Low balance confidence is prevalent among people who use lower-limb prostheses, which can affect community participation and quality of life. To address both the physical and psychological underpinnings of low balance confidence, researchers conducted a randomized controlled trial to evaluate the effectiveness of a multicomponent intervention.
The results of the trial supported the efficacy of the intervention, with at least one outcome in balance confidence, community participation, and functional mobility showing significant group-level effects or individual-level effects, according to the study’s authors. Semistructured exit interviews suggested participants perceived benefit from the intervention.
Participants included 19 adults with unilateral transtibial amputations, at least six months of experience using a prosthesis, and Activities-Specific Balance Confidence (ABC) scores of 80 or below. They completed up to eight intervention sessions following an established protocol that integrated physical therapy exercises (primarily virtual reality active gaming) and cognitive behavioral therapy strategies, or eight weeks of at-home seated exercises.
Outcome measures, collected before randomization and at zero to 16 weeks after completing the protocol, addressed four domains: balance confidence (the ABC scale, modified Gait Self Efficacy scale, and the Fear of Falling Avoidance Behavior Questionnaire); community participation (sections of the 36-Item Short Form Survey, sections of the Community Reintegration of Injured Servicemembers scale, the Frenchay Activities Index, and step counts); quality of life (the wellbeing scale of the Prosthetic Evaluation Questionnaire); and function—the Berg Balance Sale and the L-Test of walking.
Statistical tests compared baseline and post-training assessment scores between groups, and individual responsiveness was evaluated by comparing change scores to the minimum detectable change.
The researchers suggested that integrating physical therapy exercises with cognitive behavioral therapy strategies to simultaneously address physical and psychological conditions related to low balance confidence can meaningfully improve balance and walking confidence and community participation.
The open-access study, “Mixed methods analysis of an interdisciplinary intervention to promote balance confidence in lower limb prosthesis users,” was published in Frontiers in Rehabilitation Sciences.
