Article

Falls are a common adverse event among people with stroke. Previous
studies investigating risk of falls after stroke have relied primarily on
retrospective fall history ranging from 6-12 months recall, with inconsistent
findings. OBJECTIVES: To identify factors and balance assessment tools that are
associated with number of falls in individuals with chronic stroke. DESIGN:
Secondary analysis of a randomized clinical trial. SETTING: Multisite academic
and clinical institutions. PARTICIPANTS: Data from 181 participants with stroke
(age 60.67 +/- 11.77 years, post stroke 4.51 +/- 4.78 years) were included.
METHODS: Study participants completed baseline testing and were prospectively
asked about falls. A multivariate negative binomial regression was used to
identify baseline predictive factors predicting falls: age, endurance (6 minute
walk test), number of medications, motor control (Fugl-Meyer lower extremity
score), depression (Patient Health Questionnaire-9), physical activity (number of
steps per week), and cognition (Mini Mental Status Exam score). A second negative
binomial regression analysis was used to identify baseline balance assessment
scores predicting falls: gait velocity (comfortable 10 Meter Walk), Berg Balance
Scale (BBS), Timed Up and Go (TUG), and Functional Reach Test (FRT). Receiver
operating characteristic (ROC) and area under the curve (AUC) were used to
determine the cutoff scores for significant predictors of recurrent falls. MAIN
OUTCOME MEASUREMENT: The number of falls during the 42-week follow-up period.
RESULTS: Baseline measures that significantly predicted the number of falls
included increased number of medications, higher depression scores, and decreased
FRT. Cutoff scores for the number of medications were 8.5 with an AUC of 0.68.
Depression scores differentiated recurrent fallers at a threshold of 2.5 scores
with an AUC of 0.62. FRT differentiated recurrent fallers at a threshold of 18.15
cm with an AUC of 0.66. CONCLUSIONS: Number of medications, depression scores,
and decreased FRT distance at baseline were associated with increased number of
falls. Increased medications might indicate multiple comorbidities or
polypharmacy effect; increased depression scores may indicate psychological
status; and decreased functional reach distance could indicate dynamic balance
impairments.
LEVEL OF EVIDENCE: II.
CI - Copyright (c) 2018 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS