Comparative Predictive Validity of Fall-Risk Screening Assessments in Subacute Stroke.

Poststroke fall prevention is hindered by inaccurate prediction of imminent fallers. We compared the predictive validity of the Berg Balance Scale (BBS), Functional Gait Assessment (FGA), 10-m gait speed, and a novel, step test + obstacle test (STOB) in subacute stroke.A total of 64 ambulatory stroke survivors discharging home from inpatient rehabilitation completed all tests before discharge. Falls were tracked prospectively for 3 months. Logistic regression estimated the odds of being a faller with a failed test. Sensitivity, specificity, likelihood ratios, area under the curve, accuracy, and posttest probabilities for classifying fall status for each test were calculated using existing and optimized cutoffs.Twenty participants (31.3%) were fallers at 3 months. STOB had the best overall model fit with odds ratio 8.0 (95% CI 2.4-26.8). FGA ≤13 had the highest sensitivity of all tests (0.85), and gait speed ≤0.47 m/s had the highest specificity (0.89). A combination of positive tests for 10-m gait speed (≤0.47 m/s), STOB (≥3), FGA (≤13), and BBS (≤43) generated a cumulative diagnostic posttest probability of future falls of 94.5%.No single test emerged with strong discriminative power for predicting future falls at discharge from inpatient rehabilitation for stroke, but a combination of gait speed, STOB, and FGA may enhance prognostic decision-making accuracy.

Duke Scholars

Author Jody Ann Feld Orthopaedic Surgery, Physical Therapy