Effectiveness of different rehabilitation modalities for fall prevention in people with lower-limb amputation: a systematic review and meta-analysis
In brief
In amputees, virtual reality improves fall confidence but not balance or fall risk
Across 23 studies involving 832 people with lower-limb amputation, virtual reality improved confidence about falling but did not significantly improve measured balance or fall risk. Resistance training and other approaches showed potential benefits for some outcomes, but the evidence was low to very low certainty, so it is not strong enough to guide firm clinical recommendations.
- Journal
- Clinical rehabilitation (Q1)
- Published
- 22 September 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Audrey Cointo, Marianne Rangström, Abdelhak Karrouchi, Marine Maze, Laëtitia Dourlens, Kevin Arribart, et al.
- PMID
- 42770472
- DOI
- 10.1177/02692155261487458
Why clinicians should know about it
- Picked for Rehabilitation (paper of the day, 24 September 2026): Systematic review of rehab modalities for amputation fall prevention
Abstract
ObjectiveTo evaluate various rehabilitation interventions to reduce fall incidence and improve fall-related outcomes in people with lower-limb amputation.Data sourcesPubMed, PEDro, Google Scholar, ScienceDirect, Lissa, ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform were searched in February 2024, and updated in April 2026.Review methodsRandomised controlled trials investigating rehabilitation for fall incidence, risk, balance, confidence or fear of falling were included. Findings were synthesised narratively and through meta-analysis. Risk of bias was assessed using the Revised Cochrane risk-of-bias tool, and evidence certainty using the Grading of Recommendations Assessment, Development and Evaluation criteria.ResultsTwenty-three studies (n = 832) were included. Interventions encompassed virtual reality, resistance training, neuromuscular and muscular electrical stimulation, proprioceptive neuromuscular facilitation, dual-task training, harness-supported treadmill training, behavioural change interventions, education, motor imagery and comprehensive protocols. Resistance training and proprioceptive neuromuscular facilitation were associated with significant improvements in fall risk, comprehensive protocols with a significant decrease in fall incidence and preoperative education with improved balance. A meta-analysis of 10 articles revealed that virtual reality significantly improved balance confidence but had no significant impact on measures of fall risk or balance.ConclusionPreliminary, low-certainty evidence suggests that combining comprehensive protocols, resistance training, proprioceptive neuromuscular facilitation and preoperative education may offer benefits for fall-related outcomes in people with lower-limb amputation. However, given the low to very low evidence certainty and high risk of bias across most studies, these findings must be interpreted cautiously and considered exploratory, not conclusive. Standardised reporting and methodological rigour are needed before clinical mandates can be made.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.