Department of Research and Innovation, Institut Guttmann, Institut Universitari De Neurorehabilitació Adscrit a La UAB , Barcelona, Spain.
Bellaterra (Cerdanyola Del Vallès), Universitat Autònoma De Barcelona , Spain.
Top Stroke Rehabil. 2021 Jan;28(1):52-60. doi: 10.1080/10749357.2020.1765660. Epub 2020 May 20.
: Stroke-related falls occur at especially high rates in rehabilitation settings. Inpatient-hospital falls have been identified as one of the most common medical complications after stroke, negatively influencing recovery, nevertheless, the role of cognition in relation to falls during inpatient rehabilitation is largely unexplored. . We aim to predict inpatient falls in a subacute stroke rehabilitation setting using previously reported variables such as stroke severity, gender, age, ataxia, hemiparesis, and functionality in activities of daily living, further extending them with specific cognition variables assessing memory, verbal fluency, attention, and orientation. : This observational study included 158 stroke patients admitted to a rehabilitation center between 2007 and 2019, with less than 30 days since stroke onset to admission. Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS). Four logistic regressions were performed including NIHSS, age, sex, ataxia, and hemiparesis plus one of the following: (1) Functional Independence Measure cognitive (C-FIM) and motor (M-FIM) subtests. (2) individual C-FIM items, (3) Ray Auditory Verbal Memory Test (RAVLT) and (4) verbal fluency test (PMR), Digit Span from Wechsler Adult Intelligence Scale (WAIS III), and Orientation from Test Barcelona. : Neither NIHSS, age, sex, ataxia nor hemiparesis predicted falls. C-FIM was a significant predictor (AUC:0.891), but not M-FIM. The problem solving C-FIM item (AUC:0.836), the RAVLT learning subtest (AUC:0.879), and PMR verbal fluency (AUC:0.871) were significant predictors for each model, respectively. : Cognition assessments, i.e., one FIM item, one RAVLT item, or a one-minute verbal fluency test are significant falls predictors.
卒中相关性跌倒在康复环境中发生率特别高。住院患者跌倒已被确定为卒中后最常见的医疗并发症之一，对康复产生负面影响，但认知在住院康复期间与跌倒的关系在很大程度上尚未得到探索。我们旨在使用以前报告的变量（如卒中严重程度、性别、年龄、共济失调、偏瘫和日常生活活动的功能）预测亚急性卒中康复环境中的住院患者跌倒，并进一步扩展这些变量，纳入评估记忆、言语流畅性、注意力和定向力的特定认知变量。本观察性研究纳入了 2007 年至 2019 年间入住康复中心的 158 例卒中患者，卒中发病至入院时间少于 30 天。卒中严重程度使用国立卫生研究院卒中量表（NIHSS）评估。进行了 4 项逻辑回归分析，包括 NIHSS、年龄、性别、共济失调和偏瘫，以及以下任意一项：（1）功能独立性测量认知（C-FIM）和运动（M-FIM）亚测试。（2）C-FIM 单项。（3）Ray 听觉言语记忆测试（RAVLT）和（4）言语流畅性测试（PMR）、韦氏成人智力量表（WAIS III）的数字广度和测试巴塞罗那的定向力。NIHSS、年龄、性别、共济失调或偏瘫均不能预测跌倒。C-FIM 是一个显著的预测因子（AUC：0.891），但 M-FIM 不是。C-FIM 的问题解决单项（AUC：0.836）、RAVLT 学习子测试（AUC：0.879）和 PMR 言语流畅性（AUC：0.871）分别是每个模型的显著预测因子。认知评估，即一项 FIM 单项、一项 RAVLT 单项或一分钟言语流畅性测试是显著的跌倒预测因子。
