PERCEIVED AND ASSESSED BALANCE IN PATIENTS WITH STROKE WITHIN 24 HOURS AFTER DISCHARGE TO HOME

Rafsten L.^1,2, Danielsson A.³, Stibrant- Sunnerhagen K.⁴

¹University of Gothenburg, Institution of Neuroscience and Physiology, Department of Rehabilitation Medicine, Gothenburg, Sweden, ²Sahlgrenska University Hospital, Department of Occupationalterapy and Physioterapi, Gothenburg, Sweden, ³University of Gothenburg, Institute of Neuroscience and Physiology, Rehabilitation Medicine, Gothenburg, Sweden, ⁴University of Gothenburg, Inst. of Neuroscience and Physiology, Rehabilitation Medicine, Gothenburg, Sweden

Background: Stroke caused by cerebral infarction or cerebral hemorrhage, is the leading cause of permanent disability. Stroke is the most common reason to neurological handicap in adults and is the third largest cause of death after cardiac infarction and cancer. Studies show that you can discharge patients with mild to moderate stroke earlier from hospitals if the patients continues to recevie rehabilitation at home from a multidisciplinary stroke team. It has been seen that the ADL ability is just as good after home rehabilitation as after hospitalized rehabilitation. Impaired balance is a common symptom of stroke, and a common cause to fall. Home living individuals with impaired balance due to chronic stroke, have been identified as those with the highest risk of falling. A study in 2006 found that among individuals with stroke, falling was associated with the individual's belief in their own ability, fear of falling and depression.

Purpose: To explore if self - perceived balance correlated with assessed balance capacity.

Methods: This is part of a RCT with blinded assessors of very early supported discharge after stroke compared with a control group with ordinary discharge. The study was approved by the Ethics committee and informed written consent gathered. All patients admitted to the stroke unit at the Universal hospital of Sahlgrenska in Gothenburg were screened for inclusion. In this sub study 140 persons were included and stroke severity was scored with National Institute of Health Stroke Scale (NIHSS) at admittance to the hospital. The average time spent in the stroke unit was 11 days. Assessments were made at home within 24 hours after discharge using the Falls Efficacy Scale (FES), Berg Balance Test (BBS), Timed Up and GO (TUG).) The responses on FES were gathered prior to the capacity assessments. Non-parametric analyses were performed.

Results: Average age was 74 years.Eighty-five men and 55 women participated. Stroke severity was mild; average 2 NIHSS at admittance. Self perceived balance (FES) correlated moderately (Spearmans rho=0,641) with assessed balance capacity (BBS) (p 0.01). Between FES and TUG there was a moderate negative correlation (rho=-0,543) (p 0.1).

Conclusion(s): Just after discharge a relationship between self-perceived balance and assessed balance was found. People with mild stroke seem aware of that they have a risk of falling in activities but yet not to the extent one would wish. This might be a risk for falls in the home setting and that requires further investigation.

Implications: Clinicians should be aware of this discrepancy and consider this at very earlie dischargeand with rehabilitation at home to reduce the risk of falls and readmission.

Funding acknowledgements: Local research and teaching Council
Stroke center west
Rune and Ulla Almlövs foundation
The Stroke Council
Wennerströms foundation

Topic: Neurology: stroke

Ethics approval: The regional Ethical committee in Gotheburg has given ist approval to the study DNR: 042-11 Approval date: 2011-02-28

All authors, affiliations and abstracts have been published as submitted.