Risk Factors for Falling in Home-Dwelling Older Women With Stroke The Women’s Health and Aging Study

Coventry University, Coventry, England, United Kingdom
Stroke (Impact Factor: 5.72). 03/2003; 34(2):494-501. DOI: 10.1161/01.STR.0000053444.00582.B7
Source: PubMed

ABSTRACT Much of our knowledge of risk factors for falls comes from studies of the general population. The aim of this study was to estimate the risk of falling associated with commonly accepted and stroke-specific factors in a home-dwelling stroke population.
This study included an analysis of prospective fall reports in 124 women with confirmed stroke over 1 year. Variables relating to physical and mental health, history of falls, stroke symptoms, self-reported difficulties in activities of daily living, and physical performance tests were collected during home assessments.
Risk factors for falling commonly reported in the general population, including performance tests of balance, incontinence, previous falls, and sedative/hypnotic medications, did not predict falls in multivariate analyses. Frequent balance problems while dressing were the strongest risk factor for falls (odds ratio, 7.0). Residual balance, dizziness, or spinning stroke symptoms were also a strong risk factor for falling (odds ratio, 5.2). Residual motor symptoms were not associated with an increased risk of falling.
Interventions to reduce the frequency of balance problems during complex tasks may play a significant role in reducing falls in stroke. Clinicians should be aware of the increased risk of falling in women with residual balance, dizziness, or spinning stroke symptoms and recognize that risk assessments developed for use in the general population may not be appropriate for stroke patients.

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Available from: Linda P Fried, Mar 08, 2015
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    • "Stroke Research and Treatment to be high, ranging between 23–34%, 40–73%, and 43–70% during a 3-4 month [7] [16], 6-month [17] [18], and 1-year follow-up [19] [20], respectively. Most falls are reported to result from a trip, a slip, or a misplaced step while walking [17, 21–24] and walking is also the most frequently reported activity (39%–90%) at the time of a fall in stroke survivors [7] [17] [25] [26], suggesting the reduced ability of individuals with stroke to adjust walking to task and environmental demands. "
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    ABSTRACT: Control of walking has been described by a tripartite model consisting of stepping, equilibrium, and adaptability. This review focuses on walking adaptability, which is defined as the ability to modify walking to meet task goals and environmental demands. Walking adaptability is crucial to safe ambulation in the home and community environments and is often severely compromised after a stroke. Yet quantification of walking adaptability after stroke has received relatively little attention in the clinical setting. The objectives of this review were to examine the conceptual challenges for clinical measurement of walking adaptability and summarize the current state of clinical assessment for walking adaptability. We created nine domains of walking adaptability from dimensions of community mobility to address the conceptual challenges in measurement and reviewed performance-based clinical assessments of walking to determine if the assessments measure walking adaptability in these domains. Our literature review suggests the lack of a comprehensive well-tested clinical assessment tool for measuring walking adaptability. Accordingly, recommendations for the development of a comprehensive clinical assessment of walking adaptability after stroke have been presented. Such a clinical assessment will be essential for gauging recovery of walking adaptability with rehabilitation and for motivating novel strategies to enhance recovery of walking adaptability after stroke.
    Stroke Research and Treatment 08/2014; 2014. DOI:10.1155/2014/591013
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    • "Another possible explanation for this is that TUG test requires stepping and turning activity which involves shifting the centre of gravity that in turn challenges balance performance, especially in stroke survivors. Functional balance performance was reported as a significant predictor of falling [31] and patients who experienced at least one fall showed significantly lower scores on BBS [32]. Therefore, it can be concluded that functional balance is an essential domain that may influence successful turning while walking with dual-task conditions for individuals with stroke. "
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    ABSTRACT: The aim of this study was to determine whether stroke survivor's gait performance during dual-task Timed Up and Go (TUG) test is correlated with the level of functional balance and motor impairment. Thirty stroke survivors (22 men, 8 women) were recruited for this study. The level of functional balance (Berg Balance Scale) and motor impairment (Fugl-Meyer assessment lower extremity) were assessed prior to the TUG test. TUG test was conducted under three attentional loading conditions (single, dual motor, and dual-cognitive). The time and number of steps were used to quantify gait parameters. The Spearmen's rank correlation coefficient was used to evaluate the relationship between these variables. There was moderate to strong negative correlation between functional balance and gait parameters (range -0.53 to -0.73, P < 0.05). There was a weak negative correlation observed between the time taken to complete the single task and motor impairment (r s = -0.43; P = 0.02) dual motor task and motor impairment (r s = -0.41; P = 0.02). However, there were no significant correlations between lower limb motor impairment and the number of steps in all conditions. These findings suggest that functional balance may be an influential domain of successful dual-task TUG in stroke.
    Stroke Research and Treatment 03/2014; 2014:439304. DOI:10.1155/2014/439304
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    • "Over 70% of stroke survivors fall within six months of discharge from hospital [7], and nearly 50% of community-dwelling female stroke survivors continue to fall each year [8]. Gait and balance problems have been found to be important factors underlying this increased falls risk in this group [8] [9]. Effective strategies to prevent falls and minimise strokerelated disability are essential to provide quality-of-life benefits and minimise spiralling health costs. "
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    ABSTRACT: Aim. To investigate predictors of adherence to group-based exercise and physical activity participation among stroke survivors. Methods. 76 stroke survivors participated (mean age 66.7 years). Adherence was the percentage of classes attended over one year. Physical activity was the average pedometer steps/day measured over seven days at the end of the trial. Possible predictors included baseline measures of demographics, health, quality of life, falls, fear of falling, cognition, and physical functioning. Results. Mean class attendance was 60% (SD 29%). Only one variable (slow choice stepping reaction time) was an independent predictor of higher class attendance, explaining 5% of the variance. Participants completed an average of 4,365 steps/day (SD 3350). Those with better physical functioning (choice stepping reaction time, postural sway, maximal balance range, 10-m walk, or 6-min walk) or better quality of life (SF-12 score) took more steps. A model including SF-12, maximal balance range, and 6-min walk accounted for 33% of the variance in average steps/day. Conclusions. The results suggest that better physical functioning and health status are predictors of average steps taken per day in stroke survivors and that predicting adherence to group exercise in this group is difficult.
    Stroke Research and Treatment 01/2012; 2012(2):136525. DOI:10.1155/2012/136525
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