Jody A Feld1, Adam P Goode2, Vicki S Mercer3, Prudence Plummer4. 1. Department of Orthopaedic Surgery, Duke University School of Medicine, DUMC 104002, Durham, NC, 27710, USA. Electronic address: jody.feld@duke.edu. 2. Department of Orthopaedic Surgery, Duke University School of Medicine, DUMC 104002, Durham, NC, 27710, USA. Electronic address: adam.goode@duke.edu. 3. Department of Allied Health Sciences, University of North Carolina at Chapel Hill, CB# 7135, Bondurant Hall 3022, Chapel Hill, NC 27599, USA. Electronic address: vmercer@med.unc.edu. 4. Department of Physical Therapy, MGH Institute of Health Professions, 36 1st Avenue, Boston, MA 02129, USA. Electronic address: pplummer@mghihp.edu.
Abstract
BACKGROUND: Existing clinical assessments of balance and functional mobility have poor predictive accuracy for prospectively identifying post-stroke fallers, which may be due to a lack of ecological complexity that is typical of community-based fall incidents. RESEARCH QUESTION: Does an obstacle-crossing test at hospital discharge predict fall status of ambulatory stroke survivors 3 months after discharge? METHODS: Ambulatory stroke survivors being discharged home completed an obstacle-crossing test at hospital discharge. Falls were tracked prospectively for 3 months after discharge. Logistic regression examined the relationship between obstacle-crossing at discharge (pass/fail) and fall status (faller/non-faller) at 3 months post discharge. RESULTS: 45 participants had discharge obstacle test and 3-month fall data. 21 (47 %) participants experienced at least one fall during follow-up, with 52 % of the falls occurring within the first month after discharge. Of the 21 fallers, 14 failed the obstacle-crossing test (67 % sensitivity). Among the 24 non-fallers, 20 passed the obstacle-crossing test (83 % specificity). The area under the receiver operating characteristic curve was 0.75 (95 % CI 0.60-0.90). Individuals who failed the obstacle-crossing test were 10.00 (95 % CI: 2.45-40.78) times more likely to fall in the first 3 months after discharge. The unadjusted logistic regression model correctly classified 76 % of the subjects. After adjusting for age, sex, days post stroke, and post-stroke disability, the odds ratio remained significant at 6.93 (95 % CI: 1.01-47.52) and correctly classified 79.5% of the participants. SIGNIFICANCE: The obstacle-crossing test may be a useful discharge assessment to identify ambulatory stroke survivors being discharged home who are likely to fall in the first 3 months post discharge. Modifications to improve the obstacle-crossing test sensitivity should be explored further.
BACKGROUND: Existing clinical assessments of balance and functional mobility have poor predictive accuracy for prospectively identifying post-stroke fallers, which may be due to a lack of ecological complexity that is typical of community-based fall incidents. RESEARCH QUESTION: Does an obstacle-crossing test at hospital discharge predict fall status of ambulatory stroke survivors 3 months after discharge? METHODS: Ambulatory stroke survivors being discharged home completed an obstacle-crossing test at hospital discharge. Falls were tracked prospectively for 3 months after discharge. Logistic regression examined the relationship between obstacle-crossing at discharge (pass/fail) and fall status (faller/non-faller) at 3 months post discharge. RESULTS: 45 participants had discharge obstacle test and 3-month fall data. 21 (47 %) participants experienced at least one fall during follow-up, with 52 % of the falls occurring within the first month after discharge. Of the 21 fallers, 14 failed the obstacle-crossing test (67 % sensitivity). Among the 24 non-fallers, 20 passed the obstacle-crossing test (83 % specificity). The area under the receiver operating characteristic curve was 0.75 (95 % CI 0.60-0.90). Individuals who failed the obstacle-crossing test were 10.00 (95 % CI: 2.45-40.78) times more likely to fall in the first 3 months after discharge. The unadjusted logistic regression model correctly classified 76 % of the subjects. After adjusting for age, sex, days post stroke, and post-stroke disability, the odds ratio remained significant at 6.93 (95 % CI: 1.01-47.52) and correctly classified 79.5% of the participants. SIGNIFICANCE: The obstacle-crossing test may be a useful discharge assessment to identify ambulatory stroke survivors being discharged home who are likely to fall in the first 3 months post discharge. Modifications to improve the obstacle-crossing test sensitivity should be explored further.
Authors: Ziad S Nasreddine; Natalie A Phillips; Valérie Bédirian; Simon Charbonneau; Victor Whitehead; Isabelle Collin; Jeffrey L Cummings; Howard Chertkow Journal: J Am Geriatr Soc Date: 2005-04 Impact factor: 5.562
Authors: Shylie F Mackintosh; Keith D Hill; Karen J Dodd; Patricia A Goldie; Elsie G Culham Journal: Arch Phys Med Rehabil Date: 2006-12 Impact factor: 3.966