Article

Falls are common after stroke, with potentially serious consequences.
Few investigations have included age-matched control participants to directly
compare fall characteristics between older adults with and without stroke.
Further, fear of falling, a significant psychological consequence of falls, has
only been examined to a limited degree as a risk factor for future falls in a
stroke population. OBJECTIVE: To compare the fall history between older adults
with and without a previous stroke and to identify the determinants of falls and
fear of falling in older stroke survivors. DESIGN: Case-control observational
study. SETTING: Primary teaching hospital. PARTICIPANTS: Seventy-five patients
with stroke (mean age +/- standard deviation, 66 +/- 7 years) and 50 age-matched
control participants with no previous stroke were tested. METHODS: Fall history,
fear of falling, and physical, cognitive, and psychological function were
assessed. A chi2 test was performed to compare characteristics between groups,
and logistic regression was performed to determine the risk factors for falls and
fear of falling. MAIN OUTCOME MEASURES: Fall events in the past 12 months, Fall
Efficacy Scale-International, Berg Balance Scale, Functional Ambulation Category,
Fatigue Severity Scale, Montreal Cognitive Assessment, and Patient Healthy
Questionnaire-9 were measured for all participants. Fugl-Meyer Motor Assessment
was used to quantify severity of stroke motor impairments. RESULTS: Twenty-three
patients and 13 control participants reported at least one fall in the past 12
months (P = .58). Nine participants with stroke had recurrent falls (>/=2 falls)
compared with none of the control participants (P < .01). Participants with
stroke reported greater concern for falling than did nonstroke control
participants (P < .01). Female gender was associated with falls in the nonstroke
group, whereas falls in the stroke group were not significantly associated with
any measured outcomes. Fear of falling in the stroke group was associated with
functional ambulation level and balance. Functional ambulation level alone
explained 22% of variance in fear of falling in the stroke group. CONCLUSIONS:
Compared with persons without a stroke, patients with stroke were significantly
more likely to experience recurrent falls and fear of falling. Falls in patients
with stroke were not explained by any of the outcome measures used, whereas fear
of falling was predicted by functional ambulation level.
This study has
identified potentially modifiable risk factors with which to devise future
prevention strategies for falls in patients with stroke.
LEVEL OF EVIDENCE: III.
CI - Copyright (c) 2016. Published by Elsevier Inc.

Langue : ANGLAIS