Butler Forslund Emelie, Jørgensen Vivien, Skavberg Roaldsen Kirsti, Hultling Claes, Wahman Kerstin, Franzén Erika
Division of Physiotherapy, Department of Neurobiology, Karolinska Institutet, Care Sciences and Society, Stockholm, Sweden.
Rehab Station Stockholm/Spinalis Research and Development Unit, Stockholm, Sweden.
Spinal Cord. 2019 Feb;57(2):91-99. doi: 10.1038/s41393-018-0175-y. Epub 2018 Jul 9.
Prediction study.
To investigate the prediction accuracy of the Downton fall risk index (DFRI) and a question of falls the previous year; further to examine the association between time to first fall and risk indicators for falls in wheelchair users and ambulatory persons with Spinal Cord Injury (SCI).
Two SCI centres in Norway and Sweden (Sunnaas Rehabilitation Hospital, Rehab Station Stockholm /Spinalis).
Two hundred and twenty-four persons with traumatic SCI, ≥1 year post-injury, ≥18 years participated. Prospective falls were reported by text messages every second week for one year. Sensitivity, specificity and time to first fall (Kaplan Meier) were investigated for DFRI and the question of falls in the previous year. DFRI ≥3 was defined as a high risk of falls. Cox survival analysis was used to calculate hazard ratios for functional independence, gait speed and fear of falling.
The sensitivity was 36-57% for DFRI and 82-89% for the question of falls, while specificity was 74-83%, and 34-49%. For DFRI, time to first fall was shorter in the high-risk group, for both wheelchair users (p = 0.005) and ambulatory persons (p = 0.006). Falls previous year increased the hazard ratio of falls for wheelchair users (HR = 3.35, 95% CI = 1.86 to 6.02) but not for ambulatory persons.
Falls in the previous year showed a better predictive accuracy than DFRI due to the low sensitivity of DFRI. As previous falls had low specificity, it still remains difficult to predict falls in those who have not fallen yet.
预测性研究。
调查唐顿跌倒风险指数（DFRI）及前一年跌倒问题的预测准确性；进一步研究脊髓损伤（SCI）的轮椅使用者和步行者首次跌倒时间与跌倒风险指标之间的关联。
挪威和瑞典的两个SCI中心（松纳斯康复医院、斯德哥尔摩康复站/脊髓中心）。
224名创伤性SCI患者参与研究，损伤后≥1年，年龄≥18岁。前瞻性跌倒情况通过短信每两周报告一次，为期一年。对DFRI及前一年跌倒问题的敏感性、特异性和首次跌倒时间（Kaplan Meier法）进行了调查。DFRI≥3被定义为高跌倒风险。采用Cox生存分析计算功能独立性、步速和跌倒恐惧的风险比。
DFRI的敏感性为36 - 57%，前一年跌倒问题的敏感性为82 - 89%，而特异性分别为74 - 83%和34 - 49%。对于DFRI，高风险组的首次跌倒时间较短，轮椅使用者（p = 0.005）和步行者（p = 0.006）均如此。前一年跌倒增加了轮椅使用者跌倒的风险比（HR = 3.35，95%CI = 1.86至6.02），但对步行者没有影响。
由于DFRI敏感性较低，前一年跌倒的预测准确性优于DFRI。由于前一年跌倒的特异性较低，对于尚未跌倒的人来说，预测跌倒仍然困难。
