Goh Hui-Ting, Nadarajah Mohanasuntharaam, Hamzah Norhamizan Binti, Varadan Parimalaganthi, Tan Maw Pin
School of Physical Therapy, Texas Woman's University, Dallas, TX 75235(∗).
Department of Rehabilitation Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia(†).
PM R. 2016 Dec;8(12):1173-1180. doi: 10.1016/j.pmrj.2016.05.012. Epub 2016 Jun 4.
Falls are common after stroke, with potentially serious consequences. Few investigations have included age-matched control participants to directly compare fall characteristics between older adults with and without stroke. Further, fear of falling, a significant psychological consequence of falls, has only been examined to a limited degree as a risk factor for future falls in a stroke population.
To compare the fall history between older adults with and without a previous stroke and to identify the determinants of falls and fear of falling in older stroke survivors.
Case-control observational study.
Primary teaching hospital.
Seventy-five patients with stroke (mean age ± standard deviation, 66 ± 7 years) and 50 age-matched control participants with no previous stroke were tested.
Fall history, fear of falling, and physical, cognitive, and psychological function were assessed. A χ test was performed to compare characteristics between groups, and logistic regression was performed to determine the risk factors for falls and fear of falling.
Fall events in the past 12 months, Fall Efficacy Scale-International, Berg Balance Scale, Functional Ambulation Category, Fatigue Severity Scale, Montreal Cognitive Assessment, and Patient Healthy Questionnaire-9 were measured for all participants. Fugl-Meyer Motor Assessment was used to quantify severity of stroke motor impairments.
Twenty-three patients and 13 control participants reported at least one fall in the past 12 months (P = .58). Nine participants with stroke had recurrent falls (≥2 falls) compared with none of the control participants (P < .01). Participants with stroke reported greater concern for falling than did nonstroke control participants (P < .01). Female gender was associated with falls in the nonstroke group, whereas falls in the stroke group were not significantly associated with any measured outcomes. Fear of falling in the stroke group was associated with functional ambulation level and balance. Functional ambulation level alone explained 22% of variance in fear of falling in the stroke group.
Compared with persons without a stroke, patients with stroke were significantly more likely to experience recurrent falls and fear of falling. Falls in patients with stroke were not explained by any of the outcome measures used, whereas fear of falling was predicted by functional ambulation level. This study has identified potentially modifiable risk factors with which to devise future prevention strategies for falls in patients with stroke.
III.
中风后跌倒很常见，可能会产生严重后果。很少有研究纳入年龄匹配的对照参与者来直接比较有中风和无中风的老年人的跌倒特征。此外，害怕跌倒作为跌倒的一个重要心理后果，在中风人群中作为未来跌倒的风险因素仅得到了有限的研究。
比较有中风史和无中风史的老年人的跌倒史，并确定老年中风幸存者跌倒和害怕跌倒的决定因素。
病例对照观察性研究。
初级教学医院。
测试了75例中风患者（平均年龄±标准差，66±7岁）和50名年龄匹配的无中风史对照参与者。
评估跌倒史、害怕跌倒以及身体、认知和心理功能。进行χ检验以比较组间特征，并进行逻辑回归以确定跌倒和害怕跌倒的风险因素。
测量所有参与者过去12个月的跌倒事件、国际跌倒效能量表、伯格平衡量表、功能性步行分类、疲劳严重程度量表、蒙特利尔认知评估和患者健康问卷-9。Fugl-Meyer运动评估用于量化中风运动障碍的严重程度。
23例患者和13名对照参与者报告在过去12个月中至少跌倒过一次（P = 0.58）。9例中风患者有反复跌倒（≥2次跌倒），而对照参与者中无一例出现反复跌倒（P < 0.01）。与无中风的对照参与者相比，中风患者报告更担心跌倒（P < 0.01）。女性与无中风组的跌倒有关，而中风组的跌倒与任何测量结果均无显著关联。中风组害怕跌倒与功能性步行水平和平衡有关。仅功能性步行水平就解释了中风组害怕跌倒差异的22%。
与无中风的人相比，中风患者反复跌倒和害怕跌倒的可能性显著更高。中风患者的跌倒无法用所使用的任何观察指标来解释，而害怕跌倒则由功能性步行水平预测。本研究确定了潜在的可改变风险因素，可据此制定未来中风患者跌倒的预防策略。
III级。
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