Pang M Y C, Eng J J
Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hung Hom, Hong Kong, China.
Osteoporos Int. 2008 Jul;19(7):919-27. doi: 10.1007/s00198-007-0519-5. Epub 2007 Dec 21.
Chronic stroke survivors with low hip bone density are particularly prone to fractures. This study shows that fear of falling is independently associated with falls in this population. Thus, fear of falling should not be overlooked in the prevention of fragility fractures in these patients.
Chronic stroke survivors with low bone mineral density (BMD) are particularly prone to fragility fractures. The purpose of this study was to identify the determinants of balance, mobility and falls in this sub-group of stroke patients.
Thirty-nine chronic stroke survivors with low hip BMD (T-score <-1.0) were studied. Each subject was evaluated for the following: balance, mobility, leg muscle strength, spasticity, and fall-related self-efficacy. Any falls in the past 12 months were also recorded. Multiple regression analysis was used to identify the determinants of balance and mobility performance, whereas logistic regression was used to identify the determinants of falls.
Multiple regression analysis revealed that after adjusting for basic demographics, fall-related self-efficacy remained independently associated with balance/mobility performance (R2 = 0.494, P < 0.001). Logistic regression showed that fall-related self-efficacy, but not balance and mobility performance, was a significant determinant of falls (odds ratio: 0.18, P = 0.04).
Fall-related self-efficacy, but not mobility and balance performance, was the most important determinant of accidental falls. This psychological factor should not be overlooked in the prevention of fragility fractures among chronic stroke survivors with low hip BMD.
髋部骨密度低的慢性卒中幸存者特别容易发生骨折。本研究表明，害怕跌倒与该人群的跌倒独立相关。因此，在预防这些患者的脆性骨折时，不应忽视害怕跌倒这一因素。
骨矿物质密度（BMD）低的慢性卒中幸存者特别容易发生脆性骨折。本研究的目的是确定这一亚组卒中患者平衡、活动能力和跌倒的决定因素。
对39名髋部BMD低（T值<-1.0）的慢性卒中幸存者进行了研究。对每个受试者进行以下评估：平衡、活动能力、腿部肌肉力量、痉挛以及与跌倒相关的自我效能感。还记录了过去12个月内的任何跌倒情况。采用多元回归分析确定平衡和活动能力表现的决定因素，而采用逻辑回归确定跌倒的决定因素。
多元回归分析显示，在调整基本人口统计学因素后，与跌倒相关的自我效能感仍与平衡/活动能力表现独立相关（R2 = 0.494，P < 0.001）。逻辑回归表明，与跌倒相关的自我效能感而非平衡和活动能力表现是跌倒的重要决定因素（优势比：0.18，P = 0.04）。
与跌倒相关的自我效能感而非活动能力和平衡表现是意外跌倒的最重要决定因素。在预防髋部BMD低的慢性卒中幸存者的脆性骨折时，不应忽视这一心理因素。
