Article

OBJECTIVES: To investigate (1) whether clinical test scores at discharge predict
falls or limited community mobility after discharge from inpatient stroke
rehabilitation; and (2) how walking and dynamic standing balance change after
discharge. DESIGN: Follow-up observational study between 6 and 36 months after
discharge. SETTING: Rehabilitation setting. PARTICIPANTS: Community-dwelling
stroke survivors (N=30) who could walk unassisted when discharged from inpatient
rehabilitation. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Six-minute
walk test (6MWT), Four Square Step Test (FSST), Step Test (ST), Environmental
Analysis of Mobility Questionnaire (EAMQ), Falls Efficacy Scale-International
(FES-I), and self-reported falls. RESULTS: Follow-up occurred at a median of 14.5
months postdischarge. Significant improvements occurred between discharge and
follow-up for the 6MWT (mean difference [MD]=110.1m; 95% confidence interval
[CI], 70.8-149.4; P<.001), ST (MD=1.8 steps; 95% CI, 0.3-3.4; P=.03), and FSST
(MD=4.3s; 95% CI, -10.3 to 1.6; P=.05). Despite this, 40% of participants
reported falling. The group who fell had lower clinical test scores at discharge
and follow-up than nonfallers. Specific cutoff scores for the clinical tests
accurately classified falls history in 70% to 78% of participants. The cutoff
scores were <250m for the 6MWT, <10 steps on the ST, and a failure or >/=15
seconds to complete the FSST. Participants performing under the cutoff scores
reported lower levels of community mobility (EAMQ, P<.04). Concern about falling
was only higher for those classified at risk by the FSST (FES-I, P=.008).
CONCLUSIONS: The FSST, ST, and 6MWT scores at discharge had good falls
prediction. People classified at risk of falls avoided more tasks in their home
and community than those not classified at risk.
CI - Copyright (c) 2012 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS