Six-month prospective study of fall risk factors identification in patients post-stroke

Abstract

Aim: To determine if the findings at month 1 could correctly identify stroke patients who fell in the 6 months post-stroke; and to describe the characteristics of fallers and non-fallers, and their courses of recovery.

Methods: Of 133 volunteers who had their first stroke, 98 participants completed the assessment three times. Fall incidence and history were collected by telephone every 2 weeks and recorded. Fear of falling measured by the Fall Efficacy Scale (FES-S), the amount of time that physical therapy was received, and standardized outcome measures according to the International Classification Functioning, Disability and Health model were measured at month 1, 3 and 6 after stroke. The Berg Balance Scale, Barthel Index, Timed Up & Go, 10-m (10mWT) and 2-min walks and participation subscore of Stroke Impact Scale were used for assessment.

Results: A total of 25 patients (25%) fell in the 6 months; 13 had multiple falls. Fallers showed less improvement in impairments, activity and community participation compared with non-fallers. The risk of falling was greater than 1 (odds ratio [OR]) when assessed by all outcome measures at month 1, and was double at month 3. The FES-S ≥ 33 at month 1 could accurately identify a faller (OR 2.99, 95% confidence interval 1.07-8.37), moderate to high sensitivity (76%), specificity (49%), and positive and negative predicted value (34% and 85%).

Conclusions: Fear of falling was the best indicator of falling. Receiving physical therapy after a stroke seems to highly contribute to improved functional independence of activities in daily living, and increased self-confidence and cognitive function.

Keywords: Disability and Health model; International Classification Functioning; cerebrovascular disease; falls; fear of falling.