Early prediction of falls after stroke: a 12-month follow-up of 490 patients in The Fall Study of Gothenburg (FallsGOT)

Samuelsson, Carina M; Hansson, Per‐Olof; Persson, Carina U

doi:10.1177/0269215518819701

Cited by 31 publications

(51 citation statements)

References 31 publications

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“…It has been shown that the risk for falls is high during all stages post stroke (27). However, most falls occur during the first months after stroke onset (50). In order to reduce the number of falls, it is important to identify persons at risk as early as possible after stroke onset.…”

Section: Risk Factors For Fallsmentioning

confidence: 99%

“…Other tests assess the attentional and proactive gait control-demanding task of negotiating and crossing obstacles while walking (79,(84)(85)(86), but these tests cannot be performed when walking aids are used. Since persons with stroke commonly use walking aids (50), it is important to develop reliable and valid assessments of obstacle avoidance for persons with stroke (87) and to assess the predictive value for future falls of such tests. To fill this gap, HS and colleagues developed the Cone Evasion Walk test (CEW) (88).…”

Section: Obstacle Avoidance and Attention During Gait Activitiesmentioning

confidence: 99%

“…Including both is relevant due to the decisive impact on the total risk for falls of these components. In previous studies investigating how factors collected in the acute phase of stroke can predict falls after discharge (Table 1) (50)(51)(52)(53)(54)(55)(56)(57)(58)(59) this was not done. Moreover, it is valuable if assessments used for screening of fall risk are rapid and easy to administer in clinical practice (47).…”

Section: Rationale Of the Thesismentioning

confidence: 99%

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Assessments and Risk Factors for Falls in Persons with Acute Stroke

Sjöholm

2021

Linköping University Medical Dissertations

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Background: Early identification of risk factors is crucial for reducing the high fall risk associated with stroke, and sex differences in relation to falls need to be further investigated. There is a lack of uniform, standardized, and reliable testing procedures for postural reactions, and existing tests assessing negotiating obstacles while walking cannot be performed when walking aids are used. Aim:To investigate the predictive validity of fall risk in persons with acute stroke for easily administered data and assessments, as well as to investigate the psychometric properties of two new tests. Methods:The Postural Rections Test (PRT) and the Cone Evasion Walk Test (CEW) were developed based on literature, and on input from an expert panel. To estimate the reliability of the PRT and CEW, videorecordings of 20 persons with acute stroke performing each item in the PRT and CEW were assessed by 10 physiotherapists on two occasions, at least two weeks apart. The construct validity of the CEW (n = 221), was examined in relation to selected corresponding tests, and predictive validity by correlating the CEW to falls within six months. In 124 women and 160 men the results from the PRT and CEW, along with other easily administered data and assessments on participant characteristics, functions, and activities were analyzed in relation to the number of days to the first fall by Cox regression, while fall incidence was analyzed by negative binomial regression, both for the total cohort, and for women and men separately. Sex differences in monthly fall incidence were analyzed with Poisson regression.Results: For the intra-rater reliability of the PRT, the overall proportion of agreement was 87 − 92% for the different postural reactions, and in median 9-10 out of 10 physiotherapists scored the same value for interrater reliability. In the CEW the intra-class correlation coefficients for intra-rater and inter-rater reliability were 0.88-0.98. The results showed expected poor to moderate correlations to the selected tests for construct validity, and to falls within six months. Participants touched significantly more cones on the side that was opposite to the side of their lesion. The Cox regression analysis showed that intake of more than eight medications, paresis in the arms, paresis in the legs, impaired protective reactions in sitting, and limitations in self-care activities were decisive risk factors for the time to the first fall, and according to the negative Abstract 2 binomial regression, limitations in mobility activities was a decisive risk factor for high fall incidence in the total cohort (p<0.0005). The assessor's judgment of a person's six-month fall risk, was particularly well suited for identification of individuals with a high risk for multiple falls; however only in women when analyzed for each sex separately (p<0.0005). Compared to men, a higher number of fall risk factors were identified in women, including impaired mental functions, paresis in the arms, and limitations in several activities of self-care a...

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Section: Risk Factors For Fallsmentioning

confidence: 99%

Section: Obstacle Avoidance and Attention During Gait Activitiesmentioning

confidence: 99%

Section: Rationale Of the Thesismentioning

confidence: 99%

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Assessments and Risk Factors for Falls in Persons with Acute Stroke

Sjöholm

2021

Linköping University Medical Dissertations

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“…Falls are common in stroke survivors, with reported incidences between 26% to 73% within 6‐12 months after discharge from hospital 1‐3 and 23% to 48% of community dwelling older people who fall within a 1‐year period after acute hospitalization 3‐6 . Falls on inpatient stroke rehabilitation units are also common, 5‐9 with 15% to 37% of patients experiencing a fall during their inpatient stay 10,11 …”

Section: Introductionmentioning

confidence: 99%

Predicting Falls Using the Stroke Assessment of Fall Risk Tool

Yang

Ghaedi

Campbell

et al. 2020

PM&R

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Background Falls in the inpatient stroke population are common, resulting in increased morbidity and slow rehabilitation progress. Falls may result from stroke‐specific neurologic deficits; however, assessment of these deficits is lacking in many fall screening tools. Objective To compare the ability to predict falls of the Stroke Assessment of Fall Risk (SAFR) tool, which includes items related to stroke‐specific neurologic deficits, and the commonly used Morse Fall Scale, which does not include these items. Design Prospective cohort study. Setting Inpatient tertiary stroke rehabilitation unit. Participants Patients (N = 220) with acute stroke. Main Outcome Measures Falls were captured by the medical records from January 2017 to September 2018. Logistic regression analysis evaluated both screening tools for predicting falls by calculating sensitivity, specificity, area under the receiver operating characteristic (AUC‐ROC) curve, and odds ratio (OR). We compared SAFR and Morse mean scores between fallers and non‐fallers using t‐tests. Results Forty‐eight (21.8%) patients experienced ≥1 fall. SAFR, but not Morse, scores showed a statistically significant difference between fallers and non‐fallers (P = .001 vs P = .24, respectively). Higher SAFR score was associated with higher odds of falls (OR 1.36, 95% CI [1.12, 1.64]), whereas Morse was not (OR 1.04, 95% CI [0.97, 1.12]). SAFR showed a statistically significant difference in hemi‐neglect between fallers and non‐fallers (P = .03). Sensitivity and specificity of SAFR were 47.9% and 76.7%, vs 45.8% and 68.0% for Morse, respectively. SAFR positive predictive value and negative predictive value were 36.5% and 84.1%, respectively, similar to Morse (28.6% and 81.8%). The AUC‐ROC was 0.65 for SAFR and 0.56 for Morse. Conclusions SAFR was significantly associated with fall risk and had better discrimination between fallers and non‐fallers than Morse. The neurologic‐specific hemi‐neglect component of SAFR, a component not present on the Morse, was a fall risk factor. Further research evaluating the predictive value of fall scales that include neurologic deficits is needed.

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“…3 Approximately 25% to 46% of all patients in stroke rehabilitation wards have been reported to fall at least once during their stay. [4][5][6] Alarmingly, 75% of deaths in the age group of 65þ in the USA are caused by falls, 2 thus concerning 13% of the country's population. In different regions including Europe, USA, and Australia, between 0.9% and 1.5% of the total health care expenditures of each region are related to fall.…”

Section: Introductionmentioning

confidence: 99%

Automated fall risk assessment of elderly using wearable devices

Haescher

Chodan

Höpfner

et al. 2020

Journal of Rehabilitation and Assistive Technologies Engineerin

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Introduction Falls cause major expenses in the healthcare sector. We investigate the ability of supporting a fall risk assessment by introducing algorithms for automated assessments of standardized fall risk-related tests via wearable devices. Methods In a study, 13 participants conducted the standardized 6-Minutes Walk Test, the Timed-Up-and-Go Test, the 30-Second Sit-to-Stand Test, and the 4-Stage Balance Test repeatedly, producing 226 tests in total. Automated algorithms computed by wearable devices, as well as a visual analysis of the recorded data streams, were compared to the observational results conducted by physiotherapists. Results There was a high congruence between automated assessments and the ground truth for all four test types (ranging from 78.15% to 96.55%), with deviations ranging all well within one standard deviation of the ground truth. Fall risk (assessed by questionnaire) correlated with the individual tests. Conclusions The automated fall risk assessment using wearable devices and algorithms matches the validity of the ground truth, thus providing a resourceful alternative to the effortful observational assessment, while minimizing the risk of human error. No single test can predict overall fall risk; instead, a much more complex model with additional input parameters (e.g., fall history, medication etc.) is needed.

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Early prediction of falls after stroke: a 12-month follow-up of 490 patients in The Fall Study of Gothenburg (FallsGOT)

Cited by 31 publications

References 31 publications

Assessments and Risk Factors for Falls in Persons with Acute Stroke

Assessments and Risk Factors for Falls in Persons with Acute Stroke

Predicting Falls Using the Stroke Assessment of Fall Risk Tool

Automated fall risk assessment of elderly using wearable devices

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