Post-stroke patients with moderate function have the greatest risk of falls: a National Cohort Study

Abstract

BackgroundStroke 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.MethodsThis 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 ≤ 0.5 m). 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.ResultsIn all, 2255 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.ConclusionsAn 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.(263 words)

The Effect of Robotic Assisted Gait Training With Lokomat® on Balance Control After Stroke: Systematic Review and Meta-Analysis

“…Balance is an essential component of the quality of walking (2)(3)(4), and in stroke survivors, balance impairment may determine abnormal patterns of gait characterized by decreased walking speed and stride length and spatial and temporal asymmetry (5)(6)(7)(8)(9) that in turn increase the risk of falling (10)(11)(12)(13)(14). Because balance and gait disorders may persist also in the chronic stage (15), they represent one of the main limiting factors for individual independence and participation in social activities, reducing patients' quality of life (16)(17)(18).…”

Assessing the risk for falls among Portuguese community-dwelling stroke survivors. Are we using the better tools? Observational study

“…Other authors have also found a relationship between functionality and either the risk of falling and/or the occurrence of falls, regardless of the scale used to assess functionality. 33,[36][37][38][39] The current study highlights that the estimation of the risk for falls based on the usual tools has low discrimination ability in these Portuguese community-dwelling stroke survivors with autonomous gait. However, it is important to note that in this research only factors related to mobility and balance were considered and risk factors for falls may be related to other key areas.…”

Non-pharmacological interventions for bone health after stroke: A systematic review

“…From an inversed U-shaped relationship found between fall and MRS, those with MRS ≥2 were more likely to fall than those with lower or higher functional status. This scenario can be due to the low physical activity in the lower functional status group and intact motor-sensory function in the higher functional status group [ 10 ]. Therefore, stroke survivors with underlying osteoporosis were more likely to have MRS 2 or more (poor function) and at increased risk of fall, leading to injuries and fractures.…”