Can a Novel Beam-Walking Test Improve Fall Risk Assessment in Service Members, Veterans, and Civilians Who Use Lower-Limb Prostheses?
Abstract
The long-term goal of this research is to improve clinicians’ ability to effectively measure balance and fall risk in lower limb prosthesis (LLP) users. In service of this goal, the objective of the proposed research is to establish whether a new, more challenging beam-walking test, can predict fall risk with greater accuracy and reliability than existing balance tests. New balance tests are required because existing tests are too easy and thus unable to determine which LLP users are at risk for a fall. The lack of effective tests makes it difficult for clinicians to: (1) identify patients who need prosthetic technologies and/or therapies to minimize fall risk and fall-related injuries and (2) provide evidence-based justification to insurance companies for prescribed technologies or therapies. This limits patients’ access to interventions that may not only minimize fall risk and subsequent injury but also help these individuals safely participate in activities that improve their quality of life. The lack of an effective and accepted test to diagnose fall risk among LLP users also limits scientists in testing whether new interventions reduce fall risk. We have developed a novel narrowing beam-walking test (NBWT) that is simple, quick, and inexpensive to use. It consists of four low beams, each narrower than the previous. Our pilot project indicates that an initial version can identify LLP users with and without a history of multiple falls with greater accuracy than existing balance tests. However, additional research is necessary to determine if the NBWT can predict future fall risk among LLP users with greater accuracy and reliability than existing balance tests. Because of its low cost, ease of use, and strong pilot data, we believe the NBWT will have high clinical acceptance and utility. A test that can predict fall risk will help ensure that LLP users who are at risk for falls are diagnosed early and that they receive timely treatment before they experience a fall and subsequent injuries. There are between 600,000 to 700,000 people living in the United States with major limb loss, a number expected to rise to 1.6 million by 2050. More than half of adult LLP users report falling at least once a year, an event that often leads to injury and a loss of mobility. Therefore, providing clinicians with a balance test that can accurately diagnose fall risk could help prevent falls and subsequent injuries in over 300,000 LLP users. We anticipate that many other people, such as those with incomplete spinal cord injury, concussion, or traumatic brain injury, may also benefit from a more accurate test for diagnosing fall risk. Importantly, the value of this project does not rest on a sole outcome, the efficacy of the NBWT. Rather, this project will also provide sound and much needed measurement properties of existing clinical balance tests among LLP users. Measurement properties are important because they determine which tests clinicians should select and how they should interpret the results. To date, there has been limited evaluation of measurement properties among existing clinical balance tests intended to assess fall risk in LLP users. Therefore, in the event that the NBWT is less effective than existing clinical balance tests, this project will still provide important and clinically useful results to guide fall risk assessment in LLP users. We expect the results of the proposed research will rapidly translate to improved fall risk assessment among Service members, Veterans, and civilians who are LLP users. By partnering with major prosthetic clinics in the Chicago and Seattle area and developing accessible training material for clinicians, we will be able to translate our results to clinical practice by the end of the study period. Given the simplicity and low cost of the NBWT, we anticipate its clinical adoption within 1-2 years after the end of the project. The proposed research will directly and
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Oct 29, 2018
- Source ID
- W81XWH1710547
Entities
People
- Andrew Sawers
Organizations
- United States Army
- University of Illinois at Chicago