Validation of two risk-prediction models for recurrent falls in the first year after stroke: a prospective cohort study

Abstract

Key Points:• Accurate identification of stroke patients at risk of falling is important for planning rehabilitation services on discharge• Two previously derived risk-prediction models for recurrent falls post-stroke have performed poorly in this validation study• A further large prospective cohort study is required to derive a useful falls-risk prediction model for this population• Future derivation studies should conduct internal validation and adhere to TRIPOD guidelines to facilitate external validation 3 AbstractBackground: Several multivariable models have been derived to predict post-stroke falls. These require validation before integration into clinical practice. The aim of this study was to externally validate two prediction models for recurrent falls in the first year post-stroke using an Irish prospective cohort study.Methodology: Stroke patients with planned home-discharges from five hospitals were recruited. Falls were recorded with monthly diaries and interviews six and 12 months post-discharge. Predictors for falls included in two risk-prediction models were assessed at discharge. Participants were classified into risk-groups using these models. Model 1, incorporating inpatient falls-history and balance, had a six-month outcome. Model 2, incorporating inpatient near-falls history and upper limb function, had a twelve-month outcome. Measures of calibration, discrimination (area under the curve (AUC)) and clinical utility (sensitivity/ specificity) were calculated.Results: 128 participants (mean age=68.6 years, SD=13.3) were recruited. The fall status of 117 and 110 participants was available at six and 12 months respectively.Seventeen and 28 participants experienced recurrent falls by these respective time- Conclusions: Both models showed poor discrimination for predicting recurrent falls.A further large prospective cohort study would be required to derive a clinicallyuseful falls-risk prediction model for a similar population.

Hearing loss, gait and balance impairments and falls among individuals with sub-acute stroke: A comparative cross-sectional study

“…As stated earlier, auditory dysfunction compromises spatial and environmental awareness [ 15 , [17] , [18] , [19] , 38 ], and this may contribute to fall occurrence in stroke. Among other factors, balance and gait dysfunctions are independent predictors of falls in individuals with stroke [ [7] , [8] , [9] , 12 , 13 , 45 ], thus, it can be implied that balance and gait problems occasioned by auditory dysfunction after a stroke event may increase the risk of fall occurrence among patients with stroke.…”

“…Stroke patients with episodes of falls often present with poor clinical and psychosocial outcomes compared to patients with no such experience [ 7 , 9 ]. Among other factors, falls in stroke is often precipitated and perpetuated by a lack or inability to maintain balance, and poor gait parameters [ [7] , [8] , [9] , 12 , 13 ].…”

Risk factors for falling for people with Multiple Sclerosis identified in a prospective cohort study

“…29 A model for stroke involving upper limb function and a history of near falls demonstrated a sensitivity of 60%, specificity of 70% and an area under the receiving operating curve statistic of 0.69. 30 However, an external validation study examining the latter model and a second model involving falls history and balance assessment demonstrated poor discriminative ability for both models with area under the receiving operating curve statistic values of 0.55 and 0.56 respectively, 31 confirming the need to externally validate any proposed model.…”

The experience of recurrent fallers in the first year after stroke

“…Falls-risk assessment is recommended to facilitate post-stroke falls-prevention [3]. Quantitative research aiming to predict post-stroke falls has been unsuccessful to date and some researchers suggest that all individuals with residual stroke deficits should be considered at increased risk of falling [4,5]. Interventions that have been shown to reduce falls in older community-dwelling adults have shown minimal effectiveness at reducing post-stroke falls [6].…”