Standardized Outcome Measures in Stroke Rehabilitation and Falls After Discharge: A Cohort Study

Abstract

Introduction Individuals with stroke discharged from inpatient rehabilitation units (IRUs) are at increased risk for falls. In IRUs, standardized outcome measures (SOMs) have been used to predict falls, but the results have been mixed. Objective To examine the relationship between SOMs and the risk of falls in individuals with stroke within 6 months of discharge from an IRU. Design Prospective cohort study with 6‐month follow‐up. Setting IRU that was part of a large, urban academic medical center. Participants Individuals with stroke who underwent rehabilitation. Main Outcome Measures Self‐reported falls within 6 months of discharge. Results The study included 105 participants who were discharged to their homes after inpatient rehabilitation and who responded to a 6‐month follow‐up (57% response rate) phone call. Twenty‐nine participants (28%) reported falling. Significant odds ratios (ORs), adjusted for age, sex, and stroke severity, were found for the following measures: Berg Balance Scale (OR 0.95, 95% confidence interval [CI] 0.92‐0.99), Activity Measure for Post‐Acute Care basic mobility (OR 0.89, 95% CI 0.81‐0.97), Motricity Index (OR 0.96, 95% CI 0.94‐0.98), Functional Independence Measure mobility subscale (OR 0.89, 95% CI 0.80‐0.98), and Trunk Control Test (OR 0.97, 95% CI 0.95‐0.99). Areas under the curve ranged from .64 to .71. In samples of 82 to 90 patients who could complete the tests, gait speed, the Functional Reach Test, the 6‐minute Walk Test, and Timed Up and Go did not result in significant ORs. Conclusions At discharge, SOMs were associated with the odds of falls within 6 months. The multifactorial nature of falls will continue to make prediction challenging but SOMs can be helpful. Lower extremity strength deserves more attention as a risk factor.