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172 KAHLE ET AL.

studies are expensive, and it can be difficult to control 3. Miller WC, Speechley M, Deathe B. The preva-
attrition. Interface studies are particularly challeng- lence and risk factors of falling and fear of falling
ing due to the socket being an intimate part of the among lower extremity amputees. Arch Phys
prosthesis that can require weeks of accommodation Med Rehabil. 2001;82(8):1031-7.
prior to effective use. A paucity of funding has created 4. Miller WC, Speechley M, Deathe AB. Balance
a void in the understanding of a prosthetic socket confidence among people with lower-limb ampu-
interface’s role in affecting falls and walking capacity tations. Phys Ther. 2002;82(9):856-65.
(26). 5. Gooday HM, Hunter J. Preventing falls and
stump injuries in lower limb amputees during
CONCLUSION inpatient rehabilitation: completion of the audit
Prosthetic clinical documentation and outcome cycle. Clin Rehabil. 2004;18(4):379-90.
measure implementation can be effective means of 6. Pauley T, Devlin M, Heslin K. Falls sustained
demonstrating changes and improvements in clin- during inpatient rehabilitation after lower limb
ical interventions. The Activity-specific Balance amputation: prevalence and predictors. Am J
Confidence Scale and two-minute walk test are valid Phys Med Rehabil. 2006;85(6):521-32.
measures that can be used to determine differences 7. Yu WY, Hwang HF, Hu MH, Chen CY, Lin MR.
among intervenions in the transfemoral amputee Effects of fall injury type and discharge place-
population. Alternative transfemoral interface design, ment on mortality, hospitalization, falls, and
such as the HiFi socket, can improve walking capacity ADL changes among older people in Taiwan.
and balance confidence in higher functioning patients Accid Anal Prev. 2013;50:887-94.
with transfemoral amputation. 8. Davis JC, Donaldson MG, Ashe MC, Khan KM.
The role of balance and agility training in fall

ACKNOWLEDGMENTS reduction. A comprehensive review. Eura Med-
icophys. 2004;40(3):211-21.
Contents of this manuscript represent the opinions 9. Dyer D, Bouman B, Davey M, Ismond KP. An
of the authors and not necessarily those of the U.S. intervention program to reduce falls for adult
Department of Defense, U.S. Department of the Army, in-patients following major lower limb ampu-
U.S. Department of Veterans Affairs, or any academic tation. Healthc Q. 2008;11(3 Spec No.):117-21.
or health care institution. Authors declare no conflicts 10. [CMS] Centers for Medicare and Medicaid Ser-
of interest. This project was partially supported by vices. Healthcare Common Procedure Coding
the National Institutes of Health Scholars in Patient System. Springfield (VA): U.S. Department of
Oriented Research (SPOR) grant (1K30RR22270). Commerce, National Technical Information
Service; 2007.
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