Identifying factors which increase the balance confidence of soldiers using a prosthesis following below-knee amputation attending a rehabilitation institute in Ragama, Sri Lanka

Abstract

War injuries in Sri Lanka resulted in many soldiers dependent on a lower limb prosthesis following below-Knee amputation. The Balance Confidence is defined as "confidence in one's ability not to fall" and is scored by the Activities-specific Balance Confidence (ABC) scale which measures the degree of adaptation to the prosthesis. A low balance confidence level has been shown to correlate with a reduction in both preserved prosthetic capacity (what can be done) as well as prosthetic performance (what is actually done). Identifying this group is important as they will require further intervention for improving their balance confidence level. Objectives. To assess the balance confidence level of soldiers using a lower limb prosthesis following below knee amputation and to identify factors, socio-demographic, amputation-related or health-related, which independently increase the balance confidence level. Methodology. One hundred and twenty soldiers with a lower limb prosthesis following below-knee amputation and attending a rehabilitation institute in Ragama were selected over a three month period, using a convenient sampling method. A self-administrated,pre-tested questionnaire containing the Activities-specific Balance Confidence (ABC) scale with 16 global and situation-specific activities commonly encountered in daily living was used to score the balance confidence level. Independent samples t-test, one way ANOVA and multiple linear regression method were used for uni-variable and multi-variable data analysis respectively. Results. An ABC scale score of 80 was determined by previous studies as a cut off point with only 22% of individuals obtaining a "satisfactory" score (ABC scale score ? 80) while the majority of 78% had a balance confidence level deemed unsatisfactory (ABC scale score < 80) and therefore required intervention. The factors found to independently increase the balance confidence included engaging in sports activities, increased hours of prosthesis use in a day, low/absent alcohol intake and higher monthly family income level. Discussion and Conclusion. The majority (78%) of amputee solders in the study had a balance confidence level deemed "Unsatisfactory" and hence require intervention to improve their balance confidence.Engaging in sports activities, increasing the number of hours using the prosthesis and a reduced/ absent alcohol intake were found to independently increase the balance confidence level. These measures should now become a vital part of their future management.