"I was angry that I fell" all the way to "if I fall, I fall": a qualitative study of the spectrum of behavioral fall risk factors for veterans with dysvascular lower-limb amputation.

Abstract

To explore behavioral risk factors contributing to fall and near-fall scenarios for Veterans with dysvascular lower-limb amputation. Participants were a convenience sample of Veterans with unilateral dysvascular lower-limb amputation, receiving care at a single Veterans Administration Regional Amputation Center, who participated in an interview (12/2021-04/2023). We used phenomenological research and directed content analysis to explore participant perspectives on fall scenarios. Two frameworks informed <i>a priori</i> codes (The Health Action Process Approach, and the Falls-Type Classification Framework); however, analysis was also inductive, with additional codes emerging. Following an independent and iterative coding process, codes were categorized, and patterns identified to create final themes. Twenty-one veterans completed interviews. Five themes were identified that were salient across a behavioral fall risk factor spectrum from low to high: self-efficacy, trust in the prosthesis, dual-task awareness, participation, and emotional regulation, and one theme pertaining to context surrounding the index fall. Different levels of behavioral fall risk factors exist for Veterans with dysvascular lower-limb amputation. Understanding individuals' perceptions of these behavioral risk factors is important as a first step in developing comprehensive fall-risk management rehabilitation interventions for Veterans with amputation.