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Objective Assessment of Postural Control After Lower-Limb Amputation

A Pilot Study

Overgaard, Michael, PT; Gehlert, Trine Friis, PT; Pedersen, Line Kjeldgaard, MD, PhD; Nordbye-Nielsen, Kirsten, PT, MSc

JPO: Journal of Prosthetics and Orthotics: October 2018 - Volume 30 - Issue 4 - p 236–241
doi: 10.1097/JPO.0000000000000206

Introduction Postural control might be impaired after lower-limb amputation (LLA) and contributes to a high incidence of falling in individuals with LLAs with the risk of an injury occurring. There is no agreement on which objective assessment method is most appropriate for quantifying postural control during rehabilitation. Attention should be pointed to which test is most accurate at detecting a change in postural control after a given intervention. The objective of this quantitative prospective cohort pilot study was to compare four balance tests to determine their feasibility in detecting a change in postural control in persons with LLA (transtibial and transfemoral) during rehabilitation and prosthesis fitting.

Methods Four different balance tests were used as primary outcomes before and after a 4-week rehabilitation program (n = 5). The tests used were Berg Balance Scale (BBS), Timed Up and Go (TUG), and force plate measurements in standing and seated position (FPMstand + seat). Secondary outcome was quality of life assessed by the EuroQol, 5 dimensions, 5 levels (EQ-5D-5L) questionnaire.

Results All participants improved in BBS, TUG, and FPMstand. FPMseat showed varying results. The EQ-5D-5L questionnaire showed a slight improvement in quality of life in accordance with the changes in primary outcome measures.

Conclusions A change in postural control during rehabilitation and prosthesis fitting in individuals with LLAs may be assessed by BBS, TUG, and FPMstand. A criterion standard for quantifying postural control is lacking. Hence, a combination of tests to measure and detect a change in postural control can be used. Present pilot study finds that BBS, TUG, and FPMstand may be measurements used for assessment of changes in postural control in the rehabilitation of individuals with LLAs.

MICHAEL OVERGAARD, PT; TRINE FRIIS GEHLERT, PT; LINE KJELDGAARD PEDERSEN, MD, PhD; and KIRSTEN NORDBYE-NIELSEN, PT, MSC, are affiliated with the Department of Orthopaedics Surgery, Aarhus Universitetshospital, Aarhus, Denmark.

Author Contribution: Michael Overgaard and Trine Friis Gehlert are the two main authors, who contributed equally in the preparation of this manuscript.

Disclosure: The authors declare no conflict of interest.

Funding: This research received no specific grant from any funding agency in the public, commercial, or non-for-profit sectors.

Correspondence to: Michael Overgaard, PT, Aarhus Universitetshospital, Nørrebrogade 44, 8000 Aarhus C, Denmark; email:

© 2018 by the American Academy of Orthotists and Prosthetists.