Huang Min H, Shilling Tracy, Miller Kara A, Smith Kristin, LaVictoire Kayle
Physical Therapy Department, School of Health Professions and Studies, University of Michigan-Flint, Flint, MI, USA.
Clin Interv Aging. 2015 Sep 18;10:1497-503. doi: 10.2147/CIA.S89067. eCollection 2015.
Older cancer survivors may be predisposed to falls because cancer-related sequelae affect virtually all body systems. The use of a history of falls, gait speed, and balance tests to assess fall risks remains to be investigated in this population. This study examined the relationship of previous falls, gait, and balance with falls in community-dwelling older cancer survivors. At the baseline, demographics, health information, and the history of falls in the past year were obtained through interviewing. Participants performed tests including gait speed, Balance Evaluation Systems Test, and short-version of Activities-specific Balance Confidence scale. Falls were tracked by mailing of monthly reports for 6 months. A "faller" was a person with ≥1 fall during follow-up. Univariate analyses, including independent sample t-tests and Fisher's exact tests, compared baseline demographics, gait speed, and balance between fallers and non-fallers. For univariate analyses, Bonferroni correction was applied for multiple comparisons. Baseline variables with P<0.15 were included in a forward logistic regression model to identify factors predictive of falls with age as covariate. Sensitivity and specificity of each predictor of falls in the model were calculated. Significance level for the regression analysis was P<0.05. During follow-up, 59% of participants had one or more falls. Baseline demographics, health information, history of falls, gaits speed, and balance tests did not differ significantly between fallers and non-fallers. Forward logistic regression revealed that a history of falls was a significant predictor of falls in the final model (odds ratio =6.81; 95% confidence interval =1.594-29.074) (P<0.05). Sensitivity and specificity for correctly identifying a faller using the positive history of falls were 74% and 69%, respectively. Current findings suggested that for community-dwelling older cancer survivors with mixed diagnoses, asking about the history of falls may help detect individuals at risk of falling.
老年癌症幸存者可能因癌症相关后遗症几乎影响身体所有系统而容易跌倒。在这一人群中，利用跌倒史、步速和平衡测试来评估跌倒风险仍有待研究。本研究调查了社区居住的老年癌症幸存者既往跌倒情况、步态和平衡与跌倒之间的关系。在基线时，通过访谈获取人口统计学信息、健康信息以及过去一年的跌倒史。参与者进行了包括步速测试、平衡评估系统测试和特定活动平衡信心量表简版测试。通过每月邮寄报告持续6个月来跟踪跌倒情况。“跌倒者”是指在随访期间跌倒≥１次的人。单因素分析，包括独立样本ｔ检验和费舍尔精确检验，比较了跌倒者和未跌倒者的基线人口统计学特征、步速和平衡情况。对于单因素分析，采用邦费罗尼校正进行多重比较。将Ｐ<0.15的基线变量纳入向前逻辑回归模型，以年龄作为协变量来识别跌倒的预测因素。计算模型中每个跌倒预测因素的敏感性和特异性。回归分析的显著性水平为Ｐ<0.05。在随访期间，59%的参与者发生了一次或多次跌倒。跌倒者和未跌倒者在基线人口统计学特征、健康信息、跌倒史、步速和平衡测试方面无显著差异。向前逻辑回归显示，跌倒史是最终模型中跌倒的显著预测因素（比值比=6.81；95%置信区间=1.594 - 29.074）（Ｐ<0.05）。使用跌倒阳性史正确识别跌倒者的敏感性和特异性分别为74%和69%。目前的研究结果表明，对于诊断多样的社区居住老年癌症幸存者，询问跌倒史可能有助于发现有跌倒风险的个体。
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