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A block randomised controlled trial investigating changes in postural control following a personalised 12-week exercise programme for individuals with lower limb amputation

Schafer, Zoe A.; Vanicek, Natalie

Authors

Zoe A. Schafer



Abstract

Background: Individuals with a lower limb amputation (LLA) have an increased risk of falls and often report lower balance confidence. They must compensate for altered mechanics and prosthetic limitations in order to execute appropriate motor responses to postural perturbations. Personalised exercise could be an effective strategy to enhance balance and reduce falls. Research question: In this study, we investigated whether a personalised exercise programme could improve postural control and self-reported balance confidence in individuals with an LLA. Methods: Participants were block randomised into two groups (exercise, n = 7; control, n = 7) based on age and level of amputation. The exercise group completed a 12-week personalised exercise programme, including home-based exercise sessions, consisting of balance, endurance, strength, and flexibility training. The control group continued with their normal daily activities. All participants performed the Sensory Organization Test (SOT) and Motor Control Test (MCT) on the NeuroCom SMART Equitest, and completed the Activities-specific Balance Confidence-UK (ABC) self-report questionnaire, at baseline and post-intervention. Results and significance: Exercise group equilibrium scores improved significantly when standing on an unstable support surface with no visual input and inaccurate somatosensory feedback (SOT condition 5, P < 0.012, d = 1.45). There were significant group*time interactions for medium (P = 0.029) and large (P = 0.048) support surface forward translations, which were associated with a trend towards increased weight-bearing on the intact limb in the control group (medium: P = 0.055; large: P = 0.087). No significant changes in ABC score were observed. These results indicate reduced reliance on visual input, and/or enhanced interpretation of somatosensory input, following an exercise programme. However, objective improvements in aspects of postural control were not associated with subjective improvements in self-reported balance confidence. More weight-bearing asymmetry in the control group suggests that a lack of targeted exercise training may have detrimental effects, with potential adverse long-term musculoskeletal consequences, that were quantifiable within a short timeframe.

Citation

Schafer, Z. A., & Vanicek, N. (2021). A block randomised controlled trial investigating changes in postural control following a personalised 12-week exercise programme for individuals with lower limb amputation. Gait and Posture, 84, 198-204. https://doi.org/10.1016/j.gaitpost.2020.12.001

Journal Article Type Article
Acceptance Date Dec 2, 2020
Online Publication Date Dec 9, 2020
Publication Date Feb 1, 2021
Deposit Date Jan 5, 2021
Publicly Available Date Dec 10, 2021
Journal Gait & Posture
Print ISSN 0966-6362
Electronic ISSN 1879-2219
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 84
Pages 198-204
DOI https://doi.org/10.1016/j.gaitpost.2020.12.001
Keywords Postural control; Balance confidence; Lower limb amputation; Exercise ;NeuroCom
Public URL https://hull-repository.worktribe.com/output/3674291
Publisher URL https://www.sciencedirect.com/science/article/abs/pii/S0966636220306664?via%3Dihub