Ageing Work and Health Research Group, Faculty of Health Sciences, The University of Sydney, Sydney, Australia; Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore.
Ageing Work and Health Research Group, Faculty of Health Sciences, The University of Sydney, Sydney, Australia.
Arch Phys Med Rehabil. 2018 Mar;99(3):563-573.e5. doi: 10.1016/j.apmr.2017.06.032. Epub 2017 Aug 7.
To identify the risk factors for falls in community stroke survivors.
A comprehensive search for articles indexed in MEDLINE, Embase, CINAHL, PsycINFO, Cochrane Library, and Web of Science databases was conducted.
Prospective studies investigating fall risk factors in community stroke survivors were included. Reviewers in pair independently screened the articles and determined inclusion through consensus. Studies meeting acceptable quality rating using the Q-Coh tool were included in the meta-analysis.
Data extraction was done in duplicate by 4 reviewers using a standardized data extraction sheet and confirmed by another independent reviewer for completeness and accuracy.
Twenty-one articles met the minimum criteria for inclusion; risk factors investigated by ≥3 studies (n=16) were included in the meta-analysis. The following risk factors had a strong association with all fallers: impaired mobility (odds ratio [OR], 4.36; 95% confidence interval [CI], 2.68-7.10); reduced balance (OR, 3.87; 95% CI, 2.39-6.26); use of sedative or psychotropic medications (OR, 3.19; 95% CI, 1.36-7.48); disability in self-care (OR, 2.30; 95% CI, 1.51-3.49); depression (OR, 2.11; 95% CI, 1.18-3.75); cognitive impairment (OR, 1.75; 95% CI, 1.02-2.99); and history of fall (OR, 1.67; 95% CI, 1.03-2.72). A history of fall (OR, 4.19; 95% CI, 2.05-7.01) had a stronger association with recurrent fallers.
This study confirms that balance and mobility problems, assisted self-care, taking sedative or psychotropic medications, cognitive impairment, depression, and history of falling are associated with falls in community stroke survivors. We recommend that any future research into fall prevention programs should consider addressing these modifiable risk factors. Because the risk factors for falls in community stroke survivors are multifactorial, interventions should be multidimensional.
确定社区中风幸存者跌倒的风险因素。
对 MEDLINE、Embase、CINAHL、PsycINFO、Cochrane 图书馆和 Web of Science 数据库中索引的文章进行了全面检索。
纳入了调查社区中风幸存者跌倒风险因素的前瞻性研究。两位审稿人独立筛选文章，并通过共识确定纳入标准。使用 Q-Coh 工具进行了可接受质量评估的研究被纳入荟萃分析。
四名审稿人使用标准化数据提取表重复进行数据提取，并由另一名独立审稿人进行完整性和准确性确认。
有 21 篇文章符合纳入标准的最低要求；纳入了≥3 项研究（n=16）调查的风险因素进行荟萃分析。以下风险因素与所有跌倒者密切相关：行动不便（比值比[OR]，4.36；95%置信区间[CI]，2.68-7.10）；平衡能力下降（OR，3.87；95% CI，2.39-6.26）；使用镇静或精神药物（OR，3.19；95% CI，1.36-7.48）；自理能力受损（OR，2.30；95% CI，1.51-3.49）；抑郁（OR，2.11；95% CI，1.18-3.75）；认知障碍（OR，1.75；95% CI，1.02-2.99）；以及跌倒史（OR，1.67；95% CI，1.03-2.72）。跌倒史（OR，4.19；95% CI，2.05-7.01）与复发性跌倒者的相关性更强。
本研究证实，平衡和行动问题、辅助自理、使用镇静或精神药物、认知障碍、抑郁和跌倒史与社区中风幸存者的跌倒有关。我们建议，任何未来的跌倒预防计划研究都应考虑解决这些可改变的风险因素。由于社区中风幸存者跌倒的风险因素是多因素的，干预措施应该是多维度的。
