Department of Physical Medicine and Rehabilitation, Ankara Physical Medicine and Rehabilitation Education and Research Hospital, Ankara, Turkey.
Arch Phys Med Rehabil. 2012 Dec;93(12):2244-50. doi: 10.1016/j.apmr.2012.06.014. Epub 2012 Jun 26.
OBJECTIVE: To determine predictors of falls in stroke patients in the first 6 months after a baseline evaluation before their discharge from inpatient rehabilitation. DESIGN: Prospective cohort study. SETTING: Rehabilitation hospital, then home. PARTICIPANTS: Consecutive stroke patients (N=66) were followed at home after discharge from the rehabilitation hospital. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Fall occurrence within 6 months after a baseline evaluation. All patients were assessed for baseline data during their inpatient rehabilitation (1.5±1.2 wk before discharge). Data regarding cerebrovascular accident (CVA) date, number of attacks, and brain imaging results were obtained; motor function and balance impairment were examined by the Fugl-Meyer Assessment Scale. The FIM and Functional Ambulation Category were also used. Presence of urinary incontinence, drug use, fall history, postural hypotension, neglect, cognitive status, poor vision, and hearing were evaluated. Six months after the baseline evaluation, any fall occurrence was ascertained via telephone calls to the caregivers of each patient. Multivariate logistic regression analysis was used to identify risk factors. RESULTS: The mean age ± SD was 64±10 years. The median time elapsed since CVA at the time of admission was 4 months. Twenty-four (36%) patients fell within the 6-month period. The fall rate was significantly higher in patients with left (47%) versus right (21%) hemispheric stroke. Left hemispheric lesion (vs right) showed a 4 times greater risk of fall within 6 months (odds ratio=4.093; 95% confidence interval, 1.082-15.482). There were no other significant differences between fallers and nonfallers with respect to the other evaluated factors. CONCLUSIONS: Our results suggest that the fall risk within 6 months after a baseline evaluation is greater in patients with left hemispheric lesions versus those with right hemispheric lesions.
目的:确定基线评估后住院康复出院前 6 个月内脑卒中患者跌倒的预测因素。
设计:前瞻性队列研究。
地点:康复医院,然后是家庭。
参与者:连续的脑卒中患者(N=66)在从康复医院出院后在家中接受随访。
干预措施:不适用。
主要观察指标:基线评估后 6 个月内跌倒发生情况。所有患者在住院康复期间(出院前 1.5±1.2 周)都进行了基线数据评估。获取了关于脑血管意外(CVA)日期、发作次数和脑影像学结果的数据;采用 Fugl-Meyer 评估量表检查运动功能和平衡障碍。还使用了 FIM 和功能性步行分类。评估了尿失禁、药物使用、跌倒史、体位性低血压、忽视、认知状态、视力不佳和听力不佳的情况。在基线评估后 6 个月,通过电话向每位患者的护理人员确定是否发生任何跌倒。采用多变量逻辑回归分析识别危险因素。
结果:平均年龄±标准差为 64±10 岁。入院时距 CVA 的中位时间为 4 个月。24 名(36%)患者在 6 个月内跌倒。左侧(47%)半球性脑卒中患者的跌倒率明显高于右侧(21%)半球性脑卒中患者。左侧半球病变(与右侧相比)在 6 个月内跌倒的风险增加了 4 倍(优势比=4.093;95%置信区间,1.082-15.482)。在其他评估因素方面,跌倒组与非跌倒组之间没有其他显著差异。
结论:我们的结果表明,在基线评估后 6 个月内,左侧半球病变患者的跌倒风险大于右侧半球病变患者。
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