Faria-Fortini Iza, Polese Janaíne C, Faria Christina D C M, Scianni Aline Alvim, Nascimento Lucas R, Teixeira-Salmela Luci Fuscaldi
Department of Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
Department of Physical Therapy, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil.
J Bodyw Mov Ther. 2021 Apr;26:167-173. doi: 10.1016/j.jbmt.2020.12.002. Epub 2021 Feb 6.
Falls, which are common events after stroke, may lead to activity limitations and increased dependence. It is important to identify which commonly employed clinical measures could differentiate individuals, who are fallers from the non-fallers.
To investigate specific cut-off values of clinical measures that could discriminate fallers and non-fallers individuals with chronic stroke.
This cross-sectional study involved 105 community-dwelling individuals with stroke. The primary outcome was report of falls over the last six months. The clinical predictors included measures of mobility (walking speed, stair ascent/descent cadences, time to perform the Timed Up and Go test, and ABILOCO) and the Fall Efficacy Scale - International (FES-I) scores. To identify which measures were able to detect between-group differences, independent Student's t-tests were employed. For measures which were able to discriminate fallers from the non-fallers, the Receiver Operating Characteristics (ROC) and the Area Under the ROC Curve (AUC) were calculated.
Out of the 105 participants (61 men), 41% reported falls over the previous 6 months. Stair ascent cadence, ABILOCO, and FES-I scores significantly differentiated the groups, but only the FES-I demonstrated acceptable discriminatory ability (AUC = 0.71). The optimal FES-I cut-off score was 28 points (sensitivity = 0.71; specificity = 0.57; positive predictive value = 51%; and negative predictive value = 74%).
The FES-I demonstrated good discriminatory ability to classify individuals with chronic stroke, who were fallers from the non-fallers. The use of the established cut-off value of 28 points is recommended and may help clinical reasoning and decision-making in stroke rehabilitation.
跌倒作为卒中后常见事件，可能导致活动受限及依赖性增加。识别哪些常用临床指标能够区分跌倒者与未跌倒者至关重要。
研究可鉴别慢性卒中跌倒者与未跌倒者的临床指标的特定临界值。
这项横断面研究纳入了105名社区居住的卒中患者。主要结局为过去6个月内的跌倒报告。临床预测指标包括运动能力指标（步行速度、上下楼梯步频、定时起立行走测试完成时间及ABILOCO）以及国际跌倒效能量表（FES-I）评分。为确定哪些指标能够检测组间差异，采用独立样本t检验。对于能够区分跌倒者与未跌倒者的指标，计算受试者工作特征曲线（ROC）及ROC曲线下面积（AUC）。
105名参与者（61名男性）中，41%报告在过去6个月内有跌倒。上楼梯步频、ABILOCO及FES-I评分在两组间有显著差异，但只有FES-I显示出可接受的鉴别能力（AUC = 0.71）。FES-I的最佳临界值为28分（灵敏度 = 0.71；特异度 = 0.57；阳性预测值 = 51%；阴性预测值 = 74%）。
FES-I在区分慢性卒中跌倒者与未跌倒者方面显示出良好的鉴别能力。建议采用既定的28分临界值，这可能有助于卒中康复中的临床推理及决策。
