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Wang J, Bernhardt J, Johns H, Churilov L, Said C, Fini NA, Batchelor F, Collier J, Ellery F, Bower KJ. An exploration of serious falls after stroke using a large international stroke rehabilitation database. Int J Stroke 2025; 20:550-558. [PMID: 39763477 PMCID: PMC12089680 DOI: 10.1177/17474930251314330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Accepted: 12/24/2024] [Indexed: 01/28/2025]
Abstract
BACKGROUND Falls are common after stroke and can have serious consequences such as hip fracture. Prior research shows around half of individuals will fall within the 12 months post stroke, and these falls are more likely to cause serious injury compared to people without stroke. However, there is limited research on risk factors collected in the immediate post-stroke period that may relate to falls risk. Furthermore, the circumstances and consequences surrounding falls resulting in serious adverse events (serious falls) is underexplored. AIMS Using longitudinal cohort data from A Very Early Rehabilitation Trial (AVERT), we aimed to describe the occurrence, consequences, and circumstances of serious falls over 12 months post stroke and examine potential risk factors associated with these serious falls. METHODS Data from participants included in the AVERT trial (n = 2104; recruited from 56 stroke units across five countries) were analyzed. Serious falls were defined as those resulting in death, were life threatening, or required/prolonged hospitalization. Baseline variables included: demographics, pre-morbid function, stroke severity, hemi-neglect, functional independence, and mobility. Statistical analysis included Wilcoxon-Mann-Whitney tests, Fisher's tests, and Firth's logistic regressions (adjusting for age, stroke severity, and AVERT intervention group). RESULTS Of the 2104 participants, 85 (4%) experienced at least one serious fall (mean age 78.1 years, 45 male), with 91 individual falls. Fifty-five (60%) serious falls resulted in fracture, with 23 (42%) being hip fractures. Two (2%) falls resulted in death. Serious falls were most common during the day (26 of 38 reported), at home (30 of 63 reported) and while ambulating (22 of 42 reported). More serious falls were experienced by participants who were older, had worse pre-morbid mobility, were unable to walk 10 m independently in the first 24 hours post stroke, or required longer than 14 days to walk 50 m unassisted. CONCLUSION This large international prospective study found 1 in 25 stroke survivors experienced serious falls in the first year after stroke. Fractures were a common outcome of these falls, but the true post-stroke fracture rate is likely to be underestimated due to our study methods, such as the exclusion of individuals with poor pre-morbid mobility and the absence of data on fractures not relating to falls or leading to an inpatient hospital admission. Clear associations between older age, impaired pre- and early post-stroke mobility and heightened risk of serious falls were found. Integrating these factors into post-stroke screening tools could improve identification of individuals at greater risk of serious falls and lead to more focused rehabilitation and injury prevention.
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Affiliation(s)
- Julian Wang
- Melbourne Medical School, The University of Melbourne, Melbourne, VIC, Australia
| | | | - Hannah Johns
- Melbourne Medical School, The University of Melbourne, Melbourne, VIC, Australia
| | - Leonid Churilov
- Melbourne Medical School, The University of Melbourne, Melbourne, VIC, Australia
- The Florey, Heidelberg, VIC, Australia
| | - Catherine Said
- Melbourne School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
- Western Health, St Albans, VIC, Australia
- Australian Institute for Musculoskeletal Science, St Albans, VIC, Australia
| | - Natalie A Fini
- Melbourne School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Frances Batchelor
- Melbourne School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
- National Ageing Research Institute, Parkville, VIC, Australia
| | | | | | - Kelly J Bower
- Melbourne School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
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Azhari HF, Dawson J. Clinical implications of fracture severity risk with pioglitazone: a systematic review and meta-analysis of clinical randomized trials. Front Pharmacol 2025; 16:1357309. [PMID: 40115256 PMCID: PMC11922898 DOI: 10.3389/fphar.2025.1357309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 02/06/2025] [Indexed: 03/23/2025] Open
Abstract
Introduction Pioglitazone, a thiazolidinedione, effectively reduces stroke and cardiovascular events in individuals with type 2 diabetes, insulin resistance, and/or stroke. However, its potential to increase fracture risk, particularly among women and those with pre-existing skeletal conditions, has not yet been completely understood. This meta-analysis aims to clarify fracture risk associated with pioglitazone, thereby focusing on individuals with a history of stroke. Methods A systematic review was performed for clinical trials conducted up to March 2024, focusing on trials comparing pioglitazone to placebo or other antihyperglycemic drugs that reported fracture outcomes. Results From 860 trials identified, 78 satisfied the inclusion criteria: 34 with a high risk of bias, 8 with unclear risk, and 36 with low risk. The meta-analysis revealed an association between pioglitazone and a significant increase in fracture risk (risk ratio [RR] 1.21; 95% CI 1.01-1.45; P = 0.04), including non-serious (RR 1.25; 95% CI 1.03-1.51; P = 0.02) and serious fractures (RR 1.48; 95% CI 1.10-1.98; P = 0.01). Notably, the risk was exacerbated for low-energy fractures, particularly resulting from falls (RR 1.49; 95% CI 1.20-1.87; P = 0.0004), in insulin resistance individuals (RR 0.87; 95% CI 0.43-1.76; P = 0.69), and stroke survivors (RR 1.41; 95% CI 1.09-1.83; P = 0.008). Fractures were most frequently observed in lower extremities (RR 1.85; 95% CI 1.33-2.56; P = 0.0002), with women at a greater risk (RR 1.56; 95% CI 1.20-2.02; P = 0.0008). When compared with other antihyperglycemic drugs, no significant difference in fracture risk was noted (RR 1.08; 95% CI 0.73-1.59; P = 0.70), except rosiglitazone, which showed higher fracture risk (RR 1.42; 95% CI 1.23-1.64; P < 0.00001). Fracture risk was significant in the fixed-effect model but not in the random-effects model. Discussion Though pioglitazone offers several cardiovascular benefits, its association with increased fracture risk, especially among women and non-diabetic individuals post-stroke, warrants careful consideration. Individualized treatment interventions balancing cardiovascular and skeletal outcomes are essential, and further research is needed to optimize therapeutic strategies in this population. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42016038242, identifier CRD42016038242.
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Affiliation(s)
- Hala F Azhari
- College of Medicine and Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Jesse Dawson
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
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Shah S, Avery A, Bailey R, Bell B, Coulson N, Luke R, McLaughlin J, Logan P. The everydayness of falling: consequences and management for adults with cerebral palsy across the life course. Disabil Rehabil 2025; 47:1534-1542. [PMID: 38994847 DOI: 10.1080/09638288.2024.2376346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 06/27/2024] [Accepted: 06/29/2024] [Indexed: 07/13/2024]
Abstract
PURPOSE To explore the cause, influences and consequences of falling for adults with cerebral palsy (CP) across their life course, and how this is managed. MATERIALS AND METHODS We used interview data from a multimethod UK study exploring the effects of ageing with CP and healthcare across the life course. Twenty-six participants were recruited and interviewed using various digital platforms to maximise inclusive participation in the UK. Follow-up email semi-structured interviews were conducted to further explore experiences of falls. Transcribed interviews were analysed thematically. RESULTS Falling and fear of falling (FoF) is problematic for over half of the participants in the sample. They perceived falls and FoF as limiting their participation, autonomy and independence in employment, social and cultural activities. Participants used their own management strategies, due to limited specialist interventions or practitioner knowledge to manage or prevent falls. Practices, such as the use of a wheelchair or avoiding activities prompted changes to relationships and identity. CONCLUSIONS Falling for adults with CP happens earlier in life compared to the general population. Adults with CP may benefit from specialist falls prevention services to help maintain muscle strength and balance. Research is needed to evaluate effective interventions for people with CP.
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Affiliation(s)
- Sonali Shah
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Anthony Avery
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Ruth Bailey
- Faculty of Arts & Social Science, Open University, UK
| | - Brian Bell
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Neil Coulson
- School of Medicine, University of Nottingham, Nottingham, UK
| | | | | | - Pip Logan
- School of Medicine, University of Nottingham, Nottingham, UK
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Meseguer-Henarejos AB, López-Pina JA, López-García JJ, Martínez-González-Moro I. Psychometric properties of the Mini-Balance Evaluation Systems Test (Mini-BESTest) among multiple populations: a COSMIN systematic review and meta-analysis. Disabil Rehabil 2025:1-24. [PMID: 39873412 DOI: 10.1080/09638288.2025.2456602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Revised: 01/13/2025] [Accepted: 01/14/2025] [Indexed: 01/30/2025]
Abstract
PURPOSE To synthesize evidence regarding psychometric properties of the Mini-Balance Evaluation Systems Test (Mini-BESTest) in assessing postural control. METHOD Six databases were searched until October 15th, 2024. Two authors independently assessed the methodological quality and results of studies using the COSMIN checklist and Terweés criteria. The overall quality of the evidence was provided using the modified GRADE approach. RESULTS Ninety-one studies were included. The Mini-BESTest showed very good quality and sufficient structural validity (CFI: 0.91-0.99; TLI: 0.888-0.97; RMSEA: 0.05-0.45), internal consistency (α: 0.73-0.97), criterion validity (BESTest r: 0.65-0.95), convergent validity (e.g., Brief-BESTest r: 0.85-0.94; rs: 0.73-0.92; Berg Balance scale r: 0.58-0.85) and know-groups validity (AUC: 0.712-0.97; cutoffs: 9.0-22/28). However, the scale showed doubtful quality as well as sufficient and indeterminate reliability (inter-rater ICC: 0.56-0.998; r: 0.98; intra-rater ICC: 0.74-0.964) and measurement error (SEM: 0.45-3.03; MDC95: 1.23-8.40), respectively. Adequate quality and sufficient rating were found in most studies for responsiveness. The quality of evidence was moderate to low for structural validity and criterion validity, high to low for internal consistency, convergent validity, and high to very low for reliability, measurement error, know-groups validity, and responsiveness. CONCLUSIONS Moderate to high quality evidence was found for support structural validity, internal consistency, reliability, measurement error, criterion validity, hypothesis testing, and responsiveness of the Mini-BESTest only in some study populations.
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Handelzalts S, Soroker N, Melzer I. Characteristics of unsuccessful reactive responses to lateral loss of balance in people with stroke. Neurol Res 2024; 46:1095-1104. [PMID: 39168452 DOI: 10.1080/01616412.2024.2394327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 08/14/2024] [Indexed: 08/23/2024]
Abstract
PURPOSE The effectiveness of reactive responses to a sudden loss of balance is a critical factor that determines whether a fall will occur. We examined the strategies and kinematics associated with successful and unsuccessful balance recovery following lateral loss of balance in people with stroke (PwS). METHODS Eleven PwS were included in the analysis. They were exposed to unannounced right and left horizontal surface translations and demonstrated both successful and unsuccessful balance responses at the same perturbation magnitude. Reactive step strategies and kinematics were investigated comparatively in successful and unsuccessful recovery tests. RESULTS The crossover strategy was used in most of the unsuccessful tests (7/11) while the unloaded-leg side-step in the successful tests (6/11). There were no significant differences in the reactive step initiation time in unsuccessful vs. successful tests. However, the step execution time, step length and center of mass displacement were significantly higher during the first recovery step in unsuccessful tests. CONCLUSIONS PwS have difficulties in controlling and decelerating the moving center of mass following a lateral loss of balance. The increased step time and step length of the first reactive step in unsuccessful vs. successful tests suggest the crossover step strategy may be ineffective for PwS.
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Affiliation(s)
- Shirley Handelzalts
- Department of Physical Therapy, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Department of Physical Therapy, Loewenstein Rehabilitation Medical Center, Ra'anana, Israel
| | - Nachum Soroker
- Neurological Rehabilitation Department, Loewenstein Rehabilitation Medical Center, Ra'anana, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Itshak Melzer
- Department of Physical Therapy, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Ma Y, Gao Q, Shao T, Du L, Gu J, Li S, Yu Z. Establishment and validation of a nomogram for predicting the risk of hip fracture in patients with stroke: A multicenter retrospective study. J Clin Neurosci 2024; 128:110801. [PMID: 39168063 DOI: 10.1016/j.jocn.2024.110801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 08/10/2024] [Accepted: 08/13/2024] [Indexed: 08/23/2024]
Abstract
PURPOSE There are currently no models for predicting hip fractures after stroke. This study wanted to investigate the risk factors leading to hip fracture in stroke patients and to establish a risk prediction model to visualize this risk. PATIENTS AND METHODS We reviewed 439 stroke patients with or without hip fractures admitted to the Affiliated Hospital of Xuzhou Medical University from June 2014 to June 2017 as the training set, and collected 83 patients of the same type from the First Affiliated Hospital of Harbin Medical University and the Affiliated Hospital of Xuzhou Medical University from June 2020 to June 2023 as the testing set. Patients were divided into fracture group and non-fracture group based on the presence of hip fractures. Multivariate logistic regression analysis was used to screen for meaningful factors. Nomogram predicting the risk of hip fracture occurrence were created based on the multifactor analysis, and performance was evaluated using receiver operating characteristic curve (ROC), calibration curves, and decision curve analysis (DCA). A web calculator was created to facilitate a more convenient interactive experience for clinicians. RESULTS In training set, there were 35 cases (7.9 %) of hip fractures after stroke, while in testing set, this data was 13 cases (15.6 %). In training set, univariate analysis showed significant differences between the two groups in the number of falls, smoking, hypertension, glucocorticoids, number of strokes, Mini-Mental State Examination (MMSE), visual acuity level, National Institute of Health stroke scale (NIHSS), Berg Balance Scale (BBS), and Stop Walking When Talking (SWWT) (P<0.05). Multivariate analysis showed that number of falls [OR=17.104, 95 % CI (3.727-78.489), P = 0.000], NIHSS [OR=1.565, 95 % CI (1.193-2.052), P = 0.001], SWWT [OR=12.080, 95 % CI (2.398-60.851), P = 0.003] were independent risk factors positively associated with new fractures. BMD [OR = 0.155, 95 % CI (0.044-0.546), P = 0.012] and BBS [OR = 0.840, 95 % CI (0.739-0.954), P = 0.007] were negatively associated with new fractures. The area under the curve (AUC) of nomogram were 0.939 (95 % CI: 0.748-0.943) and 0.980 (95 % CI: 0.886-1.000) in training and testing sets, respectively, and the calibration curves showed a high agreement between predicted and actual status with an area under the decision curve of 0.034 and 0.109, respectively. CONCLUSIONS The number of falls, fracture history, low BBS score, high NIHSS score, and positive SWWT are risk factors for hip fracture after stroke. Based on this, a nomogram with high accuracy was developed and a web calculator (https://stroke.shinyapps.io/DynNomapp/) was created.
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Affiliation(s)
- Yiming Ma
- Harbin Medical University, Harbin, China; Department of Spine Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Qichang Gao
- Harbin Medical University, Harbin, China; Department of Spine Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Tuo Shao
- Harbin Medical University, Harbin, China; Department of Spine Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Li Du
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Jiaao Gu
- Department of Spine Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Song Li
- Department of Spine Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zhange Yu
- Department of Spine Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China.
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Kaiser JH, Zhang C, Kamel H, Navi BB, Razzak J, Liberman AL. Stroke Risk After Emergency Department Treat-and-Release Visit for a Fall. Stroke 2024; 55:2247-2253. [PMID: 38994584 PMCID: PMC11382293 DOI: 10.1161/strokeaha.124.046988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 06/18/2024] [Accepted: 06/24/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND Previous cohort studies of hospitalized patients with a delayed diagnosis of ischemic stroke found that these patients often had an initial emergency department (ED) diagnosis of a fall. We sought to evaluate whether ED visits for a fall resulting in discharge to home (ie, treat-and-release visits) were associated with increased short-term ischemic stroke risk. METHODS A case-crossover design was used to compare ED visits for falls during case periods (0-15, 16-30, 31-90, and 91-180 days before stroke) and control periods (equivalent time periods exactly 1 year before stroke) using administrative data from the Healthcare Cost and Utilization Project on all hospital admissions and ED visits across 10 states from 2016 to 2020. To identify ED treat-and-release visits for a fall and patients hospitalized for acute ischemic stroke, we used previously validated International Classification of Diseases, Tenth Revision, Clinical Modification codes. Odds ratios and 95% CIs were calculated using conditional logistic regression. RESULTS Among 90 592 hospitalized patients with ischemic stroke, 5230 (5.8%) had an ED treat-and-release visit for a fall within 180 days before their stroke. Patients with an ED treat-and-release visit for a fall were older (mean age, 74.7 [SD, 14.6] versus 70.8 [SD, 15.1] years), more often female (61.9% versus 53.4%), and had higher rates of vascular comorbidities than other patients with stroke. ED treat-and-release visits for a fall were significantly more common in the 15 days before stroke compared with the 15-day control period 1 year earlier (odds ratio, 2.7 [95% CI, 2.4-3.1]). The association between stroke and a preceding ED treat-and-release visit for a fall decreased in magnitude with increasing temporal distance from stroke. CONCLUSIONS ED treat-and-release visits for a fall are associated with significantly increased short-term ischemic stroke risk. These visits may be opportunities to improve stroke diagnostic accuracy and treatment in the ED.
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Affiliation(s)
- Jed H Kaiser
- Clinical and Translational Neuroscience Unit, Department of Neurology, Feil Family Brain and Mind Research Institute (J.H.K., C.Z., H.K., B.B.N., A.L.L.), Weill Cornell Medicine, New York, NY
| | - Cenai Zhang
- Clinical and Translational Neuroscience Unit, Department of Neurology, Feil Family Brain and Mind Research Institute (J.H.K., C.Z., H.K., B.B.N., A.L.L.), Weill Cornell Medicine, New York, NY
| | - Hooman Kamel
- Clinical and Translational Neuroscience Unit, Department of Neurology, Feil Family Brain and Mind Research Institute (J.H.K., C.Z., H.K., B.B.N., A.L.L.), Weill Cornell Medicine, New York, NY
| | - Babak B Navi
- Clinical and Translational Neuroscience Unit, Department of Neurology, Feil Family Brain and Mind Research Institute (J.H.K., C.Z., H.K., B.B.N., A.L.L.), Weill Cornell Medicine, New York, NY
| | - Junaid Razzak
- Department of Emergency Medicine (J.R.), Weill Cornell Medicine, New York, NY
| | - Ava L Liberman
- Clinical and Translational Neuroscience Unit, Department of Neurology, Feil Family Brain and Mind Research Institute (J.H.K., C.Z., H.K., B.B.N., A.L.L.), Weill Cornell Medicine, New York, NY
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Ma J, Qian S, Ma N, Zhang L, Xu L, Liu X, Meng G. Effect of short-term 10 Hz repeated transcranial magnetic stimulation on postural control ability in patients with mild hemiparesis in acute ischemic stroke: a single-blinded randomized controlled trial. Front Neurol 2024; 15:1439904. [PMID: 39206286 PMCID: PMC11350563 DOI: 10.3389/fneur.2024.1439904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Accepted: 07/26/2024] [Indexed: 09/04/2024] Open
Abstract
Background Previous studies have demonstrated that repetitive transcranial magnetic stimulation (rTMS) can improve postural control in subacute and chronic ischemic stroke, but further research is needed to investigate the effect of rTMS on acute ischemic stroke. Objective We compared the therapeutic effects of rTMS plus conventional rehabilitation and conventional rehabilitation on postural control in patients with mild hemiparesis in acute ischemic stroke. Methods Eighty-six patients with acute ischemic stroke were randomly assigned to either the experimental group or the control group within 1-7 days of onset. Patients in both groups received conventional rehabilitation for 2 weeks. Patients in the experimental group received rTMS treatments lasting for 2 weeks. Before and after the 2-week treatment, patients were assessed based on the Timed up and Go (TUG) test, Dual-Task Walking (DTW) test, Functional Ambulation Category (FAC), Tinetti Performance Oriented Mobility Assessment (POMA), gait kinematic parameters, Barthel Index (BI), Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and National Institutes of Health Stroke Scale (NIHSS). Additionally, TUG and single-task gait velocity were assessed at 2 months after the start of treatment, and independent walking recovery was also followed up. Results After 2 weeks of treatment, compared to conventional rehabilitation, participants who underwent rTMS treatment plus conventional rehabilitation exhibited notable enhancements in TUG, FAC, POMA, and some gait parameters [single-task gait velocity, gait stride length, gait cadence, gait cycle]. Changes in cognitive function partially mediated the improvement in single-task gait velocity and gait stride length by rTMS plus conventional rehabilitation. Generalized Estimating Equation (GEE) analysis showed that the trend of improvement in single-task gait velocity over time was more pronounced in the experimental group than in the control group. The results of the Kaplan-Meier curve indicated a median gait recovery time of 90 days for patients in the experimental group and 100 days for the control group. Multifactorial Cox regression analyses showed that rTMS plus conventional rehabilitation promoted faster recovery of independent walking compared with conventional rehabilitation. Conclusion rTMS plus conventional rehabilitation outperformed conventional rehabilitation in improving postural control in patients with acute ischemic stroke. Improvements in cognitive function may serve as a mediating factor in the favorable treatment outcome of rTMS plus conventional rehabilitation for improving postural control. Clinical trial registration https://www.chictr.org.cn, identifier ChiCTR1900026225.
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Affiliation(s)
- Jiangping Ma
- Department of Neurology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- Department of Neurology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Siyu Qian
- Department of Neurology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- Department of Neurology, Qingpu Branch of Zhongshan Hospital, Fudan University, Shanghai, China
| | - Nuo Ma
- Department of Neurology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lu Zhang
- Department of Neurology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Linghao Xu
- Department of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xueyuan Liu
- Department of Neurology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Guilin Meng
- Department of Neurology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
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Tran T, Bliuc D, Abrahamsen B, Chen W, Eisman JA, Hansen L, Vestergaard P, Nguyen TV, Blank RD, Center JR. Multimorbidity clusters potentially superior to individual diseases for stratifying fracture risk in older people: a nationwide cohort study. Age Ageing 2024; 53:afae164. [PMID: 39078154 DOI: 10.1093/ageing/afae164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 05/27/2024] [Indexed: 07/31/2024] Open
Abstract
RATIONALE Comorbidities are common in fracture patients, but the interaction between fracture and comorbidities remains unclear. This study aimed to define specific multimorbidity clusters in older adults and quantify the association between the multimorbidity clusters and fracture risk. METHODS This nationwide cohort study includes 1.7 million adults in Denmark aged ≥50 years who were followed from 2001 through 2014 for an incident low-trauma fracture. Chronic diseases and fractures were identified from the Danish National Hospital Discharge Register. Latent class analysis and Cox's regression were conducted to define the clusters and quantify fracture risk, respectively. RESULTS The study included 793 815 men (age: 64 ± 10) and 873 524 women (65.5 ± 11), with a third having ≥1 chronic disease. The pre-existent chronic diseases grouped individuals into low-multimorbidity (80.3% in men, 83.6% in women), cardiovascular (12.5%, 10.6%), malignant (4.1%, 3.8%), diabetic (2.4%, 2.0%) and hepatic clusters (0.7%, men only). These clusters distinguished individuals with advanced, complex, or late-stage disease from those having earlier-stage disease. During a median follow-up of 14 years (IQR: 6.5, 14), 95 372 men and 212 498 women sustained an incident fracture. The presence of multimorbidity was associated with a significantly greater risk of fracture, independent of age and sex. Importantly, the multimorbidity clusters had the highest discriminative performance in assessing fracture risk, whereas the strength of their association with fracture risk equalled or exceeded that of both the individual chronic diseases most prevalent in each cluster and of counts-based comorbidity indices. CONCLUSIONS Future fracture prevention strategies should take comorbidities into account. Multimorbidity clusters may provide greater insight into fracture risk than individual diseases or counts-based comorbidity indices.
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Affiliation(s)
- Thach Tran
- Skeletal Diseases Program, Garvan Institute of Medical Research, Sydney, New South Wales 2010, Australia
- Faculty of Medicine, UNSW Sydney, New South Wales 2052, Australia
- School of Biomedical Engineering, University of Technology Sydney, New South Wales 2007, Australia
| | - Dana Bliuc
- Skeletal Diseases Program, Garvan Institute of Medical Research, Sydney, New South Wales 2010, Australia
- Faculty of Medicine, UNSW Sydney, New South Wales 2052, Australia
| | - Bo Abrahamsen
- Department of Medicine, Holbæk Hospital, 4300 Holbæk, Denmark
- Department of Clinical Research, Odense Patient Data Explorative Network, University of Southern Denmark, 5230 Odense, Denmark
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford OX3 7LD, UK
| | - Weiwen Chen
- Skeletal Diseases Program, Garvan Institute of Medical Research, Sydney, New South Wales 2010, Australia
| | - John A Eisman
- Skeletal Diseases Program, Garvan Institute of Medical Research, Sydney, New South Wales 2010, Australia
- Faculty of Medicine, UNSW Sydney, New South Wales 2052, Australia
- School of Medicine Sydney, University of Notre Dame Australia, Sydney 2010, Australia
| | | | - Peter Vestergaard
- Department of Clinical Medicine, Aalborg University, 9260 Aalborg, Denmark
- Department of Endocrinology, Aalborg University Hospital, 9000 Aalborg, Denmark
- Steno Diabetes Center, North Jutland, 9000 Aalborg, Denmark
| | - Tuan V Nguyen
- School of Biomedical Engineering, University of Technology Sydney, New South Wales 2007, Australia
- School of Medicine Sydney, University of Notre Dame Australia, Sydney 2010, Australia
- Tam Anh Research Center, Ho Chi Minh City 736090, Vietnam
| | - Robert D Blank
- Skeletal Diseases Program, Garvan Institute of Medical Research, Sydney, New South Wales 2010, Australia
| | - Jacqueline R Center
- Skeletal Diseases Program, Garvan Institute of Medical Research, Sydney, New South Wales 2010, Australia
- Faculty of Medicine, UNSW Sydney, New South Wales 2052, Australia
- School of Medicine Sydney, University of Notre Dame Australia, Sydney 2010, Australia
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Aakrann EB, Brincks J. The psychometric properties of the Six-Spot Step Test - a systematic review using the COSMIN guidelines. Clin Rehabil 2024; 38:932-943. [PMID: 38425190 DOI: 10.1177/02692155241236609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
OBJECTIVE Accurate and reliable balance measures are important for prescribing fall prevention treatments and monitoring their effectiveness. Thus, we aimed to systematically review the psychometric properties of the Six-Spot Step Test, an increasingly used measure of dynamic balance. DATA SOURCES A literature search using the free-text term "Six-Spot Step Test" was performed on 12 February 2024, in Medline, Embase, Rehabilitation & Sports Medicine and SPORTDiscus. Eligibility criteria were adults aged 18 or more, trials evaluating the psychometric properties of the Six-Spot Step Test, and English-language articles. Conference abstracts were excluded. REVIEW METHODS Two investigators screened and selected data independently and assessed the methodological quality and evidence using the COSMIN Risk of Bias checklist and modified GRADE approach. One investigator extracted study characteristics such as design, population and psychometric properties. RESULTS Of the 159 articles identified, 16, evaluating multiple measurement properties, were included in the final analysis. A total of 1319 people participated, including people affected by Stroke, multiple sclerosis, Parkison's disease, chronic inflammatory polyneuropathy and older adults with balance problems. Eight articles assessing reliability (n = 618, intraclass correlations coefficient ≥0.7, minimal detectable change = 22%) and 12 construct validity (n = 1082, 83% true hypothesis, area under the curve >0.7) exhibited sufficient methodological quality with high-level evidence, while two studies (n = 167) examining responsiveness showed very low evidence. CONCLUSION Apart from responsiveness, robust evidence supports the reliability and validity of the Six-Spot Step Test for assessing dynamic balance in a specific group of individuals with neurological diseases and older adults. Further, it is considered feasible for clinical use.
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Affiliation(s)
- Endre Bakke Aakrann
- Faculty of Health Science, VIA University College, Research Centre for Health and Welfare Technology - Programme for Rehabilitation, Aarhus N, Denmark
| | - John Brincks
- Faculty of Health Science, VIA University College, Research Centre for Health and Welfare Technology - Programme for Rehabilitation, Aarhus N, Denmark
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11
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Feng F, Xu H, Sun Y, Zhang X, Li N, Sun X, Tian X, Zhao R. Exercise for prevention of falls and fall-related injuries in neurodegenerative diseases and aging-related risk conditions: a meta-analysis. Front Endocrinol (Lausanne) 2023; 14:1187325. [PMID: 37534209 PMCID: PMC10393124 DOI: 10.3389/fendo.2023.1187325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/21/2023] [Indexed: 08/04/2023] Open
Abstract
Introduction Neurodegenerative diseases often cause motor and cognitive deterioration that leads to postural instability and motor impairment, while aging-associated frailty frequently results in reduced muscle mass, balance, and mobility. These conditions increase the risk of falls and injuries in these populations. This study aimed to determine the effects of exercise on falls and consequent injuries among individuals with neurodegenerative diseases and frail aging people. Methods Electronic database searches were conducted in PubMed, Cochrane Library, SportDiscus, and Web of Science up to 1 January 2023. Randomized controlled trials that reported the effects of exercise on falls and fall-related injuries in neurodegenerative disease and frail aging people were eligible for inclusion. The intervention effects for falls, fractures, and injuries were evaluated by calculating the rate ratio (RaR) or risk ratio (RR) with 95% confidence interval (CI). Results Sixty-four studies with 13,241 participants met the inclusion criteria. Exercise is effective in reducing falls for frail aging people (RaR, 0.75; 95% CI, 0.68-0.82) and participants with ND (0.53, 0.43-0.65) [dementia (0.64, 0.51-0.82), Parkinson's disease (0.49, 0.39-0.69), and stroke survivors (0.40, 0.27-0.57)]. Exercise also reduced fall-related injuries in ND patients (RR, 0.66; 95% CI, 0.48-0.90) and decreased fractures (0.63, 0.41-0.95) and fall-related injuries (0.89, 0.84-0.95) among frail aging people. For fall prevention, balance and combined exercise protocols are both effective, and either short-, moderate-, or long-term intervention duration is beneficial. More importantly, exercise only induced a very low injury rate per participant year (0.007%; 95% CI, 0-0.016) and show relatively good compliance with exercise (74.8; 95% CI, 69.7%-79.9%). Discussion Exercise is effective in reducing neurodegenerative disease- and aging-associated falls and consequent injuries, suggesting that exercise is an effective and feasible strategy for the prevention of falls.
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Affiliation(s)
- Feifei Feng
- College of Physical Education, Yangzhou University, Yangzhou, China
- School of Humanities and Education, Guangzhou Nanyang Polytechnic College, Guangzhou, China
| | - Haocheng Xu
- College of Physical Education, Yangzhou University, Yangzhou, China
| | - Yu Sun
- College of Physical Education, Yangzhou University, Yangzhou, China
| | - Xin Zhang
- College of Physical Education, Yangzhou University, Yangzhou, China
| | - Nan Li
- College of Physical Education, Yangzhou University, Yangzhou, China
| | - Xun Sun
- College of Physical Education, Yangzhou University, Yangzhou, China
| | - Xin Tian
- College of Physical Education, Yangzhou University, Yangzhou, China
| | - Renqing Zhao
- College of Physical Education, Yangzhou University, Yangzhou, China
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12
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Wu JX, Deng FY, Lei SF. The Casual Association Inference for the Chain of Falls Risk Factors-Falls-Falls Outcomes: A Mendelian Randomization Study. Healthcare (Basel) 2023; 11:1889. [PMID: 37444723 DOI: 10.3390/healthcare11131889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 06/20/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
Previous associations have been observed not only between risk factors and falls but also between falls and their clinical outcomes based on some cross-sectional designs, but their causal associations were still largely unclear. We performed Mendelian randomization (MR), multivariate Mendelian randomization (MVMR), and mediation analyses to explore the effects of falls. Our study data are mainly based on White European individuals (40-69 years) downloaded from the UK Biobank. MR analyses showed that osteoporosis (p = 0.006), BMI (p = 0.003), sleeplessness (p < 0.001), rheumatoid arthritis (p = 0.001), waist circumference (p < 0.001), and hip circumference (p < 0.001) have causal effects on falls. In addition, for every one standard deviation increase in fall risk, the risk of fracture increased by 1.148 (p < 0.001), the risk of stroke increased by 2.908 (p = 0.003), and a 1.016-fold risk increase in epilepsy (p = 0.009). The MVMR found that sleeplessness is an important risk factor for falls. Finally, our mediation analyses estimated the mediation effects of falls on the hip circumference and fracture (p < 0.001), waist circumference and epilepsy (p < 0.001), and sleeplessness and fracture (p = 0.005). Our study inferred the causal effects between risk factors and falls, falls, and outcomes, and also constructed three causal chains from risk factors → falls → falls outcomes.
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Affiliation(s)
- Jia-Xin Wu
- Center for Genetic Epidemiology and Genomics, School of Public Health, Medical College of Soochow University, Suzhou 215123, China
- Collaborative Innovation Center of Bone and Immunology between Sihong Hospital and Soochow University, Suzhou 215123, China
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Soochow University, Suzhou 215123, China
| | - Fei-Yan Deng
- Center for Genetic Epidemiology and Genomics, School of Public Health, Medical College of Soochow University, Suzhou 215123, China
- Collaborative Innovation Center of Bone and Immunology between Sihong Hospital and Soochow University, Suzhou 215123, China
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Soochow University, Suzhou 215123, China
| | - Shu-Feng Lei
- Center for Genetic Epidemiology and Genomics, School of Public Health, Medical College of Soochow University, Suzhou 215123, China
- Collaborative Innovation Center of Bone and Immunology between Sihong Hospital and Soochow University, Suzhou 215123, China
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Soochow University, Suzhou 215123, China
- Changzhou Geriatric Hospital, Soochow University, Changzhou 213000, China
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13
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Sousa CV, Lee K, Alon D, Sternad D, Lu AS. A Systematic Review and Meta-analysis of the Effect of Active Video Games on Postural Balance. Arch Phys Med Rehabil 2023; 104:631-644. [PMID: 36669637 PMCID: PMC10142571 DOI: 10.1016/j.apmr.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/28/2022] [Accepted: 01/02/2023] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To conduct a comprehensive systematic review and meta-analysis of the effects of active video game (AVG) interventions on postural balance across all ages in populations with and without neurologic impairments, using all types of platforms. DATA SOURCE Six databases (PubMed, PsycINFO, Sport Discus, MEDLINE, Web of Science, and Google Scholar) were reviewed by December 31, 2020. STUDY SELECTION The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO: CRD42020204191). For inclusion, a study must be original, published in English peer-reviewed venues and employed AVGs as the sole or primary intervention to enhance, maintain, or regain postural balance. At least 2 within- or between-subjects conditions must be included with ≥10 participants per condition. DATA EXTRACTION Three reviewers independently performed data extraction and assessed the risk of bias. DATA SYNTHESIS 129 studies were identified, with 102 eligible for meta-analysis. The total number of tested participants was 6407 (60.0% women, Mage=55.1 years, range=3-99 years, SD=22.6). The average intervention duration was 35.6 min/session with 3.1 sessions/week for 7.6 weeks. The overall effect favored AVG interventions (Hedges' g=0.469; 95% confidence interval [CI]=0.407-0.531). Although the overall study quality was relatively low, the analysis expectedly indicated significantly larger effects (P<.001) for AVG-interventions over passive controls (Hedges' g=0.627; 95% CI=0.466-0.788), but importantly also favored AVG-interventions over conventional treatment (Hedges' g=0.389; 95% CI=0.311-0.468). All clinical populations responded positively, although with different effect sizes (P=.023). Children experienced larger treatment effects (Hedges' g=0.550; 95% CI=0.336-0.764), closely followed by seniors (Hedges' g=0.529; 95% CI=0.402-0.656). The largest intervention effect on balance improvements was seen in healthy people without a medical condition (Hedges' g=0.609; 95% CI=0.465-0.753). CONCLUSIONS AVGs can produce postural balance improvements and better postural maintenance. All populations could benefit from AVG interventions.
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Affiliation(s)
- Caio Victor Sousa
- From the Health and Human Sciences, Frank R. Seaver College of Science and Engineering, Loyola Marymount University, Los Angeles, CA
| | - Kelly Lee
- Health Technology Lab, Departments of Communication Studies and Health Sciences, College of Arts, Media, and Design, Bouvé College of Health Sciences, Northeastern University, Boston, MA
| | - Dar Alon
- Health Technology Lab, Departments of Communication Studies and Health Sciences, College of Arts, Media, and Design, Bouvé College of Health Sciences, Northeastern University, Boston, MA
| | - Dagmar Sternad
- Departments of Biology, Electrical & Computer Engineering, and Physics, Northeastern University, Boston, MA
| | - Amy S Lu
- Health Technology Lab, Departments of Communication Studies and Health Sciences, College of Arts, Media, and Design, Bouvé College of Health Sciences, Northeastern University, Boston, MA.
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Koren Y, Handelzalts S, Parmet Y, Bar-Haim S. Older adults and stroke survivors are steadier when gazing down. PLoS One 2023; 18:e0285361. [PMID: 37205706 DOI: 10.1371/journal.pone.0285361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 04/22/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND Advanced age and brain damage have been reported to increase the propensity to gaze down while walking, a behavior that is thought to enhance stability through anticipatory stepping control. Recently, downward gazing (DWG) has been shown to enhance postural steadiness in healthy adults, suggesting that it can also support stability through a feedback control mechanism. These results have been speculated to be the consequence of the altered visual flow when gazing down. The main objective of this cross-sectional, exploratory study was to investigate whether DWG also enhances postural control in older adults and stroke survivors, and whether such effect is altered with aging and brain damage. METHODS Posturography of older adults and stroke survivors, performing a total of 500 trials, was tested under varying gaze conditions and compared with a cohort of healthy young adults (375 trials). To test the involvement of the visual system we performed spectral analysis and compared the changes in the relative power between gaze conditions. RESULTS Reduction in postural sway was observed when participants gazed down 1 and 3 meters ahead whereas DWG towards the toes decreased steadiness. These effects were unmodulated by age but were modulated by stroke. The relative power in the spectral band associated with visual feedback was significantly reduced when visual input was unavailable (eyes-closed condition) but was unaffected by the different DWG conditions. CONCLUSIONS Like young adults, older adults and stroke survivors better control their postural sway when gazing down a few steps ahead, but extreme DWG can impair this ability, especially in people with stroke.
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Affiliation(s)
- Yogev Koren
- Physical Therapy Department, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
- Translational Neurorehabilitation Laboratory, Ofakim, Israel
| | - Shirley Handelzalts
- Physical Therapy Department, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
- Translational Neurorehabilitation Laboratory, Ofakim, Israel
| | - Yisrael Parmet
- Industrial Engineering and Management Department, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
| | - Simona Bar-Haim
- Physical Therapy Department, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
- Translational Neurorehabilitation Laboratory, Ofakim, Israel
- Zlotowski Center for Neuroscience, Ben Gurion University of the Negev, Be'er-Sheva, Israel
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15
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Ahmad Ainuddin H, Romli MH, S F Salim M, Hamid TA, Mackenzie L. A validity study to consult on a protocol of a home hazard management program for falls prevention among community dwelling stroke survivors. PLoS One 2023; 18:e0279657. [PMID: 36630460 PMCID: PMC9833545 DOI: 10.1371/journal.pone.0279657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 12/11/2022] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE A fall after a stroke is common but the consequences can be devastating not only for the stroke survivors, but also for caregivers, healthcare, and the society. However, research on falls prevention among the stroke population are limited, particularly on home hazards assessment and home modifications, demanding for a study to be conducted. The aim of the study is to validate the protocol and content of a home hazard management program guided by the Person-Environment-Occupation (PEO) Model for falls prevention among community dwelling stroke survivors. METHOD Researchers developed their own questionnaire for content validation which consist of 23 items that covers two domains, namely justification for telehealth home hazard management practice and the protocol's overall methodology. Occupational therapists with at least one year of experience in conducting a home hazard assessment were consulted for the content validation of a two-group clinical controlled trial protocol utilizing a home hazard assessment, home modifications and education over the usual care. Written consent was obtained prior to the study. The occupational therapists were given a Google Form link to review the protocol and intervention based on the questionnaire and rated each item using a four-point Likert scale for relevance and feasibility. Open-ended feedback was also recorded on the google form. Content Validity Index (CVI), Modified Kappa Index and Cronbach's Alpha was calculated for the content validity and reliability analysis. RESULTS A total of sixteen occupational therapists participated in the study. 43.7% of participants had a master's degree, 93.7% worked in the government sector and 56.2% had six years and more experience on conducting home hazard assessments. Content validity of the protocol is satisfactory for relevancy and feasibility (CVI = 0.84, ranging from 0.5 to 1.00), and for the reliability (α = 0.94 (relevance) and α = 0.97 (feasibility), respectively. The Modified Kappa ranged from 0.38 to 1.00 for all items. Feedback was also received regarding the design and procedure of the study protocol which included participant's selection criteria, sample size, equipment provided, cost, location, and care for the participants during the intervention. CONCLUSIONS Introducing a home hazard management program to prevent falls among the stroke population is viewed relevant and feasible. Practical suggestions from the consultation panel were adopted, and minor adjustments were required to strengthen the protocol's overall methodology. This study established a rigorous and robust experimental protocol for future undertaking.
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Affiliation(s)
- Husna Ahmad Ainuddin
- Department of Rehabilitation Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- Centre of Occupational Therapy Studies, Faculty of Medicine and Health Sciences, Universiti Teknologi MARA, Puncak Alam, Selangor, Malaysia
| | - Muhammad Hibatullah Romli
- Department of Rehabilitation Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Serdang, Malaysia
| | - Mazatulfazura S F Salim
- Department of Rehabilitation Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Tengku Aizan Hamid
- Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Serdang, Malaysia
| | - Lynette Mackenzie
- Discipline of Occupational Therapy, Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, Australia
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16
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Muroi D, Ohtera S, Saito Y, Koyake A, Higuchi T. Pathophysiological and motor factors associated with collision avoidance behavior in individuals with stroke. NeuroRehabilitation 2022; 52:155-163. [PMID: 36278363 DOI: 10.3233/nre-220174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND High collision rates and frequency of entering the opening from non-paretic sides are associated with collision in individuals with stroke. OBJECTIVE To identify factors associated with collision avoidance behavior when individuals with stroke walked through narrow openings. METHODS Participants with subacute or chronic stroke walked through a narrow opening and had to avoid colliding with obstacles. Multiple regression analyses were conducted with pathophysiology, motor function, and judgment ability as predictor variables; collision rate and frequency of entering the opening from non-paretic sides were outcome variables. RESULTS Sixty-one eligible individuals with stroke aged 63±12 years were enrolled. Thirty participants collided twice or more and 37 entered the opening from the non-paretic side. Higher collision occurrence was associated with slower Timed Up and Go tests and left-right sway (odds ratios, 1.2 and 5.6; 95% confidence intervals, 1.1-1.3 and 1.3-28.2; p = .008 and.025, respectively). Entering from non-paretic sides was associated with lesions in the thalamus, left-sided hemiplegia, and Brunnstrom stage 3 or lower (odds ratios, 6.6, 8.7, and 6.7; 95% confidence intervals, 1.3-52.5, 2.5-36.5, and 1.2-57.5; and p = .038,.001, and.048, respectively). CONCLUSION Walking ability is associated with avoiding obstacle collision, while pathophysiological characteristics and degree of paralysis are associated with a preference for which side of the body enters an opening first. Interventions to improve walking ability may improve collision avoidance. Avoidance behavior during intervention varies depending on the lesion position.
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Affiliation(s)
- Daisuke Muroi
- Department of Rehabilitation Sciences, Division of Physical Therapy, Faculty of Health Care Sciences, Chiba Prefectural University of Health Sciences, Chiba, Japan.,Department of Health Promotion Science, Tokyo Metropolitan University, Tokyo, Japan
| | - Shosuke Ohtera
- Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health, Saitama, Japan.,Department of Health Economics, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Yutaro Saito
- Department of Rehabilitation, Kameda Medical Center, Chiba, Japan
| | - Aki Koyake
- Department of Rehabilitation, Kameda Medical Center, Chiba, Japan
| | - Takahiro Higuchi
- Department of Health Promotion Science, Tokyo Metropolitan University, Tokyo, Japan
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Plummer P, Feld JA, Mercer VS, Ni P. Brief composite mobility index predicts post-stroke fallers after hospital discharge. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:979824. [PMID: 36275923 PMCID: PMC9583924 DOI: 10.3389/fresc.2022.979824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/12/2022] [Indexed: 11/06/2022]
Abstract
Introduction Community-dwelling, ambulatory stroke survivors fall at very high rates in the first 3-6 months. Current inpatient clinical assessments for fall risk have inadequate predictive accuracy. We found that a pre-discharge obstacle-crossing test has excellent specificity (83%) but lacks acceptable sensitivity (67%) for identifying would-be fallers and non-fallers post discharge. Hypothesis We assessed the hypothesis that combining the obstacle-crossing test with other highly discriminatory fall risk factors would compensate for the obstacle test's fair sensitivity and yield an instrument with superior prediction accuracy. Methods 45 ambulatory stroke survivors (60 ± 11 years old, 15 ± 11 days post stroke) being discharged home completed a battery of physical performance-based and self-reported measures 1-5 days prior to discharge. After discharge, participants were prospectively followed and classified as fallers (≥1 fall) or non-fallers at 3 months. Pre-discharge measures with the largest effect sizes for differentiating fallers and non-fallers were combined into a composite index. Several variations of the composite index were examined to optimize accuracy. Results A 4-item discharge composite index significantly predicted fall status at 3-months. The goodness of fit of the regression model was significantly better than the obstacle-crossing test alone, χ 2(1) = 6.036, p = 0.014. Furthermore, whereas the obstacle-crossing test had acceptable overall accuracy (AUC 0.78, 95% CI, 0.60-0.90), the composite index had excellent accuracy (AUC 0.85, 95% CI, 0.74-0.96). Combining the obstacle-crossing test with only the step test produced a model of equivalent accuracy (AUC 0.85, 95% CI, 0.73-0.96) and with better symmetry between sensitivity and specificity (0.71, 0.83) than the 4-item composite index (0.86, 0.67). This 2-item index was validated in an independent sample of n = 30 and with bootstrapping 1,000 samples from the pooled cohorts. The 4-item index was internally validated with bootstrapping 1,000 samples from the derivation cohort plus n = 9 additional participants. Conclusion This study provides convincing proof-of-concept that strategic aggregation of performance-based and self-reported mobility measures, including a novel and demanding obstacle-crossing test, can predict post-discharge fallers with excellent accuracy. Further instrument development is warranted to construct a brief aggregate tool that will be pragmatic for inpatient use and improve identification of future post-stroke fallers before the first fall.
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Affiliation(s)
- Prudence Plummer
- Department of Physical Therapy, Cognitive-Motor Behavior Laboratory, MGH Institute of Health Professions, Boston, MA, United States,Correspondence: Prudence Plummer
| | - Jody A. Feld
- Department of Orthopaedic Surgery, Duke University, Durham, NC, United States
| | - Vicki S. Mercer
- Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Pengsheng Ni
- School of Public Health, Biostatistics and Epidemiology Data Analytic Center, Boston University, Boston, MA, United States
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Abdollahi M, Whitton N, Zand R, Dombovy M, Parnianpour M, Khalaf K, Rashedi E. A Systematic Review of Fall Risk Factors in Stroke Survivors: Towards Improved Assessment Platforms and Protocols. Front Bioeng Biotechnol 2022; 10:910698. [PMID: 36003532 PMCID: PMC9394703 DOI: 10.3389/fbioe.2022.910698] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/22/2022] [Indexed: 11/26/2022] Open
Abstract
Background/Purpose: To prevent falling, a common incident with debilitating health consequences among stroke survivors, it is important to identify significant fall risk factors (FRFs) towards developing and implementing predictive and preventive strategies and guidelines. This review provides a systematic approach for identifying the relevant FRFs and shedding light on future directions of research. Methods: A systematic search was conducted in 5 popular research databases. Studies investigating the FRFs in the stroke community were evaluated to identify the commonality and trend of FRFs in the relevant literature. Results: twenty-seven relevant articles were reviewed and analyzed spanning the years 1995-2020. The results confirmed that the most common FRFs were age (21/27, i.e., considered in 21 out of 27 studies), gender (21/27), motion-related measures (19/27), motor function/impairment (17/27), balance-related measures (16/27), and cognitive impairment (11/27). Among these factors, motion-related measures had the highest rate of significance (i.e., 84% or 16/19). Due to the high commonality of balance/motion-related measures, we further analyzed these factors. We identified a trend reflecting that subjective tools are increasingly being replaced by simple objective measures (e.g., 10-m walk), and most recently by quantitative measures based on detailed motion analysis. Conclusion: There remains a gap for a standardized systematic approach for selecting relevant FRFs in stroke fall risk literature. This study provides an evidence-based methodology to identify the relevant risk factors, as well as their commonalities and trends. Three significant areas for future research on post stroke fall risk assessment have been identified: 1) further exploration the efficacy of quantitative detailed motion analysis; 2) implementation of inertial measurement units as a cost-effective and accessible tool in clinics and beyond; and 3) investigation of the capability of cognitive-motor dual-task paradigms and their association with FRFs.
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Affiliation(s)
- Masoud Abdollahi
- Industrial and Systems Engineering Department, Rochester Institute of Technology, Rochester, NY, United States
| | - Natalie Whitton
- Industrial and Systems Engineering Department, Rochester Institute of Technology, Rochester, NY, United States
| | - Ramin Zand
- Department of Neurology, Geisinger Neuroscience Institute, Danville, PA, United States
| | - Mary Dombovy
- Department of Rehabilitation and Neurology, Unity Hospital, Rochester, NY, United States
| | - Mohamad Parnianpour
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Kinda Khalaf
- Department of Biomedical Engineering, Khalifa University of Science and Technology, and Health Engineering Innovation Center, Abu Dhabi, United Arab Emirates
| | - Ehsan Rashedi
- Industrial and Systems Engineering Department, Rochester Institute of Technology, Rochester, NY, United States
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19
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Park S, Tang A, Pollock C, Sakakibara BM. Telerehabilitation for lower extremity recovery poststroke: a systematic review and meta-analysis protocol. BMJ Open 2022; 12:e055527. [PMID: 35264359 PMCID: PMC8915270 DOI: 10.1136/bmjopen-2021-055527] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Approximately 30% of individuals with stroke report unmet lower extremity recovery needs after formal hospital-based rehabilitation programmes have ended. Telerehabilitation can mitigate issues surrounding accessibility of rehabilitation services by providing ongoing support to promote recovery, however, no review exists that is specific to telerehabilitation for lower extremity recovery. This paper describes the protocol of a systematic review and meta-analysis that aims to describe and evaluate the effectiveness of lower extremity-focused telerehabilitation interventions on clinical outcomes poststroke. METHODS AND ANALYSIS A systematic review of relevant electronic databases (MEDLINE, Embase, CINAHL, PsycINFO, Web of Science, Google Scholar, PEDro, PubMed and Cochrane Library) between inception and February 2022 will be undertaken to identify eligible interventional studies published in English that compared telerehabilitation focusing on lower extremity recovery to another intervention or usual care for individuals living in the community with stroke. Clinical outcomes examined will include those related to physical function and impairment, activities and participation that are typically assessed in clinical practice and research. Two reviewers will independently screen results, identify studies to be included for review, extract data and assess risk of bias. Meta-analyses will be performed if sufficient data exist. Sensitivity analyses will be performed by removing studies with low methodological quality, and subgroup analyses will be performed if data allow by stratifying papers based on salient demographic or stroke factors and comparing results. The reporting of the review will follow the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The quality of evidence regarding various outcomes for telerehabilitation for lower extremity recovery poststroke will be assessed according to the Grading of Recommendation, Assessment, Development and Evaluation approach. ETHICS AND DISSEMINATION No ethical approval or informed consent is needed for this systematic review. The findings of this review will be disseminated via peer-reviewed publications and conference presentations. PROSPERO REGISTRATION NUMBER CRD42021246886.
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Affiliation(s)
- Sarah Park
- Faculty of Medicine, Graduate Program in Rehabilitation Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
- Faculty of Medicine, Centre for Chronic Disease Prevention and Management, The University of British Columbia, Kelowna, British Columbia, Canada
| | - Ada Tang
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Courtney Pollock
- Faculty of Medicine, Graduate Program in Rehabilitation Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
- Faculty of Medicine, Physical Therapy, The University of British Columbia, Vancouver, British Columbia, Canada
- GF Strong Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Brodie M Sakakibara
- Faculty of Medicine, Graduate Program in Rehabilitation Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
- Faculty of Medicine, Centre for Chronic Disease Prevention and Management, The University of British Columbia, Kelowna, British Columbia, Canada
- GF Strong Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
- Faculty of Medicine, Occupational Science and Occupational Therapy, The University of British Columbia, Vancouver, British Columbia, Canada
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20
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Abstract
OBJECTIVE To investigate the safety and effectiveness of direct oral anticoagulants (DOAC) versus vitamin K antagonists (VKA) after recent stroke in patients with atrial fibrillation (AF) aged ≥85 years. METHODS Individual patient data analysis from seven prospective stroke cohorts. We compared DOAC versus VKA treatment among patients with AF and recent stroke (<3 months) aged ≥85 versus <85 years. Primary outcome was the composite of recurrent stroke, intracranial hemorrhage (ICH) and all-cause death. We used simple, adjusted, and weighted Cox regression to account for confounders. We calculated the net benefit of DOAC versus VKA by balancing stroke reduction against the weighted ICH risk. RESULTS In total, 5,984 of 6,267 (95.5%) patients were eligible for analysis. Of those, 1,380 (23%) were aged ≥85 years and 3,688 (62%) received a DOAC. During 6,874 patient-years follow-up, the impact of anticoagulant type (DOAC versus VKA) on the hazard for the composite outcome did not differ between patients aged ≥85 (HR≥85y = 0.65, 95%-CI [0.52, 0.81]) and < 85 years (HR<85y = 0.79, 95%-CI [0.66, 0.95]) in simple (pinteraction = 0.129), adjusted (pinteraction = 0.094) or weighted (pinteraction = 0.512) models. Analyses on recurrent stroke, ICH and death separately were consistent with the primary analysis, as were sensitivity analyses using age dichotomized at 90 years and as a continuous variable. DOAC had a similar net clinical benefit in patients aged ≥85 (+1.73 to +2.66) and < 85 years (+1.90 to +3.36 events/100 patient-years for ICH-weights 1.5 to 3.1). INTERPRETATION The favorable profile of DOAC over VKA in patients with AF and recent stroke was maintained in the oldest old. ANN NEUROL 2021.
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21
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Tsai CY, Lin ES, Li YT, Tung TH, Chen WC. The Relationship Between Storey of Buildings and Fall Risk. Front Public Health 2021; 9:665985. [PMID: 34869135 PMCID: PMC8633840 DOI: 10.3389/fpubh.2021.665985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 10/13/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: This study examined the association between storey of building and fall risk in older adults' residences and residents' level of fear of falling. Methods: The National Health and Ageing Trends Study (NHATS) collected information that would provide an understanding of basic trends people aged 65 years and older. Using a longitudinal survey, the present study employed the first round of NHATS data that was collected in 2011. In the first round, 12,411 participants were enrolled, and 8,077 interviews were completed. The study sample sizes for falling and worry about falling are 6,153 and 6,142, respectively. Results: Unadjusted analysis revealed that storey of building was a risk factor for fall and worry about falling. There was a higher prevalence for fall and worry about falling when subjects lived in single storey of building compared with the subjects live in multi-storey. Logistic regression analysis showed no highly significant between storey of building and the fall/fear of falling. Conclusion: Several clinical factors independently were indicated pertaining to the fall and worry about falling in older adult's residences.
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Affiliation(s)
- Ching-Yao Tsai
- Department of Ophthalmology, Taipei City Hospital, Taipei, Taiwan
- Institute of Public Health, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
- MS Program in Transdisciplinary Long Term Care and Department of Business Administration, Fu Jen Catholic University, New Taipei City, Taiwan
| | - En-Sheng Lin
- Department of Psychiatry, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
| | - Yang-Tzu Li
- Department of Long Term Care, National Taipei University of Nursing and Health Science, Taipei, Taiwan
| | - Tao-Hsin Tung
- Taiwan Association of Health Industry Management and Development, Taipei, Taiwan
| | - Wei-Cheng Chen
- TAIWAN STIPENDIARY CO., LTD., Kaohsiung, Taiwan
- Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan
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22
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Djurovic O, Mihaljevic O, Radovanovic S, Kostic S, Vukicevic M, Brkic BG, Stankovic S, Radulovic D, Vukomanovic IS, Radevic SR. Risk Factors Related to Falling in Patients after Stroke. IRANIAN JOURNAL OF PUBLIC HEALTH 2021; 50:1832-1841. [PMID: 34722379 PMCID: PMC8542823 DOI: 10.18502/ijph.v50i9.7056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 04/11/2021] [Indexed: 11/24/2022]
Abstract
Background: The aim of this study was to identify the risk factors associated with falling in post stroke patients. Methods: This retrospective case-control study included 561 neurology patients hospitalized for a stroke and divided into two groups: falling patients and non-falling patients. They referred to the Special Hospital for Cerebrovascular Diseases “Sveti Sava” in Belgrade, Serbia, from 2018–2019. Logistic regression analysis was applied to examine socio-economic factors associated with predictors of unmet healthcare needs. Results: A significant difference was seen in the length of hospitalization of falling patients compared to the non-falling (P<0.001). We established statistically significant differences in mental status (P<0.001), sensibility (P=0.016), depressed mood (P<0.001), early (P=0.001) and medium insomnia (P=0.042), psychomotor slowness (P=0.030), somatic anxiety (P=0.044) and memory (P<0.001). Conclusion: Cerebrovascular disease distribution and the degree of neurological deficit primarily altered mental status, which could be recognized as one of the more important predictors for falling after stroke. The identification of risk factors may be a first step toward the design of intervention programs for preventing a future fall among hospitalized stroke patients.
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Affiliation(s)
- Olivera Djurovic
- Special Hospital for Cerebrovascular Diseases "Sveti Sava", Belgrade, Serbia
| | - Olgica Mihaljevic
- Department of Pathophysiology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Snezana Radovanovic
- Department of Social Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Smiljana Kostic
- Military Medical Academy, Neurology Clinic, Belgrade, Serbia
| | - Marjana Vukicevic
- Special Hospital for Cerebrovascular Diseases "Sveti Sava", Belgrade, Serbia
| | | | - Snezana Stankovic
- Special Hospital for Cerebrovascular Diseases "Sveti Sava", Belgrade, Serbia
| | - Danijela Radulovic
- Primary Health Care and Public Health, Faculty of Medicine, University East Sarajevo, Sarajevo, Republic of Srpska, Bosnia and Herzegovina
| | - Ivana Simic Vukomanovic
- Department of Social Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Svetlana R Radevic
- Department of Social Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
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23
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Effect of Executive Dysfunction on Posture Control and Gait after Stroke. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:3051750. [PMID: 34675982 PMCID: PMC8526208 DOI: 10.1155/2021/3051750] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 09/20/2021] [Indexed: 12/01/2022]
Abstract
Objective The purpose of the study was to observe the effects of executive dysfunction (ED) on gait and postural control during walking after stroke. Methods In this study, 34 subjects with stroke and ED (8 women and 26 men; age, 55.41 ± 7.89 years; time since stroke onset, 1.3 ± 0.12 months) were recruited. Stroop color-word test (SCWT), 10-meter walk test (10MWT), timed-up-and-go test (TUGT), and gait analysis were evaluated. The correlation among the correct number of Stroop tasks (SCWT-C), the number of time-consuming tasks (SCWT-T), the amount of interference (SIE-M and SIE-T) and posture control, and gait-related parameters was analyzed. Results The results indicated that SCWT-C was negatively correlated with 10MWT, TUGT, and bilateral symmetry (P < 0.05). However, there was no significant correlation between SCWT-C and stride (P > 0.05). A significant negative correlation was seen between SCWT-C and bilateral symmetry (P < 0.05). There was no significant correlation between SCWT-T and stride (P > 0.05). SCWT-T was positively correlated with TUGT, 10MWT, and bilateral symmetry (P < 0.05). SIE-T was positively correlated with TUGT and bilateral symmetry (P < 0.05). There was no significant correlation between SIE-T and 10MWT or stride (P > 0.05). SIE-M was positively correlated with TUGT and bilateral symmetry (P < 0.05). There was no significant correlation between SIE-T and 10MWT or stride (P > 0.05). Conclusions ED is closely related to the decline in postural control and the occurrence of falls. In the early phases of stroke rehabilitation, physiotherapists should focus on the patients' executive function to accelerate the recovery of postural control.
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24
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Gillespie D, MacLellan C, Ferguson-Pell M, Taeger A, Manns PJ. Balancing Access with Technology: Comparing In-Person and Telerehabilitation Berg Balance Scale Scores among Stroke Survivors. Physiother Can 2021; 73:276-285. [PMID: 34456445 DOI: 10.3138/ptc-2019-0095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: Stroke survivors living in rural and remote communities experience challenges in accessing specialized rehabilitation services. Access to balance assessment after stroke is an essential aspect of the physiotherapy assessment. Telerehabilitation (TRH) can eliminate access disparities; however, adoption into practice has been limited. Our primary objective was to examine agreement between Berg Balance Scale (BBS) scores obtained through TRH and those obtained through traditional in-person assessment of community-dwelling individuals with stroke. Method: Two raters administered the BBS to 20 community-dwelling individuals with stroke, using both TRH and traditional in-person approaches. The order of assessments and rater assignment was randomized. Interrater reliability between the methods was assessed using Krippendorff's α reliability estimate. A survey was then administered to examine the participants' perceptions of the two means of assessment. Results: Excellent interrater agreement was found between TRH and in-person assessment (κ = 0.97; 95% CI: 0.96, 0.99), and responses regarding patients' perceived hearing and understanding of instructions as well as perceived safety were comparable. In addition, the vast majority of participants agreed or strongly agreed that they would use TRH for future physiotherapy sessions. Conclusions: The results of this study support administration of the BBS using TRH technology; this could improve access to balance assessment for stroke survivors in rural and remote communities.
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Affiliation(s)
- Dan Gillespie
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Crystal MacLellan
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Martin Ferguson-Pell
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Andrea Taeger
- Covenant Health: St. Mary's Hospital, Camrose, Alberta, Canada
| | - Patricia J Manns
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
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25
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Xie L, Yi SX, Peng QF, Liu P, Jiang H. Retrospective study of effect of whole-body vibration training on balance and walking function in stroke patients. World J Clin Cases 2021; 9:6268-6277. [PMID: 34434993 PMCID: PMC8362547 DOI: 10.12998/wjcc.v9.i22.6268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/07/2021] [Accepted: 05/24/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Dysfunction in stroke patients has been a problem that we committed to solve and explore. Physical therapy has some effect to regain strength, balance, and coordination. However, it is not a complete cure, so we are trying to find more effective treatments.
AIM To observe the effect of whole-body vibration training (WVT) on the recovery of balance and walking function in stroke patients, which could provide us some useful evidence for planning rehabilitation.
METHODS The clinical data of 130 stroke participants who underwent conventional rehabilitation treatment in our hospital from January 2019 to August 2020 were retrospectively analyzed. The participants were divided into whole-body vibration training (WVT) group and non-WVT (NWVT) group according to whether they were given WVT. In the WVT group, routine rehabilitation therapy was combined with WVT by the Galileo Med L Plus vibration trainer at a frequency of 20 Hz and a vibration amplitude of 0+ACY-plusmn+ADs-5.2 mm, and in the NWVT group, routine rehabilitation therapy only was provided. The treatment course of the two groups was 4 wk. Before and after treatment, the Berg balance scale (BBS), 3 m timed up-and-go test (TUGT), the maximum walking speed test (MWS), and upper limb functional reaching (FR) test were performed.
RESULTS After 4 wk training, in both groups, the BBS score and the FR distance respectively increased to a certain amount (WVT = 46.08 ± 3.41 vs NWVT = 40.22 ± 3.75; WVT = 20.48 ± 2.23 vs NWVT = 16.60 ± 2.82), with P < 0.05. Furthermore, in the WVT group, both BBS score and FR distance (BBS: 18.32 ± 2.18; FR: 10.00 ± 0.92) increased more than that in the NWVT group (BBS: 13.29 ± 1.66; FR: 6.16 ± 0.95), with P < 0.05. Meanwhile, in both groups, the TUGT and the MWS were improved after training (WVT = 32.64 ± 3.81 vs NWVT = 39.56 ± 3.68; WVT = 12.73 ± 2.26 vs NWVT = 15.04 ± 2.27, respectively), with P < 0.05. The change in the WVT group (TUGT: 17.49 ± 1.88; MWS: 6.79 ± 0.81) was greater than that in the NWVT group (TUGT: 10.76 ± 1.42; MWS: 4.84 ± 0.58), with P < 0.05.
CONCLUSION The WVT could effectively improve the balance and walking function in stroke patients, which may be good for improving their quality of life.
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Affiliation(s)
- Lei Xie
- Department of Rehabilitation, Chongqing Traditional Chinese Medicine Hospital, Chongqing 400021, China
| | - Shi-Xiong Yi
- Department of Rehabilitation, Chongqing Traditional Chinese Medicine Hospital, Chongqing 400021, China
| | - Qi-Feng Peng
- Department of Rehabilitation, Chongqing Traditional Chinese Medicine Hospital, Chongqing 400021, China
| | - Pei Liu
- Department of Rehabilitation, Chongqing Traditional Chinese Medicine Hospital, Chongqing 400021, China
| | - Heng Jiang
- Department of Rehabilitation, Chongqing Traditional Chinese Medicine Hospital, Chongqing 400021, China
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Wang HP, Sung SF, Yang HY, Huang WT, Hsieh CY. Associations between stroke type, stroke severity, and pre-stroke osteoporosis with the risk of post-stroke fracture: A nationwide population-based study. J Neurol Sci 2021; 427:117512. [PMID: 34082148 DOI: 10.1016/j.jns.2021.117512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 05/08/2021] [Accepted: 05/25/2021] [Indexed: 10/21/2022]
Abstract
Background Recognizing the post-stroke fracture risk factors is crucial for targeted intervention and primary fracture prevention. We aimed to investigate whether stroke types, stroke severity, and pre-stroke osteoporosis are associated with post-stroke fracture. Methods In a nationwide cohort, we identified previously fracture-free patients who suffered from first-ever stroke, either acute ischemic stroke (AIS) or intracerebral hemorrhage (ICH), between 2003 and 2015. Information regarding stroke severity, osteoporosis, comorbidity, and medication information was collected. The outcomes analyzed included hip fracture, spine fracture, and other fractures. Cumulative incidence functions (CIFs) were used to estimate the cumulative incidence of fractures over time after accounting for competing risk of death. Multivariable Fine and Gray models were used to determine the adjusted hazard ratio (HR) and 95% confidence interval (CI). Results Of the 41,895 patients with stroke, the 5-year CIFs of any incident fracture, hip fracture, spine fracture, and other fractures were 8.03%, 3.42%, 1.87%, and 3.05%, respectively. The fracture risk did not differ between patients with AIS and ICH. While osteoporosis increased the risk of post-stroke fracture (adjusted HR [95% CI],1.42 [1.22-1.66]), stroke severity was inversely associated with post-stroke fracture (moderate, 0.88 [0.81-0.96] and severe, 0.39 [0.34-0.44], compared with mild stroke severity). Conclusions Stroke survivors had an over 8% fracture risk at 5 years after stroke. Mild stroke severity and osteoporosis were significantly associated with post-stroke fracture risk, whereas stroke type was not. Our results call for effective measures for bone health screening and fracture prevention in patients with stroke.
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Affiliation(s)
- Hung-Ping Wang
- Division of Rheumatology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
| | - Sheng-Feng Sung
- Division of Neurology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
| | - Hsin-Yi Yang
- Clinical Research Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
| | - Wan-Ting Huang
- Clinical Research Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
| | - Cheng-Yang Hsieh
- Department of Neurology, Tainan Sin Lau Hospital, Tainan, Taiwan; School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Koren Y, Mairon R, Sofer I, Parmet Y, Ben-Shahar O, Bar-Haim S. Gazing down increases standing and walking postural steadiness. ROYAL SOCIETY OPEN SCIENCE 2021; 8:201556. [PMID: 33959324 PMCID: PMC8074885 DOI: 10.1098/rsos.201556] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 02/23/2021] [Indexed: 05/30/2023]
Abstract
When walking on an uneven surface or complex terrain, humans tend to gaze downward. This behaviour is usually interpreted as an attempt to acquire useful information to guide locomotion. Visual information, however, is not used exclusively for guiding locomotion; it is also useful for postural control. Both locomotive and postural control have been shown to be sensitive to the visual flow arising from the respective motion of the individual and the three-dimensional environment. This flow changes when a person gazes downward and may present information that is more appropriate for postural control. To investigate whether downward gazing can be used for postural control, rather than exclusively for guiding locomotion, we quantified the dynamics of standing and walking posture in healthy adults, under several visual conditions. Through these experiments we were able to demonstrate that gazing downward, just a few steps ahead, resulted in a steadier standing and walking posture. These experiments indicate that gazing downward may serve more than one purpose and provide sufficient evidence of the possible interplay between the visual information used for guiding locomotion and that used for postural control. These findings contribute to our understanding of the control mechanism/s underlying gait and posture and have possible clinical implications.
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Affiliation(s)
- Yogev Koren
- Physical Therapy Department, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Rotem Mairon
- Computer Science Department, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ilay Sofer
- Physical Therapy Department, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yisrael Parmet
- Industrial Engineering and Management Department, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ohad Ben-Shahar
- Computer Science Department, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Simona Bar-Haim
- Physical Therapy Department, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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28
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Ahmad Ainuddin H, Romli MH, Hamid TA, Salim MSF, Mackenzie L. Stroke Rehabilitation for Falls and Risk of Falls in Southeast Asia: A Scoping Review With Stakeholders' Consultation. Front Public Health 2021; 9:611793. [PMID: 33748063 PMCID: PMC7965966 DOI: 10.3389/fpubh.2021.611793] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/27/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Research on rehabilitation for falls after stroke is warranted. However, published evidence on fall interventions with stroke survivors is limited and these are mainly international studies that may be less relevant for Southeast Asia. Objective: This review aims to systematically identify literature related to stroke rehabilitation for falls and risk of falls in Southeast Asia. Methods: A scoping review with stakeholders' consultation was implemented. An electronic search was conducted up to December 2020 on 4 databases (Medline, CINAHL, Scopus, ASEAN Citation Index). Only original studies conducted in Southeast Asia were selected. Results: The initial search yielded 3,112 articles, however, only 26 were selected in the final analysis. Most of the articles focused on physical rehabilitation and implemented conventional therapies. While the literature may reflect practice in Southeast Asia, stakeholders perceived that the literature was inadequate to show true practice, was not informative and missed several aspects such as functional, cognitive, and psychological interventions in managing falls. Individual-centric interventions dominated the review while community-based and environmental-focused studies were limited. Majority of the articles were written by physiotherapists while others were from physicians, occupational therapists, and an engineer but few from other healthcare practitioners (i.e., speech therapists, psychologists) or disciplines interested in falls. Conclusions: Falls prevention among stroke survivors has received a lack of attention and is perceived as an indirect goal in stroke rehabilitation in Southeast Asia. More innovative research adopted from falls research with older people is needed to advance falls prevention and intervention practice with stroke survivors.
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Affiliation(s)
- Husna Ahmad Ainuddin
- Center of Occupational Therapy Studies, Faculty of Health Sciences, Universiti Teknologi MARA Selangor, Selangor, Malaysia
- Department of Rehabilitation Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Muhammad Hibatullah Romli
- Department of Rehabilitation Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
- Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Serdang, Malaysia
| | - Tengku Aizan Hamid
- Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Serdang, Malaysia
| | - Mazatulfazura S. F. Salim
- Department of Rehabilitation Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Lynette Mackenzie
- Discipline of Occupational Therapy, Faculty of Medicine and Health, School of Health Sciences, University of Sydney, Sydney, NSW, Australia
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Effect of Cognitive Function on Balance and Posture Control after Stroke. Neural Plast 2021; 2021:6636999. [PMID: 33574837 PMCID: PMC7861954 DOI: 10.1155/2021/6636999] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/01/2021] [Accepted: 01/13/2021] [Indexed: 11/17/2022] Open
Abstract
Hemiplegic gait is the most common sequela of stroke. Patients with hemiplegic gait are at a risk of falling because of poor balance. The theory of cognitive-motor networks paved the way for a new field of research. However, the mechanism of the relationship of cognition with gait or posture control networks is unclear because of the dynamic characteristics of walking and changing postures. To explore differences in the balance function and fall risk between patients with and without cognitive impairment after stroke, we utilized the Berg balance scale, Timed “Up and Go” test, and 10 m walking test. Patients were divided into two groups: the observation group (16 patients, female 6 and male 10), comprising patients with cognitive impairment after stroke, and the control group (16 patients, female 7 and male 9), comprising patients without cognitive impairment after stroke. We found that patients with cognitive impairment had worse balance function and a higher risk of falls. They needed a longer time to turn around or sit down. Our findings indicated that posture control in turning around and sitting down required more cognitive resources in daily life.
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Deutschbein J, Grittner U, Schneider A, Schenk L. Community care coordination for stroke survivors: results of a complex intervention study. BMC Health Serv Res 2020; 20:1143. [PMID: 33341112 PMCID: PMC7749985 DOI: 10.1186/s12913-020-05993-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 12/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Outpatient follow-up care for stroke survivors is often inadequate and mostly self-organized by the patients themselves. In the German health care system, there are no standard care programs for patients after they are discharged from the hospital to support them with their multifaceted and heterogeneous health care needs. The objective of this complex intervention study was to evaluate the effectiveness of a post-stroke care coordination program in comparison to standard care in the first year after a stroke. METHODS Patients aged 55 and older who had survived a stroke or a transient ischemic attack (TIA) within the last 6 months before enrollment were included. Participants received care coordination either by telephone or face-to-face for up to 1 year. Patients' health insurance claims data were used to measure outcomes. The control group consisted of stroke survivors receiving standard care and was constructed by exact matching based on six criteria. Outcome measures were health services utilization, rate of recurrent events, readmissions and accompanying costs, and mortality. Outcomes were tested using different multiple models. RESULTS In total, N = 361 patients were included in the analyses. Intervention participants had seen an outpatient neurologist more often (OR = 4.75; 95% CI: 2.71-8.31) and were readmitted to a hospital less frequently (IRR = 0.42; 95% CI: 0.29-0.61), resulting in lower hospital costs (IQR = €0-1910 in the intervention group, IQR = €0-4375 in the control group). There were no substantial group differences in the rate of recurrent events and mortality. CONCLUSION This study showed the beneficial potential of care coordination for a vulnerable patient population: the utilization rate of important health services was increased, and the rate of hospital readmissions decreased as a result. Future research should focus on the risk of recurrent strokes and the long-term effects of improved care. TRIAL REGISTRATION DRKS00017526 on DRKS - German Clinical Trials Register (retrospectively registered: 21 June 2019).
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Affiliation(s)
- Johannes Deutschbein
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.
| | - Ulrike Grittner
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.,Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Str. 2, 10178, Berlin, Germany
| | - Alice Schneider
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.,Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Str. 2, 10178, Berlin, Germany
| | - Liane Schenk
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
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Tanislav C, Kostev K. Factors associated with fracture after stroke and TIA: a long-term follow-up. Osteoporos Int 2020; 31:2395-2402. [PMID: 32647951 DOI: 10.1007/s00198-020-05535-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 07/01/2020] [Indexed: 01/20/2023]
Abstract
UNLABELLED We assessed the long-term incidence of fractures after stroke and TIA and analyzed associated factors. The fracture incidence increases with age and is higher in stroke than in TIA. Dementia is associated with fractures after both. Our results indicate tailored measures are necessary for preventing fractures after stroke or TIA. INTRODUCTION In the present study, we aimed to assess the long-term incidence of fractures and analyze associated factors after stroke or transient ischemic attack (TIA). METHODS The current cohort study included patients who had received an initial ischemic stroke or TIA diagnosis documented anonymously in the Disease Analyzer database (IQVIA) between 2000 and 2016 by physicians in 1262 general practices in Germany. Univariate Cox and multivariate regression models were carried out. RESULTS Three groups (stroke, TIA, no stroke/TIA), each with 12,265 individuals, were selected (mean age 67.3 years, 48.1% female). A fracture was diagnosed in 12.9% of stroke patients and in 11.4% of TIA patients. Among male stroke patients, 11.1% had a fracture (15.4% among female stroke patients). The hazard ratio (HR) for fractures after stroke was 1.26 (CI: 1.15-1.39) and for fractures after TIA, it was 1.14 (CI: 1.03-1.25). In female stroke patients, the HR for fractures was 1.32 (CI: 1.15-1.60), while in males, it was 1.20 (CI: 1.03-1.39). Among TIA patients, females had an elevated HR for fractures (HR: 1.21; CI: 1.06-1.37). In individuals aged ≥ 80 years, an increased risk for fractures was only detected among TIA patients (HR: 1.26; CI: 1.05-1.51). Dementia and non-opioid analgesic therapy were positively associated with fracture after both stroke and TIA. CONCLUSION Stroke was positively associated with fracture in patients < 80 years, while TIA was positively associated with fracture in patients ≥ 80 years and females. Dementia and analgesic therapy were also associated with fracture after either stroke or TIA.
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Affiliation(s)
- C Tanislav
- Department of Geriatrics and Neurology, Diakonie Hospital Jung Stilling Siegen, Wichernstrasse 40, 57074, Siegen, Germany.
| | - K Kostev
- Epidemiology, IQVIA, Frankfurt am Main, Germany
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Zhang T, Zhao J, Li X, Bai Y, Wang B, Qu Y, Li B, Zhao S. Chinese Stroke Association guidelines for clinical management of cerebrovascular disorders: executive summary and 2019 update of clinical management of stroke rehabilitation. Stroke Vasc Neurol 2020; 5:250-259. [PMID: 32595138 PMCID: PMC7548515 DOI: 10.1136/svn-2019-000321] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 05/19/2020] [Accepted: 05/27/2020] [Indexed: 02/05/2023] Open
Abstract
Stroke is the third leading cause of long-term disability. Effective stroke rehabilitation should be provided to patients with a moderate or severe stroke so as to achieve functional recovery. Also, stroke rehabilitation is moving towards more intense therapy models that incorporate technologies such as robotics and computer games. Evidence-based guidelines are useful for promoting the best possible clinical practices. This guideline summarises the modes of stroke rehabilitation in China-three-stage rehabilitation network, rehabilitation of stroke dysfunction, training for activities of daily living, stroke complications and rehabilitation care. The aim of this guideline was to provide a synopsis of best clinical practices in the stroke rehabilitation of adult patients in China.
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Affiliation(s)
- Tong Zhang
- Department of Neurorehabilitation, China Rehabilitation Research Center, Beijing, China
| | - Jun Zhao
- Department of Neurorehabilitation, China Rehabilitation Research Center, Beijing, China
| | - Xueping Li
- Department of Rehabilitation, Nanjing First Hospital, Nanjing, Jiangsu, China
| | - Yulong Bai
- Department of Rehabilitation, Huashan Hospital Fudan University, Shanghai, China
| | - Baojun Wang
- Department of Neurorehabilitation, Inner Mongolia Baotou City Central Hospital, Baotou, Inner Mongolia, China
| | - Yun Qu
- Department of Neurorehabilitation, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Bingjie Li
- Department of Neurorehabilitation, China Rehabilitation Research Center, Beijing, China
| | - Shengjie Zhao
- Department of Neurorehabilitation, China Rehabilitation Research Center, Beijing, China
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Northuis CA, Crandall CJ, Margolis KL, Diem SJ, Ensrud KE, Lakshminarayan K. Association between post-stroke disability and 5-year hip-fracture risk: The Women's Health Initiative. J Stroke Cerebrovasc Dis 2020; 29:104976. [PMID: 32689623 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104976] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/11/2020] [Accepted: 05/16/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Hip fractures are a significant post-stroke complication. We examined predictors of hip fracture risk after stroke using data from the Women's Health Initiative (WHI). In particular, we examined the association between post-stroke disability levels and hip fracture risk. METHODS The WHI is a prospective study of 161,808 postmenopausal women aged 50-79 years. Trained physicians adjudicated stroke events and hip fractures. Our study included stroke survivors from the observational and clinical trial arms who had a Glasgow Outcome Scale of good recovery, moderately disabled, or severely disabled and survived more than 7 days post-stroke. Hip fracture-free status was compared across disability levels. Secondary analysis examined hip fracture risk while accounting for competing risk of death. RESULTS Average age at time of stroke was 74.6±7.2 years; 84.3% were white. There were 124 hip fractures among 4,640 stroke survivors over a mean follow-up time of 3.1±1.8 years. Mortality rate was 23.3%. Severe disability at discharge (Hazard Ratio (HR): 2.1 (95% Confidence Interval (CI): 1.4-3.2), but not moderate disability (HR: 1.1 (95%CI: 0.7-1.7), was significantly associated with an increased risk of hip fracture compared to good recovery status. This association was attenuated after accounting for mortality. White race, increasing age and higher Fracture Risk Assessment Tool (FRAX)-predicted hip fracture risk (without bone density information) were associated with an increased hip fracture risk. After accounting for mortality, higher FRAX risk and white race remained significant. CONCLUSION Severe disability after stroke and a higher FRAX risk score were associated with risk of subsequent hip fracture. After accounting for mortality, only the FRAX risk score remained significant. The FRAX risk score appears to identify stroke survivors at high risk of fractures. Our results suggest that stroke units can consider the incorporation of osteoporosis screening into care pathways.
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Affiliation(s)
- Carin A Northuis
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN.
| | - Carolyn J Crandall
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA.
| | | | - Susan J Diem
- Division of Epidemiology and Community Health & Department of Medicine, University of Minnesota, Minneapolis, MN.
| | - Kristine E Ensrud
- Division of Epidemiology and Community Health & Department of Medicine, University of Minnesota, Minneapolis, MN.
| | - Kamakshi Lakshminarayan
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN.
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Campo M, Toglia J, Batistick-Aufox H, O'Dell MW. Standardized Outcome Measures in Stroke Rehabilitation and Falls After Discharge: A Cohort Study. PM R 2020; 13:265-273. [PMID: 32358887 DOI: 10.1002/pmrj.12396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 04/14/2020] [Accepted: 04/22/2020] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Individuals with stroke discharged from inpatient rehabilitation units (IRUs) are at increased risk for falls. In IRUs, standardized outcome measures (SOMs) have been used to predict falls, but the results have been mixed. OBJECTIVE To examine the relationship between SOMs and the risk of falls in individuals with stroke within 6 months of discharge from an IRU. DESIGN Prospective cohort study with 6-month follow-up. SETTING IRU that was part of a large, urban academic medical center. PARTICIPANTS Individuals with stroke who underwent rehabilitation. MAIN OUTCOME MEASURES Self-reported falls within 6 months of discharge. RESULTS The study included 105 participants who were discharged to their homes after inpatient rehabilitation and who responded to a 6-month follow-up (57% response rate) phone call. Twenty-nine participants (28%) reported falling. Significant odds ratios (ORs), adjusted for age, sex, and stroke severity, were found for the following measures: Berg Balance Scale (OR 0.95, 95% confidence interval [CI] 0.92-0.99), Activity Measure for Post-Acute Care basic mobility (OR 0.89, 95% CI 0.81-0.97), Motricity Index (OR 0.96, 95% CI 0.94-0.98), Functional Independence Measure mobility subscale (OR 0.89, 95% CI 0.80-0.98), and Trunk Control Test (OR 0.97, 95% CI 0.95-0.99). Areas under the curve ranged from .64 to .71. In samples of 82 to 90 patients who could complete the tests, gait speed, the Functional Reach Test, the 6-minute Walk Test, and Timed Up and Go did not result in significant ORs. CONCLUSIONS At discharge, SOMs were associated with the odds of falls within 6 months. The multifactorial nature of falls will continue to make prediction challenging but SOMs can be helpful. Lower extremity strength deserves more attention as a risk factor.
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Affiliation(s)
- Marc Campo
- School of Health and Natural Sciences, Mercy College, Dobbs Ferry, NY
| | - Joan Toglia
- School of Health and Natural Sciences, Mercy College, Dobbs Ferry, NY
| | | | - Michael W O'Dell
- Clinical Rehabilitation Medicine, Weill Cornell Medicine, New York City, NY
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Hsieh CY, Sung SF, Huang HK. Drug treatment strategies for osteoporosis in stroke patients. Expert Opin Pharmacother 2020; 21:811-821. [PMID: 32151211 DOI: 10.1080/14656566.2020.1736556] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Osteoporosis and subsequent fractures are well-recognized complications of stroke. However, drug treatment strategies for osteoporosis after stroke have been rarely discussed in the current guidelines for the management of stroke or osteoporosis. AREAS COVERED The authors review the epidemiology, characteristics, pathophysiology, and risk prediction of post-stroke osteoporosis and fractures. Then they provide an overview of existing evidence regarding drug treatment strategies for osteoporosis in stroke patients. They also review the effects on bone mineral density (BMD) and fractures for those drugs commonly used in stroke patients. EXPERT OPINION Currently, there is scarce evidence. A small randomized control trial suggested that a single use of 4 mg of intravenous zoledronate within 5 weeks of stroke onset was beneficial for preserving BMD, while simultaneous use of calcium and vitamin D supplements may be effective in preventing hypocalcemia. Further studies are needed to address several important issues of post-stroke osteoporosis, including who (the eligibility for treatment), when (the best timing of treatment), what (which drug), and how long (the best duration of treatment). On the other hand, physicians should bear in mind that drugs commonly used for stroke, such as statins or warfarin, may have beneficial or adverse effects on BMD and fracture risks.
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Affiliation(s)
- Cheng-Yang Hsieh
- Department of Neurology, Tainan Sin Lau Hospital , Tainan, Taiwan.,School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University , Tainan, Taiwan
| | - Sheng-Feng Sung
- Division of Neurology, Department of Internal Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital , Chiayi City, Taiwan.,Department of Information Management and Institute of Healthcare Information Management, National Chung Cheng University , Chiayi County, Taiwan
| | - Huei-Kai Huang
- Departments of Family Medicine and Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation , Hualien, Taiwan.,School of Medicine, Tzu Chi University , Hualien, Taiwan
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Purnamasari AA, Arafat R, Sabriyati WONI, Erfina E. Risk factors of falls among hospitalized stroke patients. ENFERMERIA CLINICA 2020. [DOI: 10.1016/j.enfcli.2019.07.176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Huang Y, Wu C, Peng H, Chen Q, Fan X, Xiao L, Song B, Wan L. The Correlation Between Fall Prevention Knowledge and Behavior in Stroke Outpatients. J Neurosci Nurs 2020; 52:61-65. [PMID: 32032275 DOI: 10.1097/jnn.0000000000000494] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Stroke outpatients have a high risk of falling. However, fall prevention measures in the community are insufficient to effectively reduce the fall rate among outpatients with stroke. We aimed to determine the correlation between fall prevention knowledge and behavior among outpatients with stroke and provide new strategies for community fall prevention. METHODS We recruited 124 patients with stroke who were followed up in the outpatient department of a tertiary hospital in Zhuhai, China. Patients were assessed using a general information questionnaire, a fall prevention knowledge questionnaire for patients with stroke, and the Stroke Fall Prevention Behavior Scale. IBM SPSS 22.0 software was used for statistical analysis. RESULTS The median fall prevention knowledge was 82.76 (68.97, 93.10) points, out of 100. The mean (SD) score for fall prevention behavior was 2.90 (0.52; range, 1-4) points. Fall prevention knowledge scores were positively related to those fall prevention behavior (Spearman r = 0.454, P < .01). CONCLUSION Levels of fall prevention knowledge among outpatients with stroke were adequate, and this population had medium to high levels of fall prevention behavior. Better knowledge was accompanied with better prevention of falls. However, whether enriching the knowledge could lead to improvement of fall prevention is still undetermined.
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Denissen S, Staring W, Kunkel D, Pickering RM, Lennon S, Geurts ACH, Weerdesteyn V, Verheyden GSAF. Interventions for preventing falls in people after stroke. Cochrane Database Syst Rev 2019; 10:CD008728. [PMID: 31573069 PMCID: PMC6770464 DOI: 10.1002/14651858.cd008728.pub3] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Falls are one of the most common complications after stroke, with a reported incidence ranging between 7% in the first week and 73% in the first year post stroke. This is an updated version of the original Cochrane Review published in 2013. OBJECTIVES To evaluate the effectiveness of interventions aimed at preventing falls in people after stroke. Our primary objective was to determine the effect of interventions on the rate of falls (number of falls per person-year) and the number of fallers. Our secondary objectives were to determine the effects of interventions aimed at preventing falls on 1) the number of fall-related fractures; 2) the number of fall-related hospital admissions; 3) near-fall events; 4) economic evaluation; 5) quality of life; and 6) adverse effects of the interventions. SEARCH METHODS We searched the trials registers of the Cochrane Stroke Group (September 2018) and the Cochrane Bone, Joint and Muscle Trauma Group (October 2018); the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 9) in the Cochrane Library; MEDLINE (1950 to September 2018); Embase (1980 to September 2018); CINAHL (1982 to September 2018); PsycINFO (1806 to August 2018); AMED (1985 to December 2017); and PEDro (September 2018). We also searched trials registers and checked reference lists. SELECTION CRITERIA Randomised controlled trials of interventions where the primary or secondary aim was to prevent falls in people after stroke. DATA COLLECTION AND ANALYSIS Two review authors (SD and WS) independently selected studies for inclusion, assessed trial quality and risk of bias, and extracted data. We resolved disagreements through discussion, and contacted study authors for additional information where required. We used a rate ratio and 95% confidence interval (CI) to compare the rate of falls (e.g. falls per person-year) between intervention and control groups. For risk of falling we used a risk ratio and 95% CI based on the number of people falling (fallers) in each group. We pooled results where appropriate and applied GRADE to assess the quality of the evidence. MAIN RESULTS We included 14 studies (of which six have been published since the first version of this review in 2013), with a total of 1358 participants. We found studies that investigated exercises, predischarge home visits for hospitalised patients, the provision of single lens distance vision glasses instead of multifocal glasses, a servo-assistive rollator and non-invasive brain stimulation for preventing falls.Exercise compared to control for preventing falls in people after strokeThe pooled result of eight studies showed that exercise may reduce the rate of falls but we are uncertain about this result (rate ratio 0.72, 95% CI 0.54 to 0.94, 765 participants, low-quality evidence). Sensitivity analysis for single exercise interventions, omitting studies using multiple/multifactorial interventions, also found that exercise may reduce the rate of falls (rate ratio 0.66, 95% CI 0.50 to 0.87, 626 participants). Sensitivity analysis for the effect in the chronic phase post stroke resulted in little or no difference in rate of falls (rate ratio 0.58, 95% CI 0.31 to 1.12, 205 participants). A sensitivity analysis including only studies with low risk of bias found little or no difference in rate of falls (rate ratio 0.88, 95% CI 0.65 to 1.20, 462 participants). Methodological limitations mean that we have very low confidence in the results of these sensitivity analyses.For the outcome of number of fallers, we are very uncertain of the effect of exercises compared to the control condition, based on the pooled result of 10 studies (risk ratio 1.03, 95% CI 0.90 to 1.19, 969 participants, very low quality evidence). The same sensitivity analyses as described above gives us very low certainty that there are little or no differences in number of fallers (single interventions: risk ratio 1.09, 95% CI 0.93 to 1.28, 796 participants; chronic phase post stroke: risk ratio 0.94, 95% CI 0.73 to 1.22, 375 participants; low risk of bias studies: risk ratio 0.96, 95% CI 0.77 to 1.21, 462 participants).Other interventions for preventing falls in people after strokeWe are very uncertain whether interventions other than exercise reduce the rate of falls or number of fallers. We identified very low certainty evidence when investigating the effect of predischarge home visits (rate ratio 0.85, 95% CI 0.43 to 1.69; risk ratio 1.48, 95% CI 0.71 to 3.09; 85 participants), provision of single lens distance glasses to regular wearers of multifocal glasses (rate ratio 1.08, 95% CI 0.52 to 2.25; risk ratio 0.74, 95% CI 0.47 to 1.18; 46 participants) and a servo-assistive rollator (rate ratio 0.44, 95% CI 0.16 to 1.21; risk ratio 0.44, 95% CI 0.16 to 1.22; 42 participants).Finally, transcranial direct current stimulation (tDCS) was used in one study to examine the effect on falls post stroke. We have low certainty that active tDCS may reduce the number of fallers compared to sham tDCS (risk ratio 0.30, 95% CI 0.14 to 0.63; 60 participants). AUTHORS' CONCLUSIONS At present there exists very little evidence about interventions other than exercises to reduce falling post stroke. Low to very low quality evidence exists that this population benefits from exercises to prevent falls, but not to reduce number of fallers.Fall research does not in general or consistently follow methodological gold standards, especially with regard to fall definition and time post stroke. More well-reported, adequately-powered research should further establish the value of exercises in reducing falling, in particular per phase, post stroke.
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Affiliation(s)
- Stijn Denissen
- KU LeuvenDepartment of Rehabilitation SciencesLeuvenBelgium
- Vrije Universiteit BrusselCIME Cognition and Modeling group, Center For Neurosciences (C4N)BrusselsBelgium1050
| | - Wouter Staring
- Radboud University Medical CentreDepartment of Rehabilitation, Donders Institute for Brain, Cognition and BehaviourNijmegenNetherlands
| | - Dorit Kunkel
- University of SouthamptonFaculty of Health SciencesSouthampton General HospitalMP 886, Tremona RoadSouthamptonUKSO16 6YD
| | - Ruth M Pickering
- University of SouthamptonDepartment of Public Health Sciences and Medical StatisticsSouthampton General Hospital, MP 805Tremona RoadSouthamptonUKSO16 6YD
| | - Sheila Lennon
- Flinders UniversityPhysiotherapy, College of Nursing & Health SciencesAdelaideAustralia
| | - Alexander CH Geurts
- Radboud University Medical CentreDepartment of Rehabilitation, Donders Institute for Brain, Cognition and BehaviourNijmegenNetherlands
- Sint Maartenskliniek ResearchNijmegenNetherlands
| | - Vivian Weerdesteyn
- Radboud University Medical CentreDepartment of Rehabilitation, Donders Institute for Brain, Cognition and BehaviourNijmegenNetherlands
- Sint Maartenskliniek ResearchNijmegenNetherlands
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A Novel Activity Recognition System for Alternative Control Strategies of a Lower Limb Rehabilitation Robot. APPLIED SCIENCES-BASEL 2019. [DOI: 10.3390/app9193986] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Robot-aided training strategies that allow functional, assist-as-needed, or challenging training have been widely explored. Accurate activity recognition is the basis for implementing alternative training strategies. However, some obstacles to accurate recognition exist. First, scientists do not yet fully understand some rehabilitation activities, such as abnormal gaits and falls; thus, there is no standardized feature for identifying such activities. Second, during the activity identification process, it is difficult to reasonably balance sensitivity and specificity when setting the threshold. Therefore, we proposed a multisensor fusion system and a two-stage activity recognition classifier. This multisensor system integrates explicit information such as kinematics and spatial distribution information along with implicit information such as kinetics and pulse information. Both the explicit and implicit information are analyzed in one discriminant function to obtain a detailed and accurate recognition result. Then, alternative training strategies can be implemented on this basis. Finally, we conducted experiments to verify the feasibility and efficiency of the multisensor fusion system. The experimental results show that the proposed fusion system achieves an accuracy of 99.37%, and the time required to prejudge a fall is approximately 205 milliseconds faster than the response time of single-sensor systems. Moreover, the proposed system also identifies fall directions and abnormal gait types.
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Rafsten L, Meirelles C, Danielsson A, Sunnerhagen KS. Impaired Motor Function in the Affected Arm Predicts Impaired Postural Balance After Stroke: A Cross Sectional Study. Front Neurol 2019; 10:912. [PMID: 31496989 PMCID: PMC6713045 DOI: 10.3389/fneur.2019.00912] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 08/06/2019] [Indexed: 11/23/2022] Open
Abstract
Background: Impaired postural balance is a common symptom after stroke and a common cause of falling. Most common daily tasks use arm and hand movements. Impairment in an upper extremity is a common stroke symptom, affecting 50–80% in the acute phase after stroke, and 40–50% in the sub-acute phase. The impact of leg function on postural balance has been investigated in several studies, but few have stressed the importance of arm function on postural balance. Objective: To explore whether there is any association between arm function and postural balance after stroke. Method: A cross sectional study where 121 adults (mean age: 70 ± 12.3 years, 72 men) from two different data sources, Gothenburg Very Early Supported Discharge (GOTVED), and a study by Carvalho et al. were merged. Time for assessments ranged from 1 to 13 years when the patients were in the chronic phase. The dependent variables were Berg Balance scale (BBS) and Time Up and Go (TUG) both dichotomized to “impaired postural balance” and “not impaired postural balance.” As independent variables, the Fugl-Meyer Assessment-Upper Extremity (FMA-UE) scale was used. The FMA-UE was presented with the total score. Results: The motor function in the arm affected after stroke onset correlated with postural balance both measured with the BBS (0.321, p < 0.001) and the TUG (−0.315, p = 0.001). Having impaired motor function in the arm was significantly associated with impaired postural balance assessed with the BBS with OR = 0.879 (CI 0.826–0.934, p < 0.001). Regression analysis with the TUG showed the same result, OR = 0.868 (CI 0.813–0.927, p < 0.001) for FM-UE. Conclusion: The motor function of the affected arm was significantly associated with impaired postural balance post stroke, as assessed by BBS or TUG. It could be of clinical importance to be aware of the fact that not only lower extremity impairment, but also arm function can have an impact on postural balance in a late stage after stroke. Trial Registration: VGFOUGSB-669501.
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Affiliation(s)
- Lena Rafsten
- Department of Clinical Neuroscience and Rehabilitation Medicine, Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden.,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Christiane Meirelles
- Department of Therapy Service, University of Chicago Medical Center, Chicago, IL, United States
| | - Anna Danielsson
- Department of Clinical Neuroscience and Rehabilitation Medicine, Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden.,Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
| | - Katharina S Sunnerhagen
- Department of Clinical Neuroscience and Rehabilitation Medicine, Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden.,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
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Major MJ, McConn SM, Zavaleta JL, Stine R, Gard SA. Effects of upper limb loss and prosthesis use on proactive mechanisms of locomotor stability. J Electromyogr Kinesiol 2019; 48:145-151. [PMID: 31357112 DOI: 10.1016/j.jelekin.2019.07.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 07/10/2019] [Accepted: 07/22/2019] [Indexed: 12/01/2022] Open
Abstract
Persons with upper limb loss (ULL) experience a high prevalence of falls, with the majority of falls occurring when walking. This issue may be related to altered arm dynamics, which play an important role in proactive mechanisms of locomotor stability. This study investigated effects of ULL and prosthesis use on proactive stability mechanisms, particularly if matching the mass and inertia of the impaired limb to the sound limb would enhance locomotor stability. Gait data were collected on adults with unilateral ULL during level walking while: (1) not wearing a prosthesis, (2) wearing their customary prosthesis, (3) wearing a mock prosthesis that matched the sound limb mass and inertia. Main and interaction effects of limb side and condition on trunk rotations, arm swing, step width, free vertical moment, and margin-of-stability were analyzed. Across conditions, arm swing, free vertical moment, and margin-of-stability were 2.27, 1.13, and 1.20 times greater, respectively, on the sound limb side than the impaired limb side. Persons with ULL display asymmetry in proactive mechanisms of locomotor stability with potentially greater medial-lateral stability on the sound limb side irrespective of prosthesis use, but heavier prostheses reduced the walking base of support. This bias may enhance fall risk on the impaired side if the prosthetic limb is used inappropriately to regain balance following a disturbance. Research is warranted to explore the consequences of this asymmetry on perturbation response.
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Affiliation(s)
- Matthew J Major
- Jesse Brown VA Medical Center, Chicago, IL, USA; Northwestern University Prosthetics-Orthotics Center, Dept. of Physical Medicine & Rehabilitation, Feinberg School of Medicine, Chicago, IL, USA.
| | - Suzanne M McConn
- Northwestern University, Department of Biomedical Engineering, Evanston, IL, USA
| | - José Luis Zavaleta
- Laboratorio de Ortesis y Prótesis, Instituto Nacional de Rehabilitación LGII, Ciudad de México, Mexico
| | | | - Steven A Gard
- Jesse Brown VA Medical Center, Chicago, IL, USA; Northwestern University Prosthetics-Orthotics Center, Dept. of Physical Medicine & Rehabilitation, Feinberg School of Medicine, Chicago, IL, USA
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Lee KB, Lee JG, Kim BJ, Kim JY, Lee KJ, Han MK, Park JM, Kang K, Cho YJ, Park HK, Hong KS, Park TH, Lee SJ, Oh MS, Yu KH, Lee BC, Cha JK, Kim DH, Kim JT, Lee J, Hong JH, Sohn SI, Kim DE, Choi JC, Yeo MJ, Kim WJ, Chae JE, Lee JS, Lee J, Bae HJ. The Epidemiology of Fracture in Patients with Acute Ischemic Stroke in Korea. J Korean Med Sci 2019; 34:e164. [PMID: 31172697 PMCID: PMC6556443 DOI: 10.3346/jkms.2019.34.e164] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 05/22/2019] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Patients who survive an acute phase of stroke are at risk of falls and fractures afterwards. However, it is largely unknown how frequent fractures occur in the Asian stroke population. METHODS Patients with acute (< 7 days) ischemic stroke who were hospitalized between January 2011 and November 2013 were identified from a prospective multicenter stroke registry in Korea, and were linked to the National Health Insurance Service claim database. The incidences of fractures were investigated during the first 4 years after index stroke. The cumulative incidence functions (CIFs) were estimated by the Gray's test for competing risk data. Fine and Gray model for competing risk data was applied for exploring risk factors of post-stroke fractures. RESULTS Among a total of 11,522 patients, 1,616 fracture events were identified: 712 spine fractures, 397 hip fractures and 714 other fractures. The CIFs of any fractures were 2.63% at 6 months, 4.43% at 1 year, 8.09% at 2 years and 13.00% at 4 years. Those of spine/hip fractures were 1.11%/0.61%, 1.88%/1.03%, 3.28%/1.86% and 5.79%/3.15%, respectively. Age by a 10-year increment (hazard ratio [HR], 1.23; 95% confidence interval [CI], 1.17-1.30), women (HR, 1.74; 95% CI, 1.54-1.97), previous fracture (HR, 1.72; 95% CI, 1.54-1.92) and osteoporosis (HR, 1.44; 95% CI, 1.27-1.63) were independent risk factors of post-stroke fracture. CONCLUSION The CIFs of fractures are about 8% at 2 years and 13% at 4 years after acute ischemic stroke in Korea. Older age, women, pre-stroke fracture and osteoporosis raised the risk of post-stroke fractures.
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Affiliation(s)
- Kyung Bok Lee
- Department of Neurology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Jung Gon Lee
- Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Beom Joon Kim
- Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jun Yup Kim
- Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Keon Joo Lee
- Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Moon Ku Han
- Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jong Moo Park
- Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Kyusik Kang
- Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Yong Jin Cho
- Department of Neurology, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Hong Kyun Park
- Department of Neurology, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Keun Sik Hong
- Department of Neurology, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Tai Hwan Park
- Department of Neurology, Seoul Medical Center, Seoul, Korea
| | - Soo Joo Lee
- Department of Neurology, Daejeon Eulji Medical Center, Eulji University, Daejeon, Korea
| | - Mi Sun Oh
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Kyung Ho Yu
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Byung Chul Lee
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Jae Kwan Cha
- Department of Neurology, Dong-A University Hospital, Busan, Korea
| | - Dae Hyun Kim
- Department of Neurology, Dong-A University Hospital, Busan, Korea
| | - Joon Tae Kim
- Department of Neurology, Chonnam National University Hospital, Gwangju, Korea
| | - Jun Lee
- Department of Neurology, Yeungnam University Medical Center, Daegu, Korea
| | - Jeong Ho Hong
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Sung Il Sohn
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Dong Eog Kim
- Department of Neurology, Dongguk University Ilsan Hopital, Goyang, Korea
| | - Jay Chol Choi
- Department of Neurology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Min Ju Yeo
- Department of Neurology, Chungbuk National University Hospital, Cheongju, Korea
| | - Wook Joo Kim
- Department of Neurology, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, Korea
| | - Jae Eun Chae
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Ji Sung Lee
- Clinical Research Center, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
| | - Juneyoung Lee
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Hee Joon Bae
- Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
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Walsh ME, Galvin R, Williams DJ, Harbison JA, Murphy S, Collins R, McCabe DJ, Crowe M, Horgan NF. Falls-Related EvEnts in the first year after StrokE in Ireland: Results of the multi-centre prospective FREESE cohort study. Eur Stroke J 2019; 3:246-253. [PMID: 31008355 DOI: 10.1177/2396987318764961] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 02/19/2018] [Indexed: 11/16/2022] Open
Abstract
Introduction Falls are common post-stroke adverse events. This study aimed to describe the first-year falls incidence, circumstances and consequences among persons discharged home after stroke in Ireland, and to examine the association between potential risk factors and recurrent falls. Patients and methods Patients with acute stroke and planned home-discharge were recruited consecutively from five hospitals. Variables recorded pre-discharge included: age, stroke severity, co-morbidities, fall history, prescribed medications, hemi-neglect, cognition and functional independence (Barthel index). Falls were recorded with monthly diaries, and 6 and 12-month interviews. The association of pre-discharge factors with recurrent falls (>1 fall) was examined using univariable logistic regression. Results A total of 128 participants (mean age = 68.6, SD = 13.3) were recruited; 110 completed the 12-month follow-up. The first-year falls incidence was 44.5% (95% CI = 35.1-53.6) with 25.6% falling repeatedly (95% CI = 18.5-34.4). Fallers experienced 1-18 falls (median = 2) and five reported fractures; 47% of fallers experienced at least one fall outdoors. Only 10% of recurrent fallers had bone health medication prescribed at discharge. Lower Barthel index scores (<75/100, RR = 4.38, 1.64-11.72) and psychotropic medication prescription (RR = 2.10, 1.13-3.91) were associated with recurrent falls. Discussion This study presents prospectively collected information about falls circumstances. It was not powered for multivariable analysis of risk factors. Conclusion One-quarter of stroke survivors discharged to the community fall repeatedly and mostly indoors in the first year. Specific attention may be required for individuals with poor functional independence or those on psychotropic medication. Future falls-management research in this population should explore falls in younger individuals, outdoor as well as indoor falls and post-stroke bone health status.
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Affiliation(s)
- Mary E Walsh
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland.,HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Rose Galvin
- Department of Clinical Therapies, Faculty of Education and Health Sciences, Health Research Institute, University of Limerick, Ireland
| | - David Jp Williams
- School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Geriatric and Stroke Medicine, Beaumont Hospital, Dublin, Ireland
| | - Joseph A Harbison
- Department of Medicine for the Elderly, St James's Hospital, Dublin, Ireland.,Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Sean Murphy
- School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Medicine for the Older Person and Stroke Service, Mater Misericordiae University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Ronan Collins
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland.,Department of Age-related Healthcare, The Adelaide and Meath Hospital incorporating the National Children's Hospital, Dublin, Ireland
| | - Dominick Jh McCabe
- Department of Neurology, Vascular Neurology Research Foundation and Stroke Service, The Adelaide and Meath Hospital incorporating the National Children's Hospital, Dublin, Ireland.,Department of Clinical Neurosciences, Royal Free Campus, UCL Institute of Neurology, London, UK.,Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Morgan Crowe
- Department of Medicine for the Elderly, St Vincent's University Hospital, Dublin 4, Ireland
| | - N Frances Horgan
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
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Major MJ. Fall Prevalence and Contributors to the Likelihood of Falling in Persons With Upper Limb Loss. Phys Ther 2019; 99:377-387. [PMID: 30561742 PMCID: PMC6684228 DOI: 10.1093/ptj/pzy156] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 10/20/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Arms are important for locomotor stability and preventing falls by controlling whole-body angular momentum, redirecting the body's center of mass, and providing support to arrest descent. Hence, upper limb loss (ULL) can increase fall risk. However, the prevalence of falls and factors that influence fall risk have not previously been reported for people with ULL. OBJECTIVE This study quantified fall prevalence in persons with ULL at or proximal to the wrist and identified clinical factors that contributed to the likelihood of falling. DESIGN This was a cross-sectional study. METHODS Factors including body and health characteristics, activity level, fall history, prosthesis use, and balance confidence were determined for persons with ULL proximal to the wrist using an online survey. Logistic regression analyses assessed the contribution of these factors to the classification of fallers (≥2 falls in previous year) and nonfallers. RESULTS A percentage (28.6%) of participants (n = 105) reported experiencing 2 or more falls in the past year. The regression model (R2 = 0.473) correctly classified 84.5% of cases and indicated that increased likelihood of falling was significantly influenced by reduced balance confidence, use of upper limb prostheses, and reduced physical capabilities. LIMITATIONS Data were collected online from a convenience sample, and fall classification was based on retrospective data. CONCLUSIONS Falls in persons with ULL are prevalent, suggesting that clinicians should use screening methods to identify at-risk individuals. Balance confidence, use of upper limb prostheses, and perceived physical capabilities could be useful screening metrics. Research is warranted to better understand the factors that underlie fall risk in persons with ULL and the efficacy of therapeutic interventions capable of mitigating fall risk.
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Affiliation(s)
- Matthew J Major
- Department of Physical Medicine and Rehabilitation, Northwestern University, 680 N Lake Shore Dr, Suite 1100, Chicago, IL 60611 (USA); and Jesse Brown VA Medical Center, Chicago, Illinois
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Bower K, Thilarajah S, Pua YH, Williams G, Tan D, Mentiplay B, Denehy L, Clark R. Dynamic balance and instrumented gait variables are independent predictors of falls following stroke. J Neuroeng Rehabil 2019; 16:3. [PMID: 30612584 PMCID: PMC6322221 DOI: 10.1186/s12984-018-0478-4] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 12/19/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Falls are common following stroke and are frequently related to deficits in balance and mobility. This study aimed to investigate the predictive strength of gait and balance variables for evaluating post-stroke falls risk over 12 months following rehabilitation discharge. METHODS A prospective cohort study was undertaken in inpatient rehabilitation centres based in Australia and Singapore. A consecutive sample of 81 individuals (mean age 63 years; median 24 days post stroke) were assessed within one week prior to discharge. In addition to comfortable gait speed over six metres (6mWT), a depth-sensing camera (Kinect) was used to obtain fast-paced gait speed, stride length, cadence, step width, step length asymmetry, gait speed variability, and mediolateral and vertical pelvic displacement. Balance variables were the step test, timed up and go (TUG), dual-task TUG, and Wii Balance Board-derived centre of pressure velocity during static standing. Falls data were collected using monthly calendars. RESULTS Over 12 months, 28% of individuals fell at least once. The faller group had increased TUG time and reduced stride length, gait speed variability, mediolateral and vertical pelvic displacement, and step test scores (P < 0.001-0.048). Significant predictors, when adjusted for country, prior falls and assistance (i.e., physical assistance and/or gait aid use) were stride length, step length asymmetry, mediolateral pelvic displacement, step test and TUG scores (P < 0.040; IQR-odds ratio(OR) = 1.37-7.85). With comfortable gait speed as an additional covariate, to determine the additive benefit over standard clinical assessment, only mediolateral pelvic displacement, TUG and step test scores remained significant (P = 0.001-0.018; IQR-OR = 5.28-10.29). CONCLUSIONS Reduced displacement of the pelvis in the mediolateral direction during walking was the strongest predictor of post-stroke falls compared with other gait variables. Dynamic balance measures, such as the TUG and step test, may better predict falls than gait speed or static balance measures.
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Affiliation(s)
- Kelly Bower
- Department of Physiotherapy, The University of Melbourne, Parkville, VIC, 3010, Australia.
| | - Shamala Thilarajah
- School of Health and Sport Sciences, University of the Sunshine Coast, Queensland, Sippy Downs, 4556, Australia.,Department of Physiotherapy, Singapore General Hospital, Bukit Merah, Singapore, 169608, Singapore
| | - Yong-Hao Pua
- Department of Physiotherapy, Singapore General Hospital, Bukit Merah, Singapore, 169608, Singapore
| | - Gavin Williams
- Department of Physiotherapy, The University of Melbourne, Parkville, VIC, 3010, Australia.,Department of Physiotherapy, Epworth HealthCare, Richmond, VIC, 3121, Australia
| | - Dawn Tan
- Department of Physiotherapy, Singapore General Hospital, Bukit Merah, Singapore, 169608, Singapore
| | - Benjamin Mentiplay
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, VIC, 3086, Australia.,Victorian Infant Brain Studies, Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia
| | - Linda Denehy
- Department of Physiotherapy, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Ross Clark
- School of Health and Sport Sciences, University of the Sunshine Coast, Queensland, Sippy Downs, 4556, Australia
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Samuelsson CM, Hansson PO, Persson CU. Early prediction of falls after stroke: a 12-month follow-up of 490 patients in The Fall Study of Gothenburg (FallsGOT). Clin Rehabil 2018; 33:773-783. [PMID: 30569752 DOI: 10.1177/0269215518819701] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE: To identify the incidence of falls and factors present shortly after stroke, which are associated with the occurrence of falls over the first 12 months after stroke onset, following discharge from inpatient rehabilitation. DESIGN: Prospective follow-up study. SETTING: Stroke unit and outpatient department. SUBJECTS: A total of 490 individuals with acute stroke. METHODS: Postural control was assessed using the Swedish modified version of the Postural Assessment Scale for Stroke Patients. Data on self-reported falls were collected using a standardized questionnaire at three months after discharge and six and 12 months after stroke onset. Associations between characteristics during the acute phase after a stroke and falls after six and 12 months were investigated using univariable and multivariable regression analyses. MAIN MEASURES: The endpoint was a self-reported fall. RESULTS: Within three months after discharge, 38 of 165 respondents (23%) had experienced at least one fall. Within six and 12 months after stroke onset, respectively, 108 of 376 (29%) and 140 of 348 (40%) of the respondents had experienced at least one fall. Poor postural control (odds ratio 3.92, 95% confidence interval 2.07-7.45, P < 0.0001) and using a walking aid (odds ratio 2.84, 95% confidence interval 1.71-4.72, P < 0.0001) were predictors of falls after discharge within 12 months after stroke onset. The same variables were independent predictors of falls within six months. CONCLUSION: Poor postural control and using a walking aid in the acute phase after a stroke are associated with falls after discharge from a stroke unit within 12 months after stroke onset.
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Affiliation(s)
- Carina M Samuelsson
- 1 Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Per-Olof Hansson
- 2 Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Carina U Persson
- 3 Rehabilitation Medicine, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Zou L, Yeung A, Li C, Chiou SY, Zeng N, Tzeng HM, Wang L, Ren Z, Dean T, Thomas GA. Effects of Mind⁻Body Movements on Balance Function in Stroke Survivors: A Meta-Analysis of Randomized Controlled Trials. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:1292. [PMID: 29925770 PMCID: PMC6025433 DOI: 10.3390/ijerph15061292] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 06/15/2018] [Accepted: 06/17/2018] [Indexed: 11/18/2022]
Abstract
Objective: We performed a systematic review with meta-analysis and meta-regression to determine if mind⁻body movements (MBM) could be effective in rehabilitating balance function among stroke survivors. Methods: A literature search was conducted using major Chinese and English electronic databases from an inception until January 2018. Randomized controlled studies were included in our meta-analysis. Data was independently extracted by two review authors using a pre-developed table and confirmed by a third party to reach a consensus. Pooled effect size (Hedge’s g) was computed while the random-effect model was set. Results: The meta-analytic results showed a significant benefit of the MBM intervention on increased balance function compared to the control groups (Hedge’s g = 1.59, CI 0.98 to 2.19, p < 0.001, I² = 94.95%). Additionally, the meta-regression indicated that the total number of sessions (β = 0.00142, 95% CI 0.0039 to 0.0244, p = 0.0067) and dose of weekly training (β = 0.00776, 95% CI 0.00579 to 0.00972, p = 0.00) had significantly positive effects on balance function. Conclusions: The study encouraging findings indicate the rehabilitative effect of a MBM intervention for balance function in stroke survivors. However, there were significant limitations in the design among several of the included trials. Additional studies with more robust methodologies are needed to provide a more definitive conclusion.
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Affiliation(s)
- Liye Zou
- Department of Physical Education, Wuhan University of Technology, Wuhan 430070, China.
- Department of Sports Science and Physical Education, the Chinese University of Hong Kong, Shatin, Hong Kong, China.
| | - Albert Yeung
- Depression Clinical and Research Program, Harvard Medical School, Harvard University, Boston, MA 02114, USA.
| | - Chunxiao Li
- Department of Health and Physical Education, The Education University of Hong Kong, Tai Po, Hong Kong, China.
| | - Shin-Yi Chiou
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 2TT, UK.
| | - Nan Zeng
- School of Kinesiology, University of Minnesota-Twin Cities, Minneapolis, MN 55455, USA.
| | - Huey-Ming Tzeng
- College of Nursing, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK S7N 2Z4, Canada.
| | - Lin Wang
- Department of Physical Education, Wuhan University of Technology, Wuhan 430070, China.
| | - Zhanbing Ren
- Department of Physical Education, Shenzhen University, Shenzhen 518060, China.
| | - Taquesha Dean
- Depression Clinical and Research Program, Harvard Medical School, Harvard University, Boston, MA 02114, USA.
| | - Garrett Anthony Thomas
- Depression Clinical and Research Program, Harvard Medical School, Harvard University, Boston, MA 02114, USA.
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Roos MA, Reisman DS, Hicks G, Rose W, Rudolph KS. Development of the Modified Four Square Step Test and its reliability and validity in people with stroke. ACTA ACUST UNITED AC 2018; 53:403-12. [PMID: 27271003 DOI: 10.1682/jrrd.2014.04.0112] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 09/23/2015] [Indexed: 11/05/2022]
Abstract
Adults with stroke have difficulty avoiding obstacles when walking, especially when a time constraint is imposed. The Four Square Step Test (FSST) evaluates dynamic balance by requiring individuals to step over canes in multiple directions while being timed, but many people with stroke are unable to complete it. The purposes of this study were to (1) modify the FSST by replacing the canes with tape so that more persons with stroke could successfully complete the test and (2) examine the reliability and validity of the modified version. Fifty-five subjects completed the Modified FSST (mFSST) by stepping over tape in all four directions while being timed. The mFSST resulted in significantly greater numbers of subjects completing the test than the FSST (39/55 [71%] and 33/55 [60%], respectively) (p < 0.04). The test-retest, intrarater, and interrater reliability of the mFSST were excellent (intraclass correlation coefficient ranges: 0.81-0.99). Construct and concurrent validity of the mFSST were also established. The minimal detectable change was 6.73 s. The mFSST, an ideal measure of dynamic balance, can identify progress in people with stroke in varied settings and can be completed by a wide range of people with stroke in approximately 5 min with the use of minimal equipment (tape, stop watch).
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Affiliation(s)
- Margaret A Roos
- Department of Physical Therapy, University of the Sciences in Philadelphia, Philadelphia, PA
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Foster EJ, Barlas RS, Bettencourt-Silva JH, Clark AB, Metcalf AK, Bowles KM, Potter JF, Myint PK. Long-Term Factors Associated With Falls and Fractures Poststroke. Front Neurol 2018; 9:210. [PMID: 29666603 PMCID: PMC5891595 DOI: 10.3389/fneur.2018.00210] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 03/16/2018] [Indexed: 12/21/2022] Open
Abstract
Background Risk factors for poststroke falls and fractures remain poorly understood. This study aimed to evaluate which factors increased risk of these events after stroke. Methods Data from 7,267 hospitalized stroke patients were acquired from the Norfolk and Norwich University Hospital Stroke Register from 2003–2015. The impacts of multiple patient level and stroke characteristics and comorbidities on post-discharge falls and fractures were assessed. Univariate and multivariable models were constructed, adjusting for multiple confounders, using binary logistic regression for short-term analysis (up to 1-year post-discharge) and Cox-proportional hazard models for longer term analysis (1–3, 3–5, and 0–10 years follow-up). Results The mean age (SD) was 76.3 ± 12.1 years at baseline. 1,138 (15.7%) participants had an incident fall; and 666 (9.2%) an incident fracture during the 10-year follow-up (total person years = 64,447.99 for falls and 67,726.70 for fractures). Half of the sample population were females (50.6%) and the majority had an ischemic stroke (89.8%). After adjusting for confounders: age, sex, previous history of falls, and atrial fibrillation were associated with an increased risk of both falls and fractures during follow-up. Furthermore, chronic kidney disease and hyperlipidemia were associated with an increased risk of falls, while previous stroke/transient ischemic attack increased fracture risk. Total anterior circulation stroke and a prestroke modified Rankin Scale score of 3–5 were associated with decreased risk of both events, with hypertension and cancer decreasing risk of falls only. Conclusion We identified demographic, stroke-related, and comorbid factors associated with poststroke falls and fracture incidence. Further studies are required to examine and establish the relationship between reversible factors and further explore the role of preventative measures to prevent poststroke falls and fractures.
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Affiliation(s)
- Emma J Foster
- Ageing Clinical and Experimental Research (ACER) Team, School of Medicine, Medical Sciences & Nutrition, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Raphae S Barlas
- Ageing Clinical and Experimental Research (ACER) Team, School of Medicine, Medical Sciences & Nutrition, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Joao H Bettencourt-Silva
- Norfolk and Norwich University Hospital, Norwich, United Kingdom.,Norwich Cardiovascular Research Group, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
| | - Allan B Clark
- Norwich Cardiovascular Research Group, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
| | - Anthony K Metcalf
- Norfolk and Norwich University Hospital, Norwich, United Kingdom.,Norwich Cardiovascular Research Group, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
| | - Kristian M Bowles
- Norfolk and Norwich University Hospital, Norwich, United Kingdom.,Norwich Cardiovascular Research Group, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
| | - John F Potter
- Norfolk and Norwich University Hospital, Norwich, United Kingdom.,Norwich Cardiovascular Research Group, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
| | - Phyo K Myint
- Ageing Clinical and Experimental Research (ACER) Team, School of Medicine, Medical Sciences & Nutrition, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom.,Norwich Cardiovascular Research Group, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
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50
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Prediction of Falls in Subjects Suffering From Parkinson Disease, Multiple Sclerosis, and Stroke. Arch Phys Med Rehabil 2018; 99:641-651. [PMID: 29102438 DOI: 10.1016/j.apmr.2017.10.009] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 09/26/2017] [Accepted: 10/05/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To compare the risk of falls and fall predictors in patients with Parkinson disease (PD), multiple sclerosis (MS), and stroke using the same study design. DESIGN Multicenter prospective cohort study. SETTING Institutions for physical therapy and rehabilitation. PARTICIPANTS Patients (N=299) with PD (n=94), MS (n=111), and stroke (n=94) seen for rehabilitation. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Functional scales were applied to investigate balance, disability, daily performance, self-confidence with balance, and social integration. Patients were followed for 6 months. Telephone interviews were organized at 2, 4, and 6 months to record falls and fall-related injuries. Incidence ratios, Kaplan-Meier survival curves, and Cox proportional hazards models were used. RESULTS Of the 299 patients enrolled, 259 had complete follow-up. One hundred and twenty-two patients (47.1%) fell at least once; 82 (31.7%) were recurrent fallers and 44 (17.0%) suffered injuries; and 16%, 32%, and 40% fell at 2, 4, and 6 months. Risk of falls was associated with disease type (PD, MS, and stroke in decreasing order) and confidence with balance (Activities-specific Balance Confidence [ABC] scale). Recurrent fallers were 7%, 15%, and 24% at 2, 4, and 6 months. The risk of recurrent falls was associated with disease type, high educational level, and ABC score. Injured fallers were 3%, 8%, and 12% at 2, 4, and 6 months. The only predictor of falls with injuries was disease type (PD). CONCLUSIONS PD, MS, and stroke carry a high risk of falls. Other predictors include perceived balance confidence and high educational level.
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