Evaluation of the relationship between tools predicting the risk falling in rehabilitation setting in post-stroke patients
Authors:
I. Fiedorová 1,2; E. Mrázková 1,3; H. Tomášková 1; M. Zádrapová 1,2
Authors‘ workplace:
Ostravská univerzita Lékařská fakulta Ústav epidemiologie a ochrany veřejného zdraví, Přednosta: doc. MUDr. Rastislav Maďar, Ph. D., MBA, FRCPS
1; Fakultní nemocnice Ostrava Klinika rehabilitace a tělovýchovného lékařství, Přednosta: doc. MUDr. Dalibor Pastucha, Ph. D., MBA
2; Krajská nemocnice Havířov Oddělení ORL a chirurgie hlavy a krku, Primářka: MUDr. Eva Mrázková, Ph. D.
3
Published in:
Prakt. Lék. 2022; 102(2): 83-89
Category:
Of different specialties
Overview
Background: The consequences of stroke can lead to impaired balance skills associated with a high risk of falls in the hospital setting and after discharge. Many heterogeneous tools exist to assess the level of fall risk. Evaluating the relationships between the most commonly used tests may lead to an explanation of their applicability and effectiveness in practice. Aim: To assess the relationship between selected tools used in clinical practice in the rehabilitation setting to assess fall risk in post-stroke patients and to confirm the validity of this relationship in cognitive dysfunction.
Methods: A prospective cross-sectional study was conducted on a cohort of 84 patients (42 women, age 66.7 ± 9.36 years) after ischemic stroke ≤ 3 months with a follow-up period of 6 months. All subjects performed instrumented posturography (Somatosensory Organization Test – SOT), clinical test (Berg Balance Scale – BBS), nursing screening (Risk of Falls by Juraskova – RPJ) and subjective fear of falls questionnaire (The Falls Efficacy Scale International – FESI). Cognitive function was assessed with the Montreal Cognitive Test. The correlation between the tests was determined by Spearman’s correlation coefficient at the 5% significance level.
Results: Statistically significant negative correlations between SOT and FESI, BBS and FESI, and positive correlations between SOT and BBS were found in all cases. Nursing screening of RPJ showed a statistically significant correlation, only in the case of the assessment group with unconfirmed cognitive deficit, in the other cases the correlation was statistically insignificant.
Conclusion: Increased fear of falling in the study population of post-stroke patients has a statistically significant association with low level of balance, which is valid in the whole population, but also in the group of patients with confirmed cognitive deficit. Nursing screening did not show a statistically significant correlation with balance assessment tools.
Keywords:
stroke – fall risk – fall risk assessment
Sources
1. GBD 2017 Causes of death Collaboratosrs. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392(10159): 1736–1788.
2. Batchelor FA, Mackintosh SF, Said CM, Hill KD. Falls after stroke. Int J Stroke 2012; 7(6): 482–490.
3. Persson CU, Kjellberg S, Lernfelt B, et al. Risk of falling in a stroke unit after acute stroke: The Fall Study of Gothenburg (FallsGOT). Clin Rehabil 2018; 32(3): 398–409.
4. Samuelsson CM, Hansson PO, Persson CU. Early prediction of falls after stroke: a 12-month follow-up of 490 patients in The Fall Study of Gothenburg (FallsGOT). Clin Rehabil 2019; 33(4): 773–783.
5. Minet LR, Peterson E, von Koch L, Ytterberg C. Occurrence and predictors of falls in people with stroke six-year prospective study. Stroke 2015; 46(9): 2688–2690.
6. Nystrom A, Hellstrom K. Fall risk six weeks from onset of stroke and the ability of the prediction of falls in rehabilitation settings tool and motor function to predict falls. Clin Rehabil 2013; 27(5): 473–479.
7. Campbell GB, Matthews JT. An integrative review of factors associated with falls during post-stroke rehabilitation. J Nurs Scholarsh 2010; 42(4): 395–404.
8. Lee K-B, Lee J-S, Jeon I-P, et al. An analysis of fall incidence rate and risk factors in an inpatient rehabilitation unit: A retrospective study. Top Stroke Rehabil 2020; 28(2): 81–87.
9. Goh HT, Nadarajah M, Hamzah NB, et al. Falls and fear of falling after stroke: a case-control study. PM R 2016; 8(12): 1173–1180.
10. Laren A, Odqvist A, Hansson PO, et al. Fear of falling in acute stroke: The Fall Study of Gothenburg (FallsGOT). Top Stroke Rehabil 2018; 25(4): 256–260.
11. Thomas D, Pavic A, Bisaccia E, et al. Validation of fall risk assessment specific to the inpatient rehabilitation facility setting. Rehabil Nurs 2016; 41(5): 253–259.
12. Persson CU, Hansson P-O. Determinants of falls after stroke based on data on 5065 patients from the Swedish Väststroke and Riksstroke Registers. Sci Rep 2021; 11(1): 24035.
13. Goljar N, Rudolf M, Bizovicar N. Algorithm for selection of balance assessment tools in post-stroke patients. Int J Rehabil Res 2019; 42(3): 229–233.
14. Strini V, Schiavolin R, Prendin A. Fall risk assessment scales: a systematic literature review. Nurs Rep 2021; 11(2): 430–443.
15. Ministerstvo zdravotnictví ČR. Národní ošetřovatelský postup prevence pádů a postup při zranění způsobených pády [online]. Dostupné z: https://www.mzcr.cz/wp-content/ uploads/wepub/18576/40360/NOP%20Prevence%20 p%C3%A1d%C5%AF%20a%20postup%20p%C5%99i%20 zran%C4%9Bn%C3%ADch%20zp%C5%AFsoben%C3%BDch%20 p%C3%A1dy.pdf [cit. 2022-03-18].
16. Jedlinská M, Holmerová I. Hodnocení validity vybraných screeningových škál posuzujících riziko pádu u hospitalizovaných seniorů. Prakt. Lék. 2012; 92(7): 392–395.
17. Lendraitienė E, Tamošauskaitė A, Petruševičienė D, et al. Balance evaluation techniques and physical therapy in poststroke patients: A literature review. Neurol Neurochir Pol 2017; 51(1): 92–100.
18. Garcia-Rudolph A, Garcia-Molina A, Opisso E, et al. Cognition assessments to predict inpatient falls in a subacute stroke rehabilitation setting. Top Stroke Rehabil 2021; 28(1): 52–60.
19. Munthe-Kaas R, Aam S, Saltvedt I, et al. Test accuracy of the Montreal Cognitive Assessment in Screening for early poststroke neurocognitive disorder The Nor-COAST Study. Stroke 2021; 52(1): 317–320.
20. Kudlac M, Sabol J, Kaiser K, et al. Reliability and Validity of the Berg Balance Scale in the Stroke Population: A Systematic Review. Phys Occup Ther Geriatr 2019; 37(3): 196–221.
21. Genthon N, Gissot A-S, Froger J, et al. Posturography in patients with stroke: estimating the percentage of body weight on each foot from a single force platform. Stroke 2008; 39(2): 489.
22. Reguli Z, Svobodová L. Česká verze diagnostiky strachu z pádů u seniorů – FESI (Falls Efficacy Scale International). Studia sportiva 2011; 5(2): 5–12.
23. Oguz S, Demirbuken I, Kavlak B, et al. The relationship between objective balance, perceived sense of balance, and fear of falling in stroke patients. Top Stroke Rehabil 2017; 24(7): 527–532.
24. Schinkel-Ivy A, Inness EL, Mansfield A. Relationships between fear of falling, balance confidence, and control of balance, gait, and reactive stepping in individuals with sub-acute stroke. Gait Posture 2016; 43: 154–159.
25. Park S, Cho O-H. Fear of falling and related factors during everyday activities in patients with chronic stroke. Appl Nurs Res 2021; 62: 151492.
26. Lima CA, Ricci NA, Nogueira EC, et al. The Berg Balance Scale as a clinical screening tool to predict fall risk in older adults: a systematic review. Physiotherapy 2018; 104(4): 383–394.
27. Sawacha Z, Carraro E, Contessa P, et al. Relationship between clinical and instrumental balance assessments in chronic poststroke hemiparesis subjects. J Neuroeng Rehabil 2013; 10: 95.
28. Bóriková I, Tomagová M, Miertová M, et al. Predictive value of the Morse Fall Scale. Cent Eur J Nurs Midw 2017; 8(1): 588–595.
29. Yang C, Ghaedi B, Campbell TM, et al. Predicting falls using the Stroke Assessment of Fall Risk Tool. Pm&R 2021; 13(3): 274–281.
30. Mehrholz J, Wagner K, Rutte K, et al. Predictive validity and responsiveness of the functional ambulation category in hemiparetic patients after stroke. Arch Phys Med Rehab 2007; 88(10): 1314–1319.
Labels
General practitioner for children and adolescents General practitioner for adultsArticle was published in
General Practitioner
2022 Issue 2
Most read in this issue
- Nutrition as primary support of immunity
- The importance of personal internal feelings ("gut feeling") of general practitioners in the diagnosis of oncological diseases
- Patient experience with the use of information and communication technologies in primary care during the COVID-19 pandemic
- Nezapomínáte na prevenci? Přeočkování proti tetanu je stále důležité