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Pimenta C1,2, Correia A1,2, Alves M3, Virella D3
1Centro Hospitalar Universitário Lisboa Central, Physiotherapy Department, Hospital Curry Cabral, Lisboa, Portugal, 2Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, Department of Rehabilitation Science and Technology, Lisboa, Portugal, 3Centro Hospitalar Universitário Lisboa Central, Epidemiology and Statistics Office of the Research Unit, Lisboa, Portugal
Background: In the sub-acute phase of stroke, most of the patients with moderate or severe impairments typically attend in-patient rehabilitation. Functional recovery continues after discharge and patients can benefit of outpatient physiotherapy. Homecoming may lead to an increased risk for falls, as the patient is no longer in a protected environment. The physiotherapy assessment should identify the risk of falling, in order to minimize it.
Purpose: To estimate the risk for falls among community-dwelling stroke survivors referred to the outpatient physiotherapy in a tertiary care hospital and to explore factors associated with increased risk for falls.
Methods: Observational, cross-sectional study with nested case-control study, of individuals referred to the physiotherapy department less than 12 months after stroke and able to walk independently. A referral period of 4 years was considered. Three functional tools were applied: Berg Balance Scale (BBS), Timed Up and Go Test (TUG) and the Motor Assessment Scale (MAS); demographic and clinical data were collected. Risk for falls was defined as BBS≤45 or TUG>14. Independent variables to include in the multivariable logistic regression model were identified by Chi-Square test and Mann-Whitney test.
Results: Of 217 individuals referred for ambulatory treatment, 140 fulfilled the inclusion criteria. Patients were 21 to 87 years old (median 66), 80 males, in 109 the stroke occurred in the lasts 6 months, 117 had ischemic stroke and in 29 it was a recurrent stroke. Risk for falls was identified in 117 individuals (83.6% [95%CI 76.6 - 88.8]); 95 cases were identified by both BBS and TUG, 12 only by BBS and 10 by TUG alone. The model for risk for falls included age, gender and MAS shows that for each increase in one year of age, the odds for falls increased 10% (adjusted OR 1.10; 95%CI 1.04 - 1.17; p=0.002), odds for falls was 14 fold higher in females (adjusted OR 14.43; 95%CI 1.89 - 110.12; p=0.010) and for each increase in MAS units, the odds for falls decreased 23% (adjusted OR 0.77; 95%CI 0.66 - 0.88; p 0.001).
Conclusion(s): Estimated risk for falls is very frequent after stroke (75-90%), especially in the elder and in females; it is associated with lower autonomous functionality. Evidence is needed for the adequate physiotherapy interventions to prevent falls after stroke, customized by standardized risk assessment.
Implications: The identification of the risk for falls and its causes, such as the balance disorders should be translated into physical therapy practice.
Keywords: Fall Risk, Stroke, Functionality
Funding acknowledgements: No external funding was granted to this institutional study.
Purpose: To estimate the risk for falls among community-dwelling stroke survivors referred to the outpatient physiotherapy in a tertiary care hospital and to explore factors associated with increased risk for falls.
Methods: Observational, cross-sectional study with nested case-control study, of individuals referred to the physiotherapy department less than 12 months after stroke and able to walk independently. A referral period of 4 years was considered. Three functional tools were applied: Berg Balance Scale (BBS), Timed Up and Go Test (TUG) and the Motor Assessment Scale (MAS); demographic and clinical data were collected. Risk for falls was defined as BBS≤45 or TUG>14. Independent variables to include in the multivariable logistic regression model were identified by Chi-Square test and Mann-Whitney test.
Results: Of 217 individuals referred for ambulatory treatment, 140 fulfilled the inclusion criteria. Patients were 21 to 87 years old (median 66), 80 males, in 109 the stroke occurred in the lasts 6 months, 117 had ischemic stroke and in 29 it was a recurrent stroke. Risk for falls was identified in 117 individuals (83.6% [95%CI 76.6 - 88.8]); 95 cases were identified by both BBS and TUG, 12 only by BBS and 10 by TUG alone. The model for risk for falls included age, gender and MAS shows that for each increase in one year of age, the odds for falls increased 10% (adjusted OR 1.10; 95%CI 1.04 - 1.17; p=0.002), odds for falls was 14 fold higher in females (adjusted OR 14.43; 95%CI 1.89 - 110.12; p=0.010) and for each increase in MAS units, the odds for falls decreased 23% (adjusted OR 0.77; 95%CI 0.66 - 0.88; p 0.001).
Conclusion(s): Estimated risk for falls is very frequent after stroke (75-90%), especially in the elder and in females; it is associated with lower autonomous functionality. Evidence is needed for the adequate physiotherapy interventions to prevent falls after stroke, customized by standardized risk assessment.
Implications: The identification of the risk for falls and its causes, such as the balance disorders should be translated into physical therapy practice.
Keywords: Fall Risk, Stroke, Functionality
Funding acknowledgements: No external funding was granted to this institutional study.
Topic: Neurology: stroke
Ethics approval required: Yes
Institution: Centro Hospitalar Lisboa Central (CHLC)
Ethics committee: Comissão de Ética para a Saúde do CHLC
Ethics number: Processo 140/2012
All authors, affiliations and abstracts have been published as submitted.
