Wang Julian, Bernhardt Julie, Johns Hannah, Churilov Leonid, Said Catherine, Fini Natalie A, Batchelor Frances, Collier Janice, Ellery Fiona, Bower Kelly J
Melbourne Medical School, The University of Melbourne, Melbourne, VIC, Australia.
The Florey, Heidelberg, VIC, Australia.
Int J Stroke. 2025 Jun;20(5):550-558. doi: 10.1177/17474930251314330. Epub 2025 Jan 27.
Falls are common after stroke and can have serious consequences such as hip fracture. Prior research shows around half of individuals will fall within the 12 months post stroke, and these falls are more likely to cause serious injury compared to people without stroke. However, there is limited research on risk factors collected in the immediate post-stroke period that may relate to falls risk. Furthermore, the circumstances and consequences surrounding falls resulting in serious adverse events (serious falls) is underexplored.
Using longitudinal cohort data from A Very Early Rehabilitation Trial (AVERT), we aimed to describe the occurrence, consequences, and circumstances of serious falls over 12 months post stroke and examine potential risk factors associated with these serious falls.
Data from participants included in the AVERT trial (n = 2104; recruited from 56 stroke units across five countries) were analyzed. Serious falls were defined as those resulting in death, were life threatening, or required/prolonged hospitalization. Baseline variables included: demographics, pre-morbid function, stroke severity, hemi-neglect, functional independence, and mobility. Statistical analysis included Wilcoxon-Mann-Whitney tests, Fisher's tests, and Firth's logistic regressions (adjusting for age, stroke severity, and AVERT intervention group).
Of the 2104 participants, 85 (4%) experienced at least one serious fall (mean age 78.1 years, 45 male), with 91 individual falls. Fifty-five (60%) serious falls resulted in fracture, with 23 (42%) being hip fractures. Two (2%) falls resulted in death. Serious falls were most common during the day (26 of 38 reported), at home (30 of 63 reported) and while ambulating (22 of 42 reported). More serious falls were experienced by participants who were older, had worse pre-morbid mobility, were unable to walk 10 m independently in the first 24 hours post stroke, or required longer than 14 days to walk 50 m unassisted.
This large international prospective study found 1 in 25 stroke survivors experienced serious falls in the first year after stroke. Fractures were a common outcome of these falls, but the true post-stroke fracture rate is likely to be underestimated due to our study methods, such as the exclusion of individuals with poor pre-morbid mobility and the absence of data on fractures not relating to falls or leading to an inpatient hospital admission. Clear associations between older age, impaired pre- and early post-stroke mobility and heightened risk of serious falls were found. Integrating these factors into post-stroke screening tools could improve identification of individuals at greater risk of serious falls and lead to more focused rehabilitation and injury prevention.
中风后跌倒很常见，可能会导致严重后果，如髋部骨折。先前的研究表明，约一半的个体在中风后的12个月内会跌倒，与未中风的人相比，这些跌倒更有可能导致严重伤害。然而，关于中风后即刻收集的可能与跌倒风险相关的危险因素的研究有限。此外，导致严重不良事件（严重跌倒）的跌倒情况及后果尚未得到充分研究。
利用来自一项极早期康复试验（AVERT）的纵向队列数据，我们旨在描述中风后12个月内严重跌倒的发生情况、后果及情形，并研究与这些严重跌倒相关的潜在危险因素。
对纳入AVERT试验的参与者（n = 2104；来自五个国家的56个中风单元）的数据进行分析。严重跌倒定义为导致死亡、危及生命或需要/延长住院治疗的跌倒。基线变量包括：人口统计学特征、病前功能、中风严重程度、半侧忽视、功能独立性和活动能力。统计分析包括Wilcoxon-Mann-Whitney检验、Fisher检验和Firth逻辑回归（对年龄、中风严重程度和AVERT干预组进行校正）。
在2104名参与者中，85名（4%）经历了至少一次严重跌倒（平均年龄78.1岁，45名男性），共发生91次跌倒。55次（60%）严重跌倒导致骨折，其中23次（42%）为髋部骨折。2次（2%）跌倒导致死亡。严重跌倒最常发生在白天（38次报告中有26次）、家中（63次报告中有30次）以及行走时（42次报告中有22次）。年龄较大、病前活动能力较差、中风后24小时内无法独立行走10米或需要超过14天才能在无辅助的情况下行走50米的参与者经历的严重跌倒更多。
这项大型国际前瞻性研究发现，每25名中风幸存者中有1人在中风后的第一年经历了严重跌倒。骨折是这些跌倒的常见后果，但由于我们的研究方法，如排除病前活动能力差的个体以及缺乏与跌倒无关或未导致住院的数据，中风后的真实骨折率可能被低估。研究发现年龄较大、中风前后活动能力受损与严重跌倒风险增加之间存在明显关联。将这些因素纳入中风后筛查工具可以改善对严重跌倒风险较高个体的识别，并导致更有针对性的康复和伤害预防。
