Post-Stroke Patients with Moderate Function Have the Greatest Risk of Falls: A National Cohort Study

Abstract

Background Stroke patients have increased risks of falls. We examined national registry data to evaluate the association between post-stroke functional level and the risk of low falls among post-stroke patients. Methods This retrospective cohort study analyzed data from national registries to examine the risk factors for post-stroke falls. Data for patients who suffered ischemic strokes and survived the index hospital admission was obtained from the Singapore National Stroke Registry and matched to the National Trauma Registry, from 2011 to 2015. The primary outcome measure was a low fall (fall height ≤0.5m). Competing risk analysis was performed to examine the association between functional level (by modified Rankin score [mRS] at discharge) and the risk of subsequent low falls. Results In all, 2,255 patients who suffered ischemic strokes had recorded mRS. The mean age was 66.6 years and 58.5% were men. By the end of 2015, 54 (2.39%) had a low fall while 93 (4.12%) died. After adjusting for potential confounders, mRS was associated with fall risk with an inverted U-shaped relationship. Compared to patients with a score of zero, the sub-distribution hazard ratio (SHR) increased to a maximum of 3.42 (95%CI:1.21-9.65, p=0.020) for patients with a score of 2. The SHR then declined to 2.45 (95%CI:0.85-7.12, p=0.098), 2.86 (95%CI:0.95-8.61, p=0.062) and 1.93 (95%CI:0.44-8.52, p=0.38) for patients with scores of 3, 4 and 5 respectively. Conclusions An inverted U-shaped relationship between functional status and fall risk was observed. This is consistent with the complex interplay between decreasing mobility (hence decreased opportunity to fall) and increasing susceptibility to falls. Fall prevention intervention could be targeted accordingly.

Cumulative Risk And Associated Factors For Fall-Related Fractures In Stroke Survivors After Discharge From Rehabilitation Wards: A Retrospective Study With A 6-Year Follow-Up

“…Similarly, individuals with intermediate stroke severity, as defined by the National Institutes of Health Stroke Scale, had the highest risk of fractures (20). Furthermore, previous studies have reported that moderately severe disability in individuals with stroke is associated with a risk of falling (21,28,29). Therefore, our findings are consistent with previous reports of an inverted U-shaped relationship between impairment/disability and the risk of fractures.…”

“…Thus, mobile individuals with limb weakness might have a greater risk of fall-related fractures. Although the effects of motor paresis severity have not been specifically assessed in previous studies, the current findings are supported by previous studies that have reported that moderate impairments (20,22) and disabilities (21,28,29) are related to an increased risk of falling. A moderate initial stroke severity, defined using the Canadian Neurological Scale, has been associated with subsequent fracture risk in stroke survivors (22).…”

Fall assessment in subacute inpatient stroke rehabilitation using clinical characteristics and the most preferred stroke severity and outcome measures

“…In the present population, mRS and the ICF minimal generic data set with strong activity/mobility weighting showed the same pattern of occurrence of incidents mostly in the midrange. In a recent study in community dwelling post-stroke patients, a similar inverted U-shaped relationship between functional status rated with mRS and fall risk was observed [77].…”

Changes in kinesiostabilogram parameters and movement speed of stroke patients while increasing their physical activity due to the use of biofeedback method

“…33 A number of works show the relationship between the equilibrium function and the fall after a stroke. [34][35][36] Also important is the change in position of the body balance in space. Thus, people who had a stroke showed a greater displacement of the pelvis in walking compared with healthy ones.…”