Effect of a Recreational Rehabilitation Program on Selected Double-Support Gait Outcomes and Gait Symmetry in Lower-Limb Prosthesis Users with Lower-Limb Amputation

Abstract

Lower-limb prosthesis users with lower-limb amputation often experience impaired double-support control and reduced gait symmetry, both of which are closely related to stability and functional walking performance. This study investigated the effect of a recreational rehabilitation program on selected double-support gait outcomes and gait symmetry in four prosthesis users with lower-limb amputation. Muscle activity was assessed using a 16-channel wireless electromyography system (Myon Simply 16 Channels Wireless Device), and gait was analyzed using a three-dimensional motion-analysis system (3D SIMI Reality Motion Systems). To strengthen the statistical interpretation, the study data were further analyzed using exact p values, 95% confidence intervals, multiple effect-size indices, Benjamini-Hochberg, Holm, and Bonferroni corrections, as well as sensitivity analysis, directional consistency testing, and pooled evidence synthesis. The results showed that 42 of 73 pre-post outcomes were initially significant at p < .05; 38 remained significant after global BH-FDR correction, 18 after Holm correction, and 14 after Bonferroni correction, with 22 outcomes retained in the sensitivity analysis. For asymmetry-gap outcomes, 6 of 32 were initially significant, 5 remained after global correction, and only 2 remained after Holm and Bonferroni correction. Overall, the findings indicate broad improvement in direct double-support outcomes, whereas improvement in asymmetry-gap measures was more selective. Although these findings are promising, they should be interpreted cautiously as exploratory because of the very small sample size, the absence of participant-level raw data, and the large number of statistical comparisons