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. 2023 Apr 27:14:1157453.
doi: 10.3389/fneur.2023.1157453. eCollection 2023.

Fallers after stroke: a retrospective study to investigate the combination of postural sway measures and clinical information in faller's identification

Johanna Jonsdottir  1 , Fabiola Giovanna Mestanza Mattos  2 , Alessandro Torchio  1 , Chiara Corrini  1 , Davide Cattaneo  1   2
Affiliations

Fallers after stroke: a retrospective study to investigate the combination of postural sway measures and clinical information in faller's identification

Johanna Jonsdottir et al. Front Neurol. .

Abstract

Background: Falls can have devastating effects on quality of life. No clear relationships have been identified between clinical and stabilometric postural measures and falling in persons after stroke.

Objective: This cross-sectional study investigates the value of including stabilometric measures of sway with clinical measures of balance in models for identification of faller chronic stroke survivors, and the relations between variables.

Methods: Clinical and stabilometric data were collected from a convenience sample of 49 persons with stroke in hospital care. They were categorized as fallers (N = 21) or non-fallers (N = 28) based on the occurrence of falls in the previous 6 months. Logistic regression (model 1) was performed with clinical measures, including the Berg Balance scale (BBS), Barthel Index (BI), and Dynamic Gait Index (DGI). A second model (model 2) was run with stabilometric measures, including mediolateral (SwayML) and anterior-posterior sway (SwayAP), velocity of antero-posterior (VelAP) and medio-lateral sway (VelML), and absolute position of center of pressure (CopX abs). A third stepwise regression model was run including all variables, resulting in a model with SwayML, BBS, and BI (model 3). Finally, correlations between independent variables were analyzed.

Results: The area under the curve (AUC) for model 1 was 0.68 (95%CI: 0.53-0.83, sensitivity = 95%, specificity = 39%) with prediction accuracy of 63.3%. Model 2 resulted in an AUC of 0.68 (95%CI: 0.53-0.84, sensitivity = 76%, specificity = 57%) with prediction accuracy of 65.3%. The AUC of stepwise model 3 was 0.74 (95%CI: 0.60-0.88, sensitivity = 57%, specificity = 81%) with prediction accuracy of 67.4%. Finally, statistically significant correlations were found between clinical variables (p < 0.05), only velocity parameters were correlated with balance performance (p < 0.05).

Conclusion: A model combining BBS, BI, and SwayML was best at identifying faller status in persons in the chronic phase post stroke. When balance performance is poor, a high SwayML may be part of a strategy protecting from falls.

Keywords: balance; falls; postural sway; stabilometric assessment; stroke.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Receiver operating characteristic (ROC) curves of model 1, model 2, and model 3. Sensitivity: percentage of fallers correctly identified; Specificity: percentage of non-fallers correctly identified.
Figure 2
Figure 2
Scatterplot of relation of Berg Balance Scale and SwayML with faller status. BBS, Berg Balance Scale; SwayML, amplitude of sway in mediolateral direction; horizontal dashed line, fall risk cut-off value of BBS (46.5 points); and vertical band, SwayML range of values corresponding to normative data (2.25–4.59 mm).
See this image and copyright information in PMC

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