Effectiveness of different rehabilitation modalities for fall prevention in people with lower-limb amputation: a systematic review and meta-analysis.

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.