An Analysis of Falls Occurring in Patients with Stroke on an Acute Rehabilitation Unit

Horgan

J Epidemiol Community Health

et al. 2016

What this study adds?This review identifies risk prediction models for falls after stroke that require validation and impact measurement. It will facilitate future researchers in the appropriate measurement of prognostic factors for model validation, a key step in the development process of models that can be incorporated into clinical decisionmaking post stroke. 4 ABSTRACTBackground: Falls are a significant cause of morbidity after stroke. The aim of this

Section: Resultsmentioning

confidence: 99%

“…Within the inpatient setting, the majority of studies focused on the occurrence or timing of the first fall 21–23 25. With shorter follow-up time periods in this setting, it may have been difficult to account for multiple fall events.…”

Section: Discussionmentioning

confidence: 99%

Systematic review of risk prediction models for falls after stroke

Horgan

J Epidemiol Community Health

et al. 2016

J NeuroEngineering Rehabil

“…The consequences of stroke often include impaired postural control [1]. Several clinical scales and tests are used to assess postural control.…”

Section: Introductionmentioning

confidence: 99%

Responsiveness of a modified version of the postural assessment scale for stroke patients and longitudinal change in postural control after stroke- Postural Stroke Study in Gothenburg (POSTGOT) -

Persson

Sunnerhagen

Danielsson

et al. 2013

BackgroundResponsiveness data certify that a change in a measurement output represents a real change, not a measurement error or biological variability. The objective was to evaluate the responsiveness of the modified version of the Postural Assessment Scale for Stroke Patients (SwePASS) in patients with a first event of stroke. An additional aim was to estimate the change in postural control during the first 12 months after stroke onset.MethodsThe SwePASS assessments were conducted during the first week and 3, 6 and 12 months after stroke in 90 patients. Svensson’s method, Relative Position (RP), Relative Concentration (RC) and Relative Rank Variance (RV), were used to estimate the scale’s responsiveness and the patients’ change in postural control over time.ResultsFrom the first week to 3 months after stroke, the patients improved in terms of postural control with 2 to 12 times larger systematic changes in Relative Position (RP), for which 9 items and the total score showed a significant responsiveness to change when compared to the intrarater reliability measurement error of the SwePASS reported in a previous study. When SwePASS was used to assess change in postural control between the first week and 3 months, 74% of the patients received higher scores while 10% received lower scores, RP 0.31 (95% CI 0.219-0.402). The corresponding figures between 3 and 6 and between 6 and 12 months were 37% and 16%, RP 0.09 (95% CI 0.030-0.152), and 18% and 26%, RP −0.07 (95% CI −0.134- (−0.010)), respectively.ConclusionsThe SwePASS is responsive to change. Postural control evaluated using the SwePASS showed an improvement during the first 6 months after stroke. The measurement property, in the form of responsiveness, shows that the SwePASS scoring method can be considered for use in rehabilitation when assessing postural control in patients after stroke, especially during the first 3 months.

“…Our study proposes considering turning strategies according to the side of the hemiparesis as new indicators to evaluate the risk of fall after stroke. The question of the importance of this aspect among other well-known risk factors [balance impairment (2–4, 43, 54) with sensitive deficits, motor deficits, and hemineglect (1, 55–57)] is of interest for future study. The spontaneous choice of turning and the number of external steps taken do not require the use of IMUs in daily clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Observational Study of 180° Turning Strategies Using Inertial Measurement Units and Fall Risk in Poststroke Hemiparetic Patients

et al. 2017

ObjectiveWe analyzed spontaneous 180° turning strategies in poststroke hemiparetic patients by using inertial measurement units (IMUs) and the association of turning strategies with risk of falls.MethodsWe included right paretic (RP) and left paretic (LP) post-stroke patients, and healthy controls (HCs) from a physical and rehabilitation department in France between July 2015 and October 2015. All subjects were right-handed and right-footed for mobilization tasks. Participants were instructed to turn 180° in a self-selected direction after a 10-m walk while wearing three IMUs on their trunk and both feet. We defined three turning patterns based on the number of external steps (pattern I = 1; II = 2–4 steps; and III ≥ 5) and four turning strategies based on the side chosen to turn (healthy or paretic) and the stance limb used during the first step of the turn (healthy or paretic). Falls in the 6 months after measurement were investigated.ResultsWe included 17 RP [mean (SD) age 57.5 (9.5) years (range 43–73)], 20 LP patients [mean age 60.7 (8.8) years (range 43–63)], and 15 HCs [mean age 56.7 (16.1) years (range 36–83)]. The LP and RP groups behaved similarly in turning patterns, but 90% of LP patients turned spontaneously to the paretic side versus 59% of RP patients. This difference increased with turning strategies: 85% of LP versus 29% of RP patients used strategy 4 (paretic turn side with paretic limb). Patients using strategy 4 had the highest rate of falls.ConclusionWe propose to consider spontaneous turning strategies as new indicators to evaluate the risk of fall after stroke. IMU could be routinely used to identify this risk and guide balance rehabilitation programs.