Premium
Falls and Fear of Falling After Stroke: A Case‐Control Study
Author(s) -
Goh HuiTing,
Nadarajah Mohanasuntharaam,
Hamzah Norhamizan Binti,
Varadan Parimalaganthi,
Tan Maw Pin
Publication year - 2016
Publication title -
pmandr
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.617
H-Index - 66
eISSN - 1934-1563
pISSN - 1934-1482
DOI - 10.1016/j.pmrj.2016.05.012
Subject(s) - fear of falling , stroke (engine) , medicine , balance (ability) , physical therapy , poison control , falling (accident) , logistic regression , physical medicine and rehabilitation , injury prevention , fall prevention , berg balance scale , population , psychiatry , medical emergency , mechanical engineering , environmental health , engineering
Abstract Background Falls are common after stroke, with potentially serious consequences. Few investigations have included age‐matched control participants to directly compare fall characteristics between older adults with and without stroke. Further, fear of falling, a significant psychological consequence of falls, has only been examined to a limited degree as a risk factor for future falls in a stroke population. Objective To compare the fall history between older adults with and without a previous stroke and to identify the determinants of falls and fear of falling in older stroke survivors. Design Case‐control observational study. Setting Primary teaching hospital. Participants Seventy‐five patients with stroke (mean age ± standard deviation, 66 ± 7 years) and 50 age‐matched control participants with no previous stroke were tested. Methods Fall history, fear of falling, and physical, cognitive, and psychological function were assessed. A χ 2 test was performed to compare characteristics between groups, and logistic regression was performed to determine the risk factors for falls and fear of falling. Main Outcome Measures Fall events in the past 12 months, Fall Efficacy Scale–International, Berg Balance Scale, Functional Ambulation Category, Fatigue Severity Scale, Montreal Cognitive Assessment, and Patient Healthy Questionnaire–9 were measured for all participants. Fugl‐Meyer Motor Assessment was used to quantify severity of stroke motor impairments. Results Twenty‐three patients and 13 control participants reported at least one fall in the past 12 months ( P = .58). Nine participants with stroke had recurrent falls (≥2 falls) compared with none of the control participants ( P < .01). Participants with stroke reported greater concern for falling than did nonstroke control participants ( P < .01). Female gender was associated with falls in the nonstroke group, whereas falls in the stroke group were not significantly associated with any measured outcomes. Fear of falling in the stroke group was associated with functional ambulation level and balance. Functional ambulation level alone explained 22% of variance in fear of falling in the stroke group. Conclusions Compared with persons without a stroke, patients with stroke were significantly more likely to experience recurrent falls and fear of falling. Falls in patients with stroke were not explained by any of the outcome measures used, whereas fear of falling was predicted by functional ambulation level. This study has identified potentially modifiable risk factors with which to devise future prevention strategies for falls in patients with stroke. Level of Evidence III