gms | German Medical Science

7th EFSMA – European Congress of Sports Medicine, 3rd Central European Congress of Physical Medicine and Rehabilitation, Annual Assembly of the German and the Austrian Society of Physical Medicine and Rehabilitation

Austrian Society of Physical Medicine and Rehabilitation

26.-29.10.2011, Salzburg, Österreich

Association between falls and balance in stroke patients:attempt to predict falls using the Berg Balance Scal

Meeting Abstract

Suche in Medline nach

  • corresponding author presenting/speaker Noriaki Maeda - Hiroshima University, Faculty of Medicine, Division of Physical Therapy, Hiroshima, Japan
  • author presenting/speaker Junichi Kato - Hyogo Rehabilitation Center at Nishi-Harima, Department of Internal Medicine, Tatsuno, Japan
  • author presenting/speaker Keisuke Itotani - Hyogo Rehabilitation Center at Nishi-Harima, Department of Physical Therapy, Tatsuno, Japan
  • author presenting/speaker Yukio Urabe - Hiroshima University, Faculty of Medicine, Division of Physical Therapy, Hiroshima, Japan

7th EFSMA – European Congress of Sports Medicine, 3rd Central European Congress of Physical Medicine and Rehabilitation. Salzburg, 26.-29.10.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. Doc11esm034

DOI: 10.3205/11esm034, URN: urn:nbn:de:0183-11esm0349

Veröffentlicht: 24. Oktober 2011

© 2011 Maeda et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: A high risk of falling after stroke has been reported, both during hospital stay and after patients have been discharged [1], [2]. In order to assist with fall prevention, it is necessary to identify the risk factors for falling and subsequently to take counter-measures against these. Many of the methods that are used by medical institutions to identify patients at risk of falling are, however, based on personal experience, subjective observations and mental evaluations, and there have been only a few reports that have focused on specific investigational methods, standardized judgment criteria for fall prediction and the establishment of an evaluation index [3]. The objective of this study was to identify risk factors for falling in hemiplegic stroke patients so as to develop a predictive model.

Material/Methods: In total, 72 stroke patients (42 males, 30 females; age 67.6±10.3 years) were included in the study. All falls were reported by medical staff using a dedicated fall report and this formed the basis on which the subjects were allocated into either a faller (occasional and repeat) or non-faller group. The following were extracted from the inpatients’ hospital records: occurrence of falls during hospital stay; age; gender; stroke type; time from stroke onset; length of hospital stay (LOS); the affected side of the body (right, left or bilateral); FIM on admission and discharge; BBS on admission; and MMSE. The relationships between falls and these patient characteristics were investigated. Fallers and non-fallers were compared to detect mean differences between the two groups for continuous variables using a Student’s t-test and the χ2 test. The variables that achieved statistical significance were then included in a multivariate logistic regression analysis. Pearson correlation coefficients were calculated to determine the strength of the relationships between variables. Sensitivity and specificity in predicting fall status were calculated. The ability to predict the outcome of falling in stroke patients was assessed by the area under the receiver operating characteristic (ROC) curve. Statistical evaluation of the data was carried out using the SPSS® statistical package (SPSS Inc., Chicago, IL, USA) for Windows®. A P-value of <0.05 was considered to be statistically significant with the exception of the entry probability for logistic analysis.

Results: The characteristics of the stroke patients and statistical comparisons between the faller and non-faller groups are shown in Table 1 [Tab. 1]. Age and LOS were significantly higher in the faller group compared with the non-faller group, while significantly lower values were recorded in the faller group compared with the non-faller group for time from stroke onset, total FIM on admission and discharge, BBS on admission and MMSE The Pearson correlation coefficients for the variables (Table 2 [Tab. 2]) show a strong correlation between BBS on admission and total and motor FIM on admission and discharge Age, time from stroke onset, LOS, cognitive FIM on admission and discharge, BBS on admission, and MMSE were subjected to logistic regression analysis using the occurrence of falls as a dependent variable. To prevent multicollinearity, the strongly correlated total and motor FIM on admission and discharge were excluded, and the factor selected was BBS on admission. Based on the calculated OR, BBS on admission was found to be significantly related to falls (Table 2 [Tab. 2]). The ROC curve analysis (Figure 1 [Fig. 1]) showed that BBS on admission best differentiated subjects who had fallen from those who had not fallen at a threshold score of 29 points (sensitivity 80%; specificity 78%) and area under the curve of 0.81.

Conclusion: The numerical presentation of predicted fall risk and the establishment of a practical index for use in clinical practice were investigated in stroke patients. With stroke patients in the convalescence to maintenance stage, balance on admission was closely related to the risk of falling.


References

1.
Forster A, Young J. Incidence and consequences of falls due to stroke: a systematic inquiry. BMJ. 1995;311:83-6.
2.
Davenport RJ, Dennis MS, Wellwood I, et al. Complications after acute stroke. Stroke. 1996;27:415-20.
3.
Hyndman D, Ashburn A, Stack E. Fall events among people with stroke living in the community: circumstances of falls and characteristics of fallers. Arch Phys Med Rehabil. 2002;83:165-70.