Hanger's research arm is asking whether specific Plus-M questions predict injurious falls in prosthetic users

The Plus-M shows up in prosthetics appointments as a standard check: a set of questions about daily mobility, from walking on uneven ground to keeping pace with others. Clinicians use the composite score to track functional progress over time.

Research the American Academy of Orthotists and Prosthetists selected for a 2027 award suggests those individual questions may be doing something more. Bretta Fylstra, a research scientist at Hanger’s Institute for Clinical Research and Education, has been examining whether specific items from the Plus-M can reliably predict injurious falls in prosthetic users, rather than relying on the overall score alone. The abstract, titled “Predicting Injurious Falls Risk Using Single Items of the Plus-M Outcome Instrument,” is one of two chosen for the Academy’s 2027 Thranhardt Lecture Series Award.

The full findings haven’t been released. They will be presented at the 2027 Academy Annual Meeting and Scientific Symposium, and the abstract has been submitted to the Journal of Prosthetics and Orthotics for potential publication.

The research question has practical stakes.

Fall rates among lower-limb prosthetic users are high. Injurious falls, meaning those resulting in fractures, head trauma, or significant soft tissue damage, drive emergency care visits, re-hospitalization, and lasting loss of function. The risk isn’t limited to early rehabilitation. It continues, and it isn’t evenly distributed.

What Fylstra’s project is asking, stripped of the clinical framing, is whether a few questions already being answered at a routine appointment can reliably identify who is most likely to have a serious fall. The Plus-M is already being administered in many prosthetics clinics. If certain items carry predictive signal that the composite score spreads too thin, that information changes what a clinician should do after reading the results.

The clinical implication isn’t a score for patients to monitor themselves. What matters is whether a prosthetist who sees a specific response pattern can now refer for a gait assessment, suggest a balance program, or reconsider a prosthetic setup before a fall rather than after one.

The Academy also named Tiffany Graham, an associate professor at UT Southwestern Medical Center, for research on whether age affects outcomes in 3D-printed cranial remolding orthoses for infants. Both presentations are scheduled for the 2027 Annual Meeting.

What this means

Clinical fall-risk prediction in prosthetic users is an active area of O&P research, and this award points to one direction it’s moving: using data clinicians are already collecting, rather than adding new assessments.

The specific findings from Fylstra’s work aren’t public yet. What’s already documented is that the Plus-M is a validated outcome measure that many clinics use, and that injurious falls carry real clinical and quality-of-life consequences. If the research identifies specific items with reliable predictive value, clinicians would have a structured tool rather than an informal impression.

For prosthetic users, a practical question to raise at any follow-up appointment is whether your clinic uses the Plus-M and what happens with the results. Not every clinic acts on them beyond tracking a score. That may be worth asking about directly.

This article covers a research award announcement. The full study findings will be presented at the 2027 American Academy of Orthotists and Prosthetists Annual Meeting and submitted to the Journal of Prosthetics and Orthotics for peer review. This is not medical advice; talk with your care team about fall prevention and mobility assessment.