, Rachael B. Akay, Tonya Rich, Chelsey A. Anderson, Arlene Schmid, Cory L. Christiansen, Kathryn A. Nearing
PURPOSE: To understand behavioral fall risk factors for Veterans with dysvascular lower limb amputation from their recent fall and near-fall scenarios.
DESIGN: A phenomenological design with directed content analysis using two established frameworks (The Health Action Process Approach, and The Falls-Type Classification Framework).
METHOD: Each participant engaged in an audio-recorded interview that was professionally transcribed cleaned-up verbatim. Two independent analysts coded with a priori codes from the frameworks, and allowed additional inductive codes to emerge and then met to establish patterns and categorize codes for the development of themes.
RESULTS: Veterans (n = 21) interviews averaged 83 minutes, and participants were all male, majority White (n = 15), had a transtibial lower limb amputation (n = 14), and averaged 9.5 falls in the last year. Behavioral fall risk factors were arranged into five themes (self-efficacy [low to high], prosthesis perception [prosthesis is separate to prosthesis is part of me], dual-tasking [limited awareness to clear awareness], life participation [limiting to high], and fall emotions [intense to apathetic]) on a spectrum and one theme surrounding (context). For example, in fall emotions: one Veteran said ‘Damn I can’t stop from falling’ (intense) and another stated ‘If I fall, I fall’ (apathetic), both emotions were part of the fall story and represented behavioral risk factors.
CONCLUSION: Different levels of the behavioral fall risk factors exist for each Veteran interviewed with dysvascular lower limb amputation, but each theme and end of the spectrum represent fall risk as explained by Veterans with lower limb amputation.
IMPACT STATEMENT: Occupational therapy practitioners serve an essential role in fall prevention programming and should consider these modifiable behavioral fall risk factors for assessment and also fall prevention program development for individuals with dysvascular lower limb amputation.
References
Clemens, S., Doerger, C., & Lee, S.-P. (2020). Current and emerging trends in the management of fall risk in people with lower limb amputation. Current geriatrics reports, 9, 134–141. https://doi.org/10.1007/s13670-020-00328-4
Hunter, S. W., Batchelor, F., Hill, K. D., Hill, A.-M., Mackintosh, S., & Payne, M. (2017). Risk factors for falls in people with a lower limb amputation: a systematic review. PM&R, 9(2), 170–180. e171. https://doi.org/10.1016/j.pmrj.2016.07.531
Nugent, K., Payne, M. W., Viana, R., Unger, J., & Hunter, S. W. (2022). A concern for falling impacts quality of life for people with a lower limb amputation. International journal of rehabilitation research, 45(3), 253–259. https://doi.org/10.1097/MRR.0000000000000537
The Rehabilitation of Individuals with Lower Limb Amputation Work Group. (2017). VA/DoD CLINICAL PRACTICE GUIDELINE FOR REHABILITATION OF INDIVIDUALS WITH LOWER LIMB AMPUTATION. D. o. V. A. a. D. o. Defense. www.healthquality.va.gov/guidelines/Rehab/amp/VADoDLLACPG092817.pdf
