Factors associated with the likelihood of fall-related injury among people with lower limb loss

BACKGROUND: People with lower limb loss that live in the community fall at a rate that exceeds that of other vulnerable populations such as hospitalized elderly people. Past research in a small single state study has identified factors associated with fall-related injury. The purpose of this study was to use a larger multistate sample of people with lower limb loss living in community settings to evaluate factors associated with fall-related injury in a multivariable model. METHOD: This retrospective cohort study included community-dwelling people with lower limb loss participating in wellness-walking programs in 6 states within the United States. Fall-related injury was considered injury sustained during a fall to the ground that required medical care. Pearson’s Chi-squared test and student’s t-test were used for descriptive statistics. Odds ratios and 95% confidence intervals from multivariable logistic regression modelling were used to estimate the likelihood of fall-related injuries. RESULTS: Of the 303 subjects recruited, 257 (84.8%) were included in the analyses. Overall, 45 subjects (17.5%) reported at least a single fall-related injury. Most subjects reported two or more falls within the previous 12 months (N = 161, 63.1%), were male (N = 177, 68.9%), and were White (N = 212, 83.8%). Most falls were associated with gait (44.5%), activities of daily living (ADL, 15.7%), or ramps and/or stairs (12%). The likelihood of fall-related injury was elevated among females versus males (OR = 2.90, 95% CI 1.35, 6.24), people of non-White versus White race (OR = 4.79, 95% CI 1.06, 21.76), people with vascular amputations due to peripheral artery disease or diabetes versus non-vascular amputations (OR = 2.22, 95% CI 1.04, 4.73) and people with transtibial versus transfemoral amputations (OR = 2.32, 95% CI 1.01, 4.89). DISCUSSION: Results of this study show that the likelihood of fall-related injury was significantly higher among women, non-White race, people with vascular and transtibial amputations. The results from this study were largely consistent with results from the prior multivariable fall-related injury model. CONCLUSION: The results highlight the association of female sex, non-White race, vascular and transtibial amputations with the likelihood of fall-related injury. Future studies may use the study findings to develop educational fall prevention programs for women, minorities, and people with vascular etiology and transtibial amputations.