Dual-tasking for Individuals With Lower Limb Amputation: Exploring the Relationship to Falls and Instrumental Activities of Daily Living
- Conditions
- Amputation
- Registration Number
- NCT05119192
- Lead Sponsor
- VA Office of Research and Development
- Brief Summary
Veterans with dysvascular lower limb amputation (LLA) have a high fall risk, which persists despite completion of conventional rehabilitation. The presence of fall risk could be a primary reason for the high disability and low quality of life outcomes in this Veteran population. A potential novel intervention for this population is to train performance of tasks that require both physical and cognitive attention (i.e., dual-tasking). Therefore, the purpose of this study is to explore relationships between dual-task performance and self-reported falls for Veterans with dysvascular LLA. Further, dual-tasking occurs during everyday life and this project will examine the association between dual-task performance and participation in activities of daily living (basic and instrumental). The results will form the foundation for development and future study of a novel dual-task training program for Veterans with dysvascular LLA.
- Detailed Description
Purpose: To explore the relationship between dual-task performance, self-reported falls, and activities of daily living for Veterans with lower limb amputation.
Dual-task performance will be assessed using overground ambulation and serial subtraction. Dual-tasking will then be compared to single-task silent walking or seated serial subtraction to determine the category each participant falls into: gait-priority trade off, cognitive-priority trade off, mutual facilitation, or mutual interference. Self-reported falls with be assessed with questionnaires including recent falls (1 month, 1 year), number of falls, fall injuries, and near-falls. Activities of daily living will be assessed using the Modified Barthel Index, and Frenchay Activities Index. Other self-report descriptive questionnaires include: demographic information, the Functional Comorbidities Index, and the Falls Behavioral Scale for the Older Person. Other performance measures include: the Berg Balance Scale, and the SLUMS cognitive screen.
Aim 1: Compare the proportion of participants experiencing mutual interference during dual-task walking between fall groups (Non-fall is 1 fall vs. Recurrent-fall is \>1 fall).
Aim 2: Identify the relationships dual-task effects have with self-reported participation in activities of daily living (basic and instrumental ADLs).
Aim 3: Qualitatively explore the effects of dual-tasking on self-reported fall or near-fall dual-task scenarios. Veterans with dysvascular LLA (n 30) will participate in semi-structured interviews describing these scenarios, and dual-task awareness in fall prevention.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 48
- unilateral, transtibial, or transfemoral LLA
- diagnosis of diabetes mellitus or peripheral artery disease
- age 50 to 89 years
- able to ambulate around the home with or without an assistive device
- at least one year since LLA
- trauma or cancer-related etiology of the LLA
- decisionally challenged individuals (SLUMS score in "Dementia" range)
- prisoners
- active cancer treatment
- clinical discretion of principle investigator to exclude patients who are determined to be unsafe and/or inappropriate to participate in the described intervention
Study & Design
- Study Type
- OBSERVATIONAL
- Study Design
- Not specified
- Primary Outcome Measures
Name Time Method Dual-task Performance Baseline Dual-task performance will be classified into one of 4 categories (gait priority trade off, cognitive priority trade off, mutual interference, or mutual facilitation) based on performance in 3 different 2-minute conditions (gait single task, cognitive single task, dual-task). The gait task will be overground walking on a 12 meter obstacle-free course with a 1 meter turning area. Gait speed (m/s) will be calculated using the total distance covered over the 2 minutes. The cognitive task will be serial subtractions of seven, starting between 590-599. A corrected response rate will be calculated as: responses per second\*percent of correct responses. Dual-task performance will represent a participant's performance on improvement or decline on both gait and cognitive performance comparing single and dual-tasking. For example, mutual interference would be a decline in both gait (slower speed), and cognitive (lower corrected response ratio) from single to dual-tasking.
- Secondary Outcome Measures
Name Time Method Self-reported falls Baseline Participants will be asked: "How many times have you fallen in the last year?". Participants will be provided with the definition of a fall as: "an unexpected event in which.\[you\] come to rest on the ground, floor, or lower level" excluding intentional change in position. To account for potential disproportion of Fall groups, follow-up questions will be asked, including: near-falls in the past year, and presence of fear of falling.
Modified Barthel Index Baseline The Modified Barthel Index assesses 10 different ADLs, with the overall score ranging from 0 (total dependence) to 100 (independence). The MBI has been used effectively for individuals with dysvascular LLA one year after amputation, and demonstrates excellent test-retest reliability in the outpatient setting.
Frenchay Activities Index Baseline The Frenchay Activities Index is pragmatic for community-dwelling adults to self-rate participation in three domains: domestic chores, leisure/work, and outdoor activities. Frenchay Activity Index scores range from 15-60, with higher scores indicating greater participation in instrumental ADLs.
Trial Locations
- Locations (1)
Rocky Mountain Regional VA Medical Center, Aurora, CO
🇺🇸Aurora, Colorado, United States