Validation of a fall risk index in stroke rehabilitation.

A fall risk index has previously been developed to identify fall-prone individuals in stroke rehabilitation. The purpose of this study was to validate the predictive accuracy of the index. The validation sample (n = 158) consisted of patients admitted to a specialized geriatric stroke rehabilitation ward. The index was scored for each subject, and the relationship between the score and falls was assessed. The index was then remodeled and cross-validated in the sample from which it was derived (model fit sample, n = 135). The total index score (0-11) was significantly connected with the time to first fall (hazard ratio, 1.22; confidence interval [CI], 1.03-1.44). However, the classification of subjects into groups with low, intermediate, and high risk of falling could not be correlated with the time to first fall. A remodeled index contained 3 of the separate original index items. Its relationship to fall risk in the model fit sample was (hazard ratio, 1.82; CI, 1.38-2.40). The fall risk index showed some correlation with the fall risk among patients in stroke rehabilitation, but the results indicate that it should be modified to reach acceptable accuracy. A remodeled index showed a higher association with fall risk.

[1]  L. Jongbloed.  Prediction of function after stroke: a critical review. , 1986, Stroke.

[2]  L. Nyberg,et al.  Using the Downton index to predict those prone to falls in stroke rehabilitation. , 1996, Stroke.

[3]  L. Nyberg,et al.  Patient falls in stroke rehabilitation. A challenge to rehabilitation strategies. , 1995, Stroke.

[4]  G. Murray,et al.  Medical complications after stroke: a multicenter study. , 2000, Stroke.

[5]  Beth Dawson,et al.  Basic & Clinical Biostatistics , 1990 .

[6]  Lillemor Lundin-Olsson,et al.  Fall and Injury Prevention in Older People Living in Residential Care Facilities: A Cluster Randomized Trial , 2002, Annals of Internal Medicine.

[7]  Friedman Pj.  Spatial neglect in acute stroke: the line bisection test. , 1990 .

[8]  A. Forster,et al.  Incidence and consequences offalls due to stroke: a systematic inquiry , 1995, BMJ.

[9]  L. Nyberg,et al.  Incidence of falls in three different types of geriatric care , 1997, Scandinavian journal of social medicine.

[10]  B. Vellas,et al.  Prospective study of restriction of activity in old people after falls. , 1987, Age and ageing.

[11]  A. Fugl-Meyer,et al.  The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance. , 1975, Scandinavian journal of rehabilitation medicine.

[12]  Ann Ashburn,et al.  Fall events among people with stroke living in the community: circumstances of falls and characteristics of fallers. , 2002, Archives of physical medicine and rehabilitation.

[13]  A. Campbell,et al.  Examination by logistic regression modelling of the variables which increase the relative risk of elderly women falling compared to elderly men. , 1990, Journal of clinical epidemiology.

[14]  Hélène Corriveau,et al.  Screening older adults at risk of falling with the Tinetti balance scale , 2000, The Lancet.

[15]  M. Reding,et al.  Medical and Neurological Complications During Inpatient Stroke Rehabilitation , 1994, Stroke.

[16]  C. Sackley,et al.  Falls, sway, and symmetry of weight-bearing after stroke. , 1991, International disability studies.

[17]  S. Katz,et al.  STUDIES OF ILLNESS IN THE AGED. THE INDEX OF ADL: A STANDARDIZED MEASURE OF BIOLOGICAL AND PSYCHOSOCIAL FUNCTION. , 1963, JAMA.

[18]  F. Tang,et al.  Symmetrical body-weight distribution training in stroke patients and its effect on fall prevention. , 2001, Archives of physical medicine and rehabilitation.

[19]  Robert Teasell,et al.  The incidence and consequences of falls in stroke patients during inpatient rehabilitation: factors associated with high risk. , 2002, Archives of physical medicine and rehabilitation.

[20]  L. Rapport,et al.  Rightward orienting bias, wheelchair maneuvering, and fall risk. , 1995, Archives of physical medicine and rehabilitation.

[21]  C. Ugur,et al.  Characteristics of falling in patients with stroke , 2000, Journal of neurology, neurosurgery, and psychiatry.

[22]  M. Y. Lee,et al.  The sit-to-stand movement in stroke patients and its correlation with falling. , 1998, Archives of physical medicine and rehabilitation.

[23]  A. Ramnemark,et al.  Fractures after Stroke , 1998, Osteoporosis International.

[24]  D. Wade,et al.  Assessing motor impairment after stroke: a pilot reliability study. , 1990, Journal of neurology, neurosurgery, and psychiatry.

[25]  S. Folstein,et al.  "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. , 1975, Journal of psychiatric research.

[26]  N. Mayo,et al.  Relationship between response time and falls among stroke patients undergoing physical rehabilitation , 1990, International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation.

[27]  L. Jørgensen,et al.  Higher Incidence of Falls in Long-Term Stroke Survivors Than in Population Controls: Depressive Symptoms Predict Falls After Stroke , 2002, Stroke.

[28]  L Nyberg,et al.  Fall prediction index for patients in stroke rehabilitation. , 1997, Stroke.

[29]  J. M. Guralnik,et al.  Risk Factors for Falling in Home-Dwelling Older Women With Stroke: The Women’s Health and Aging Study , 2003, Stroke.

[30]  Stephanie Studenski,et al.  Falls in community-dwelling stroke survivors: an accumulated impairments model. , 2002, Journal of rehabilitation research and development.