Pinto Elen Beatriz, Nascimento Carla, Monteiro Maiana, Castro Mayra, Maso Iara, Campos Adriana, Marinho Camila, Barreto-Neto Nestor J, Lopes Antônio A, Jesus Pedro A P, Oliveira-Filho Jamary
Stroke Clinic of the Federal University of Bahia, Brazil; Department of Physical Therapy, Bahia School of Medicine and Public Health, Brazil; Ambulatório de Doenças Cerebrovasculares, Hospital Universitário Prof. Edgard Santos-HUPES, Salvador, Brazil.
Stroke Clinic of the Federal University of Bahia, Brazil; Department of Physical Therapy, Bahia School of Medicine and Public Health, Brazil; Ambulatório de Doenças Cerebrovasculares, Hospital Universitário Prof. Edgard Santos-HUPES, Salvador, Brazil.
J Stroke Cerebrovasc Dis. 2016 Nov;25(11):2619-2626. doi: 10.1016/j.jstrokecerebrovasdis.2016.06.045. Epub 2016 Jul 27.
This study aimed to determine risk factors related to the occurrence of falls in stroke patients and to propose a new predictive scale for falls.
Demographic and clinical data were collected and the following scales were applied: Barthel Index, Timed Up and Go Test (TUG), and National Institutes of Health Stroke Scale (NIHSS). Subjects were followed prospectively for 2 years for the occurrence of recurrent (≥2) falls. Kaplan-Meier curves were constructed and univariable associations were tested using log-rank test. Two separate multivariable models were then used: the first used Cox proportional hazards regression and the second used Poisson regression. In each model, significant associations were considered present with a P value less than .05.
We evaluated 150 individuals and the final analysis included 131 patients; the average age of the patients was 55.8 ± 13 years, 52% were women, and the median NIHSS score was 2 (interquartile range = 1-5). Falls occurred in 17% of patients, with a median of 23 months of follow-up (interquartile range = 16-26 months). In the multivariable Cox regression model, only TUG quartile, female gender, and posterior circulation territory involvement remained significant predictors of recurrent falls. We used the predictors from the Cox regression model to propose a new recurrent fall risk scale. The area under the receiver operating characteristic curve was 73%, 95% confidence interval = 62%-83%, P = .001, with 81.3% sensitivity and 41.8% specificity.
The new predictive scale for recurrent risk (including TUG, posterior circulation territory involvement, and female gender) is presented as an instrument for monitoring the risk of recurrent falls.
本研究旨在确定与中风患者跌倒发生相关的危险因素，并提出一种新的跌倒预测量表。
收集人口统计学和临床数据，并应用以下量表：巴氏指数、定时起立行走测试（TUG）和美国国立卫生研究院卒中量表（NIHSS）。对受试者进行前瞻性随访2年，观察复发性（≥2次）跌倒的发生情况。构建Kaplan-Meier曲线，并使用对数秩检验检验单变量关联。然后使用两个单独的多变量模型：第一个使用Cox比例风险回归，第二个使用泊松回归。在每个模型中，P值小于0.05被认为存在显著关联。
我们评估了150名个体，最终分析纳入131名患者；患者的平均年龄为55.8±13岁，52%为女性，NIHSS评分中位数为2（四分位间距=1-5）。17%的患者发生跌倒，中位随访时间为23个月（四分位间距=16-26个月）。在多变量Cox回归模型中，只有TUG四分位数、女性性别和后循环区域受累仍然是复发性跌倒的显著预测因素。我们使用Cox回归模型中的预测因素提出了一种新的复发性跌倒风险量表。受试者工作特征曲线下面积为73%，95%置信区间=62%-83%，P=0.001，敏感性为81.3%，特异性为41.8%。
提出了新的复发性风险预测量表（包括TUG、后循环区域受累和女性性别），作为监测复发性跌倒风险的工具。
