Faculty of Physical Therapy, Mahidol University, Salaya, Nakhon Pathom, Thailand.
Institute for Population and Social Research, Mahidol University, Salaya, Nakhon Pathom, Thailand.
PLoS One. 2020 Apr 10;15(4):e0231491. doi: 10.1371/journal.pone.0231491. eCollection 2020.
To use structural equation model (SEM) to explain falls at home in individuals with chronic stroke, based on the International Classification of Functioning, Disability and Health (ICF).
A cross sectional observation study was conducted in home-dwelling individuals with chronic stroke (N = 236; 148 non-fallers, 88 fallers). Participants were assessed; structural impairments using Modified Ashworth Scale, Fugl-Meyer Assessment upper (FMA-UE), lower (FMA-LE), and sensory function, ankle plantarflexor strength; activity limitations using Timed Up and Go Test, Step Test, Berg Balance Scale, Barthel Index (BI); participation restrictions using Stroke Impact Scale-participation (SIS-P); and contextual factors using home hazard environments, home safety surroundings, risk behaviors, and Fall-related Self Efficacy. The measurement model was analyzed by confirmatory factor analysis. The SEM was conducted to analyze a structural model of falls at home.
FMA-UE was significantly (p<0.01) associated with FMA-LE, combining as one variable in the structural impairments. In the measurement model, variables were fit to their domains, except variables of contextual factors, but the ICF domains did not correspond to disability. A structural model of falls at home demonstrated a significant (p<0.01) direct path of contextual factors and activity limitations with falls at home. The structural impairments showed a significant (p<0.01) direct path with activity limitations. All variables, except BI, SIS-P and risk behaviors, related to their domains in the structural model.
A structural model of falls at home proposes contextual factors being the strongest association with falls at home that home hazard environments seem the most influence in its domain. The activity limitations presented by balance ability are directed to falls at home. The structural impairments are associated with falls at home through activity limitations. Home assessment to decrease home hazard environments is suggested to prevent falls at home for individuals with chronic stroke.
基于国际功能、残疾和健康分类（ICF），使用结构方程模型（SEM）解释慢性脑卒中患者的居家跌倒。
本研究为横断面观察性研究，共纳入 236 名居家慢性脑卒中患者（148 名非跌倒者，88 名跌倒者）。评估患者结构损伤情况（采用改良 Ashworth 量表）、上肢 Fugl-Meyer 评估（FMA-UE）、下肢 Fugl-Meyer 评估（FMA-LE）和感觉功能、踝关节跖屈肌力量；活动受限情况（采用计时起立行走测试、台阶测试、伯格平衡量表、Barthel 指数（BI））；参与受限情况（采用脑卒中影响量表-参与部分（SIS-P））；以及环境因素（居家环境危险度、居家安全环境、风险行为和跌倒相关自我效能）。采用验证性因子分析对测量模型进行分析。进行 SEM 分析以构建居家跌倒的结构模型。
FMA-UE 与 FMA-LE 显著相关（p<0.01），将两者结合作为结构损伤的一个变量。在测量模型中，除环境因素变量外，各变量均符合其所属领域，但 ICF 领域与残疾程度不对应。居家跌倒的结构模型显示，环境因素和活动受限与居家跌倒有显著（p<0.01）的直接关联。结构损伤与活动受限有显著（p<0.01）的直接关联。除 BI、SIS-P 和风险行为外，结构模型中的所有变量均与其所属领域相关。
居家跌倒的结构模型表明，环境因素是与居家跌倒最密切相关的因素，居家环境危险度似乎在其领域中影响最大。平衡能力所表现出的活动受限直接导致居家跌倒。结构损伤通过活动受限与居家跌倒相关。建议对居家环境进行评估以减少居家环境危险度，从而预防慢性脑卒中患者的居家跌倒。
