A randomised controlled trial assigned 44 older lower-limb prosthesis users to usual care or education plus 16 home exercises three times weekly for eight weeks; 41 completed follow-up. Change in Timed Up and Go did not differ between groups, nor did static balance or balance confidence. No falls were reported during the study, but the sample and follow-up were too small to establish fall prevention or definitive lack of benefit. The null finding applies to this relatively high-mobility study population.
Key findings
- Forty-one of 44 randomised participants completed follow-up. Mean age was 68.6±6.7 years; 86% were men, 61% had transtibial amputation and 66% had traumatic amputation.
- Median TUG change was -0.6 s (IQR -1.5 to 0.4) with the program and -0.4 s (-1.2 to 0.3) with usual care, with no between-group difference (p=0.584, r=0.09).
- No significant between-group differences were detected in static balance or balance confidence after eight weeks.
- No falls were reported, but zero events in a small, short trial do not demonstrate fall prevention or equivalent safety.
- The authors describe relatively high baseline mobility and unblinded outcome assessment, which may respectively limit room for improvement and increase measurement-bias risk.
Why this matters globally
Older prosthesis users face fall and injury risk, yet population-specific evidence is sparse. The null result cautions against assuming that generic older-adult programs transfer unchanged to prosthesis users and supports tailoring by prosthesis level, amputation cause, baseline capacity and home environment. Larger multicentre trials tracking actual falls and injuries over longer periods would inform ageing rehabilitation services globally.
Thai researcher contribution
Sirindhorn School of Prosthetics and Orthotics at Siriraj and Mahidol tested an older-prosthesis-user safety question in a randomised trial and transparently reported a null result, with international prosthetics and movement-science expertise. The study provides a base for adapting fall-prevention services to Thai rehabilitation and home contexts rather than adopting generic programs without evaluation.
Limitations to consider
A 44-person single-centre sample and eight-week follow-up provide limited power for group differences or falls. Forty-one completed follow-up, and the largely male, relatively high-mobility, predominantly traumatic-amputation sample may not represent frailer users, women or people with vascular amputation. Outcome assessment was unblinded, and no observed falls do not establish efficacy for long-term clinical fall prevention.