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The influence of balance confidence on social activity after discharge from prosthetic rehabilitation for first lower limb amputation

Background: Community living individuals with lower limb amputation have low balance confidence but the level of balance confidence in the first six months after discharge from prosthetic rehabilitation is not known. Objectives: To determine if balance confidence levels differ after discharge from prosthetic rehabilitation and to determine if balance confidence at discharge predicts social activity at three months post-discharge while controlling for important covariates such as walking ability. Study Design: Prospective study. Methods: Subjects (n = 65) experiencing their first unilateral transfemoral or transtibial amputation were recruited and followed-up one and three months post-discharge. Measures of balance confidence (Activities-specific Balance Confidence Scale) and walking ability (L Test) collected at discharge were used to predict social activity (Frenchay Activities Index) at follow-up. Results: Despite a 14-second mean improvement in walking ability the mean balance confidence scores did not change significantly between discharge (71.2/100) and at three-month follow-up (69.4/100). Confidence scores and basic walking ability at discharge were the two strongest predictors of three-month social activity. Multiple regression modelling indicated that balance confidence and walking ability explained 64% of the variance (standardized beta = 0.34 and -0.37 respectively) in social activity (adjusted R2 = 39%). Conclusions: Balance confidence after discharge from prosthetic rehabilitation for lower limb amputation is low and scores do not improve over the first three months post-discharge despite improvements in walking ability. Discharge balance scores confidence independently predicts three-month social activity scores.