Falls in community-dwelling stroke survivors: an accumulated impairments model.

Published

Journal Article

UNLABELLED: Falling has been identified as a major complication in persons who have had a stroke. The purpose of this study was to investigate the effect of accumulated impairments on the risk of falling in community-dwelling stroke survivors. METHODS: Community-dwelling stroke survivors were identified from the Kansas City Stroke Study, a large cohort study of stroke survivors. We evaluated the subjects within 14 days of stroke onset. Impairments were determined at baseline and were defined as motor = Fugl-Meyer lower-limb score > 28, sensory = sensory score on National Institutes of Health (NIH) Stroke Scale > 0, and visual = hemianopsia score on NIH Stroke Scale > 0. Accumulated impairments were characterized as motor only (n = 101), motor + sensory (n = 88), and motor + sensory + visual (n = 47). The reference group did not possess motor, sensory, or visual impairments. We completed follow-ups at 1 month, 3 months, and 6 months poststroke to determine the fall status of the subjects. RESULTS: Two hundred eighty subjects were included. Falls were reported by 142 subjects (51%) between 1 month and 6 months poststroke. Univariate analysis revealed that the risk of falling for subjects with motor impairment only was odds ratio (OR) = 2.2 (95% confidence interval [CI] 1.05 to 4.70), motor + sensory impairments OR = 3.1 (95% CI 1.46 to 6.79), and motor + sensory + visual impairments OR = 2.4 (95% CI 1.05 to 5.83) as compared to the group with no motor, sensory, and visual impairments. In multiple logistic regression, the risk of falling increased with motor impairment only and motor + sensory impairments. However, the motor + sensory + visual impairments group had a lower risk of falling. Secondary analysis revealed a significant difference in mobility scores (Orpington Prognostic Scale-balance) among individuals with motor impairment only, motor + sensory impairments, motor + sensory + visual impairments, and the reference group. This lower risk of falling in stroke survivors with motor + sensory + visual impairments may be explained by more involved strokes, more impaired balance, and subsequently less mobility, therefore, lowering their risk of falling. In conclusion, community-dwelling persons who have had a stroke are at a higher risk of falling. However, the risk of falling is not linearly related to the number of impairments. Individuals with motor, sensory, and visual impairments are less mobile and less likely to fall than those individuals with motor deficits only or motor and sensory deficits.

Full Text

Cited Authors

  • Yates, JS; Lai, SM; Duncan, PW; Studenski, S

Published Date

  • May 2002

Published In

Volume / Issue

  • 39 / 3

Start / End Page

  • 385 - 394

PubMed ID

  • 12173758

Pubmed Central ID

  • 12173758

Electronic International Standard Serial Number (EISSN)

  • 1938-1352

International Standard Serial Number (ISSN)

  • 0748-7711

Language

  • eng