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Pin TW, Winser SJ, Chan WLS, Chau B, Ng S, Wong T, Mak M, Pang M. Association between fear of falling and falls following acute and chronic stroke: a systematic review with meta-analysis. J Rehabil Med 2024; 56:jrm18650. [PMID: 38226564 PMCID: PMC10802787 DOI: 10.2340/jrm.v56.18650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/14/2023] [Indexed: 01/17/2024] Open
Abstract
OBJECTIVES To examine the association between falls and fear of falling in people with stroke and to evaluate the differences between patients with acute stroke and those with chronic stroke with regard to any such association. METHODS Articles were searched in Medline, CINAHL, AMED, Embase, PsycINFO, Cochrane Library of Reviews and PEDro from inception until March 2023. Experimental, observational or explorative studies investigating the association between fear of falling and falls in people with stroke were included. Articles were screened by 2 independent reviewers. Data were extracted by an independent reviewer. RESULTS A total of 26 reports were included in this review (n = 2863). Fear of falling, assessed by a single-question survey, was significantly associated with falls (relative risk = 1.44; 95% confidence interval (95% CI) = 1.22, 1.70; I2 = 0%) in people with acute stroke. Significant mean differences in fear of falling, based on the Falls Efficacy Scale (mean difference = 12.80; 95% CI = 1.81, 23.78; I² = 28%) and Activities-specific Balance Confidence Scale (mean difference = -9.99; 95% CI = -15.36, -4.62; I² = 57%), were also reported between fallers and non-fallers in people with chronic stroke. CONCLUSION A small, but significant, association exists between falls and fear of falling in both acute and chronic stroke patients.
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Affiliation(s)
- Tamis W Pin
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Stanley J Winser
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Wayne L S Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong.
| | - Bolton Chau
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Shamay Ng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Thomson Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Margaret Mak
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Marco Pang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
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2
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Oda S, Takechi K, Hirai S, Takatori S, Otsuka T. Association between nocturnal falls and hypnotic drug use in older patients at acute care hospitals. Eur J Clin Pharmacol 2023; 79:753-758. [PMID: 37010536 DOI: 10.1007/s00228-023-03485-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 03/23/2023] [Indexed: 04/04/2023]
Abstract
PURPOSE Although hypnotic drug use is a known risk factor for falls, few reports have analyzed fall risk associated with individual hypnotic drugs after adjusting for confounding factors. While it is recommended that benzodiazepine receptor agonists not be prescribed for older adults, it is unknown whether melatonin receptor agonists and orexin receptor antagonists are safe in this population. Here, we aimed to assess the influence of various hypnotic drugs on fall risk in older patients admitted to acute care hospitals. METHODS We investigated the relationship between nocturnal falls and sleeping pill use in 8,044 hospitalized patients aged > 65 years. We used a propensity score matching method to homogenize characteristics of patients with and without nocturnal falls (n = 145 patients per group) using 24 extracted factors (excluding hypnotic drugs) as covariates. RESULTS Our analysis of fall risk for each hypnotic drug revealed that benzodiazepine receptor agonists were the only drugs significantly associated with falls, suggesting that use of the drugs is a risk factor for falls in older adults (p = 0.003). In addition, a multivariate analysis of 24 selected factors, excluding hypnotic drugs, revealed that patients with advanced recurrent malignancies were at greatest risk of experiencing falls (OR: 2.62; 95% CI: 1.23-5.60; p = 0.013). CONCLUSION Benzodiazepine receptor agonists should be avoided in older hospitalized patients since they increase fall risk, with melatonin receptor agonists and orexin receptor antagonists used instead. Particularly, fall risk associated with hypnotic drugs should be considered in patients with advanced recurrent malignancies.
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Affiliation(s)
- Shinji Oda
- Department of Pharmacy, Matsuyama Shimin Hospital, Matsuyama, Japan
| | - Kenshi Takechi
- Department of Drug Information Analysis, College of Pharmaceutical Sciences, Matsuyama University, 4-2 Bunkyo-cho, Ehime, 790-8578, Matsuyama, Japan.
| | - Satoru Hirai
- Department of Rehabilitation, Matsuyama Shimin Hospital, Matsuyama, Japan
| | - Shingo Takatori
- Department of Drug Information Analysis, College of Pharmaceutical Sciences, Matsuyama University, 4-2 Bunkyo-cho, Ehime, 790-8578, Matsuyama, Japan
| | - Takashi Otsuka
- Department of Pharmacy, Matsuyama Shimin Hospital, Matsuyama, Japan
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3
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Motanova E, Bekreneva M, Rukavishnikov I, Shigueva TA, Saveko AA, Tomilovskaya ES. Application of Space Technologies Aimed at Proprioceptive Correction in Terrestrial Medicine in Russia. Front Physiol 2022; 13:921862. [PMID: 35784861 PMCID: PMC9243534 DOI: 10.3389/fphys.2022.921862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 05/27/2022] [Indexed: 12/02/2022] Open
Abstract
Space technologies greatly contributed not only to space medicine but also to terrestrial medicine, which actively involves these technologies in everyday practice. Based on the existing countermeasures, and due to similarities of sensorimotor alterations provoked by the weightlessness with various neurological disorders, a lot of work has been dedicated to adaptation and introduction of these countermeasures for rehabilitation of patients. Axial loading suit and mechanical stimulation of the soles' support zones are used in mitigation of stroke and traumatic brain injury consequences. They are also applied for rehabilitation of children with cerebral palsy. Complex application of these proprioceptive correction methods in neurorehabilitation programs makes it possible to effectively treat neurological patients with severe motor disturbances and significant brain damage.
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Affiliation(s)
- Eugenia Motanova
- Institute of Biomedical Problems, Russian Academy of Sciences (RAS), Moscow, Russia
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4
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Assessing the risk for falls among Portuguese community-dwelling stroke survivors. Are we using the better tools? Observational study. Porto Biomed J 2022; 7:e160. [PMID: 35801217 PMCID: PMC9257293 DOI: 10.1097/j.pbj.0000000000000160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/09/2021] [Accepted: 06/07/2021] [Indexed: 11/25/2022] Open
Abstract
This study assesses the estimation of the risk for falls among community-dwelling stroke survivors referred for ambulatory physiotherapy and explores factors that affect the risk.
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5
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Gillespie D, MacLellan C, Ferguson-Pell M, Taeger A, Manns PJ. Balancing Access with Technology: Comparing In-Person and Telerehabilitation Berg Balance Scale Scores among Stroke Survivors. Physiother Can 2021; 73:276-285. [PMID: 34456445 DOI: 10.3138/ptc-2019-0095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: Stroke survivors living in rural and remote communities experience challenges in accessing specialized rehabilitation services. Access to balance assessment after stroke is an essential aspect of the physiotherapy assessment. Telerehabilitation (TRH) can eliminate access disparities; however, adoption into practice has been limited. Our primary objective was to examine agreement between Berg Balance Scale (BBS) scores obtained through TRH and those obtained through traditional in-person assessment of community-dwelling individuals with stroke. Method: Two raters administered the BBS to 20 community-dwelling individuals with stroke, using both TRH and traditional in-person approaches. The order of assessments and rater assignment was randomized. Interrater reliability between the methods was assessed using Krippendorff's α reliability estimate. A survey was then administered to examine the participants' perceptions of the two means of assessment. Results: Excellent interrater agreement was found between TRH and in-person assessment (κ = 0.97; 95% CI: 0.96, 0.99), and responses regarding patients' perceived hearing and understanding of instructions as well as perceived safety were comparable. In addition, the vast majority of participants agreed or strongly agreed that they would use TRH for future physiotherapy sessions. Conclusions: The results of this study support administration of the BBS using TRH technology; this could improve access to balance assessment for stroke survivors in rural and remote communities.
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Affiliation(s)
- Dan Gillespie
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Crystal MacLellan
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Martin Ferguson-Pell
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Andrea Taeger
- Covenant Health: St. Mary's Hospital, Camrose, Alberta, Canada
| | - Patricia J Manns
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
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6
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Tarvonen-Schröder S, Niemi T, Hurme S, Koivisto M. Fall assessment in subacute inpatient stroke rehabilitation using clinical characteristics and the most preferred stroke severity and outcome measures. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2021. [DOI: 10.1080/21679169.2021.1960600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Sinikka Tarvonen-Schröder
- Neurocenter, Turku University Hospital, Turku, Finland
- Clinical Neurosciences, University of Turku, Turku, Finland
| | - Tuuli Niemi
- Department of Expert Services, Turku University Hospital, Turku, Finland
| | - Saija Hurme
- Department of Biostatistics, University of Turku, Turku, Finland
| | - Mari Koivisto
- Department of Biostatistics, University of Turku, Turku, Finland
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Tennison JM, Ng AH, Rianon NJ, Liu DD, Bruera E. Patient-Reported Continuity of Care and Functional Safety Concerns After Inpatient Cancer Rehabilitation. Oncologist 2021; 26:887-896. [PMID: 34080755 DOI: 10.1002/onco.13843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 05/21/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Patients with cancer have been noted to have inadequate continuity of care after discharge from hospital. We sought to assess patient-reported continuity of care and functional safety concerns after acute inpatient rehabilitation. METHODS This was a prospective study that used cross-sectional surveys at a National Cancer Institute Comprehensive Cancer Center. All patients who were admitted to acute inpatient rehabilitation from September 5, 2018, to February 7, 2020, met the inclusion criteria, and completed two surveys (assessing continuity of care and functional safety concerns) upon discharge and 1 month after discharge were included in the study. RESULTS A total of 198 patients completed the study, and no major concerns were reported by the patients. The greatest concern was a lack of adequate communication management among different providers, reported by only 10 (5.0%) patients. The combined fall and near-fall rate within 1 month after discharge was (25/198) 13%. Brain metastasis, a comorbidity of depression, and a history of falls were significantly associated with a higher risk of falls or near falls within 1 month after discharge. CONCLUSION Although overall patients with cancer reported adequate continuity of care and feeling safe to function at home after acute inpatient rehabilitation, it is important to be aware that fall or near-fall events within 1 month after acute inpatient rehabilitation are associated with brain metastasis, comorbidity of depression, and a history of falls. Thus, patients with these risk factors may benefit from including more focused fall prevention education and interventions. IMPLICATIONS FOR PRACTICE Patients with cancer often have extensive problems that require care from multiple health care providers simultaneously, and a high level of coordination is needed for adequate transition of care from the inpatient to the outpatient setting. This transition of care period is prone to inadequate continuity of care and, for older adults, a particular risk for falls. Assessment for risk of fall is also an important factor to consider when evaluating patients to continue oncology treatments. There is a gap in knowledge regarding patient-reported continuity of care and functional safety concerns after acute inpatient cancer rehabilitation.
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Affiliation(s)
- Jegy M Tennison
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Amy H Ng
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nahid J Rianon
- Department of Family & Community Medicine and Joan & Stanford Alexander Division of Geriatric and Palliative Medicine, McGovern Medical School, The University of Texas Houston Health Science Center, Houston, Texas, USA
| | - Diane D Liu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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8
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Ishigo T, Takada R, Kondo F, Ibe Y, Nakano K, Tateishi R, Fujii S, Katano S, Kitagawa M, Kimyo T, Nakata H, Hashimoto A, Miyamoto A. [Association Suvorexant and Ramelteon Use with the Risk of Falling: A Retrospective Case-control Study]. YAKUGAKU ZASSHI 2020; 140:1041-1049. [PMID: 32741862 DOI: 10.1248/yakushi.20-00018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Sedative hypnotics are among the classes of drugs reported to influence falls. However, the effects of the sedative hypnotic drugs, suvorexant and ramelteon, on falls are not well known. Therefore, we conducted this retrospective case-control study to examine the association of the use of these two sedative hypnotics with the risk of falls. Conducted at the Sapporo Medical University Hospital in Japan, our study included 360 patients with fall incidents and 819 randomly selected control patients. Patients in the fall group were significantly older with a lower body mass index, and had a history of falls, disabilities in activities of daily living, cognitive impairment, and delirium. Monovariate analysis revealed that patients in the fall group frequently used ramelteon [odds ratio (OR) 2.38, 95% confidence interval (CI): 1.49-3.81, p<0.001], but rarely used suvorexant (OR 0.66, 95% CI: 0.29-1.39, p=0.317), compared with control patients. Furthermore, multivariate analysis revealed that ramelteon use did not increase the risk of falls (adjusted OR 1.43, 95% CI: 0.82-2.48, p=0.207), whereas suvorexant use significantly decreased the risk of falls (adjusted OR 0.32, 95% CI: 0.13-0.76, p=0.009). Although ramelteon tends to be used in patients at a high risk of falls, it may not increase the risk of falls. In contrast, the use of suvorexant may reduce the risk of falls.
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Affiliation(s)
- Tomoyuki Ishigo
- Division of Hospital Pharmacy, Sapporo Medical University Hospital
| | - Ryo Takada
- Division of Hospital Pharmacy, Sapporo Medical University Hospital
| | - Fuki Kondo
- Division of Hospital Pharmacy, Sapporo Medical University Hospital
| | - Yuta Ibe
- Division of Hospital Pharmacy, Sapporo Medical University Hospital
| | - Keita Nakano
- Division of Hospital Pharmacy, Sapporo Medical University Hospital
| | - Riho Tateishi
- Division of Hospital Pharmacy, Sapporo Medical University Hospital
| | - Satoshi Fujii
- Division of Hospital Pharmacy, Sapporo Medical University Hospital
| | - Satoshi Katano
- Division of Rehabilitation, Sapporo Medical University Hospital
| | - Manabu Kitagawa
- Division of Hospital Pharmacy, Sapporo Medical University Hospital
| | - Tomoko Kimyo
- Division of Hospital Pharmacy, Sapporo Medical University Hospital
| | - Hiromasa Nakata
- Division of Hospital Pharmacy, Sapporo Medical University Hospital
| | - Akiyoshi Hashimoto
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine.,Division of Health Care Administration and Management, Sapporo Medical University School of Medicine
| | - Atsushi Miyamoto
- Division of Hospital Pharmacy, Sapporo Medical University Hospital
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9
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Teasell R, Salbach NM, Foley N, Mountain A, Cameron JI, Jong AD, Acerra NE, Bastasi D, Carter SL, Fung J, Halabi ML, Iruthayarajah J, Harris J, Kim E, Noland A, Pooyania S, Rochette A, Stack BD, Symcox E, Timpson D, Varghese S, Verrilli S, Gubitz G, Casaubon LK, Dowlatshahi D, Lindsay MP. Canadian Stroke Best Practice Recommendations: Rehabilitation, Recovery, and Community Participation following Stroke. Part One: Rehabilitation and Recovery Following Stroke; 6th Edition Update 2019. Int J Stroke 2020; 15:763-788. [PMID: 31983296 DOI: 10.1177/1747493019897843] [Citation(s) in RCA: 175] [Impact Index Per Article: 43.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The sixth update of the Canadian Stroke Best Practice Recommendations: Rehabilitation, Recovery, and Reintegration following Stroke. Part one: Rehabilitation and Recovery Following Stroke is a comprehensive set of evidence-based guidelines addressing issues surrounding impairments, activity limitations, and participation restrictions following stroke. Rehabilitation is a critical component of recovery, essential for helping patients to regain lost skills, relearn tasks, and regain independence. Following a stroke, many people typically require rehabilitation for persisting deficits related to hemiparesis, upper-limb dysfunction, pain, impaired balance, swallowing, and vision, neglect, and limitations with mobility, activities of daily living, and communication. This module addresses interventions related to these issues as well as the structure in which they are provided, since rehabilitation can be provided on an inpatient, outpatient, or community basis. These guidelines also recognize that rehabilitation needs of people with stroke may change over time and therefore intermittent reassessment is important. Recommendations are appropriate for use by all healthcare providers and system planners who organize and provide care to patients following stroke across a broad range of settings. Unlike the previous set of recommendations, in which pediatric stroke was included, this set of recommendations includes primarily adult rehabilitation, recognizing many of these therapies may be applicable in children. Recommendations related to community reintegration, which were previously included within this rehabilitation module, can now be found in the companion module, Rehabilitation, Recovery, and Community Participation following Stroke. Part Two: Transitions and Community Participation Following Stroke.
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Affiliation(s)
- Robert Teasell
- Stroke Rehabilitation Program, 60446Parkwood Hospital, London, Canada
- Western University, London, Canada
| | - Nancy M Salbach
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | | | - Anita Mountain
- Division of Physical Medicine and Rehabilitation, 3688Dalhousie University, Halifax, Canada
- Queen Elizabeth II Health Sciences Centre, Nova Scotia Rehabilitation Centre Site, Halifax, Canada
| | - Jill I Cameron
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Andrea de Jong
- 33484Heart and Stroke Foundation of Canada, Toronto, Canada
| | - Nicole E Acerra
- Neurosciences and Physical Therapy, Vancouver Coastal Health, Vancouver, Canada
| | - Diana Bastasi
- School of Physical and Occupational Therapy, 5620McGill University, Montréal, Canada
| | - Sherri L Carter
- Department of Psychology and Neuroscience, 3688Dalhousie University, Halifax, Canada
| | - Joyce Fung
- School of Physical and Occupational Therapy, 5620McGill University, Montréal, Canada
- Jewish Rehabilitation Hospital (CISSS-Laval) research site of CRIR, Montréal, Canada
| | - Mary-Lou Halabi
- Stroke Program, Edmonton Zone, Alberta Health Services, Edmonton, Canada
| | | | - Jocelyn Harris
- School of Rehabilitation Sciences, 3710McMaster University, Hamilton, Canada
| | - Esther Kim
- Department of Communication Sciences and Disorders, 3158University of Alberta, Edmonton, Canada
| | - Andrea Noland
- School of Audiology and Speech Sciences, University of British Columbia, Vancouver, Canada
| | - Sepideh Pooyania
- Physical Medicine and Rehabilitation, University of Manitoba, Winnipeg, Canada
| | - Annie Rochette
- School of Rehabilitation, University of Montreal, Montreal, Canada
| | | | - Erin Symcox
- Tertiary Neuro Rehabilitation, 26634Foothills Medical Centre, Calgary, Alberta
| | - Debbie Timpson
- Physical Medicine and Rehabilitation, 153197Pembroke Regional Hospital, Pembroke, Canada
| | - Suja Varghese
- Rehabilitation and Palliative Care Program, 102793Eastern Health, Newfoundland and Labrador, St. John's, Canada
| | - Sue Verrilli
- Northeastern Ontario Stroke Network, Sudbury, Canada
| | - Gord Gubitz
- Queen Elizabeth II Health Sciences Centre Stroke Program, Halifax, Canada
| | | | - Dar Dowlatshahi
- Faculty of Medicine, 6363University of Ottawa, Ottawa, Canada
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10
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Kristensen J, Birn I, Mechlenburg I. Fractures after stroke-A Danish register-based study of 106 001 patients. Acta Neurol Scand 2020; 141:47-55. [PMID: 31550049 DOI: 10.1111/ane.13172] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 09/14/2019] [Accepted: 09/18/2019] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To estimate the incidence of fractures, possibly caused by falls, in patients aged 65 and older with first episode of stroke, and to estimate the incidence of fracture types for this group of patients. Another objective was to investigate stroke severity and marital status, as risk factors for fractures. MATERIALS AND METHODS A large retrospective dataset of 116 519 patients with first episode of stroke was extracted from the Danish Stroke Registry between January 2003 and December 2017. The occurrence of fractures was identified in the Danish National Patient Registry. A univariate analysis was conducted and a multivariate analysis was conducted to determine the relationship between stroke severity and fractures, and marital status and fractures, adjusting for multiple confounders. Cox regression with time-varying covariates was used, taking time-dependent variables into account. RESULTS The incidence rate of fractures post-stroke was 41.07 per 1000 person-years between 2003 and 2017 in Denmark. A total of 15 872 (14.86%) sustained a fracture and the mean time at risk until outcome was 3.67 years post-stroke. Femur fracture was the most common fracture type. Mild, moderate, severe, and unknown stroke severity are associated with fractures after stroke compared to very severe stroke, and living alone at the time of stroke is associated with fractures after stroke compared to living with someone. CONCLUSIONS The incidence rate of fractures in Denmark was 41.07 per 1000 person-years. Moreover, mild, moderate, and severe stroke severity, and living alone at the time of stroke were found to be risk factors for fracture.
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Affiliation(s)
- Jonas Kristensen
- Department of Orthopaedic Surgery Aarhus University Hospital Aarhus Denmark
- Department of Public Health Aarhus University Aarhus Denmark
| | - Ida Birn
- Department of Orthopaedic Surgery Aarhus University Hospital Aarhus Denmark
- Sano Rehabilitation Center Aarhus Denmark
- Department of Clinical Medicine Aarhus University Aarhus Denmark
| | - Inger Mechlenburg
- Department of Orthopaedic Surgery Aarhus University Hospital Aarhus Denmark
- Department of Public Health Aarhus University Aarhus Denmark
- Department of Clinical Medicine Aarhus University Aarhus Denmark
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11
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Wei WE, De Silva DA, Chang HM, Yao J, Matchar DB, Young SHY, See SJ, Lim GH, Wong TH, Venketasubramanian N. Post-stroke patients with moderate function have the greatest risk of falls: a National Cohort Study. BMC Geriatr 2019; 19:373. [PMID: 31878876 PMCID: PMC6933903 DOI: 10.1186/s12877-019-1377-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 12/08/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Stroke patients have increased risks of falls. We examined national registry data to evaluate the association between post-stroke functional level and the risk of low falls among post-stroke patients. METHODS This retrospective cohort study analyzed data from national registries to examine the risk factors for post-stroke falls. Data for patients who suffered ischemic strokes and survived the index hospital admission was obtained from the Singapore National Stroke Registry and matched to the National Trauma Registry, from 2011 to 2015. The primary outcome measure was a low fall (fall height ≤ 0.5 m). Competing risk analysis was performed to examine the association between functional level (by modified Rankin score [mRS] at discharge) and the risk of subsequent low falls. RESULTS In all, 2255 patients who suffered ischemic strokes had recorded mRS. The mean age was 66.6 years and 58.5% were men. By the end of 2015, 54 (2.39%) had a low fall while 93 (4.12%) died. After adjusting for potential confounders, mRS was associated with fall risk with an inverted U-shaped relationship. Compared to patients with a score of zero, the sub-distribution hazard ratio (SHR) increased to a maximum of 3.42 (95%CI:1.21-9.65, p = 0.020) for patients with a score of 2. The SHR then declined to 2.45 (95%CI:0.85-7.12, p = 0.098), 2.86 (95%CI:0.95-8.61, p = 0.062) and 1.93 (95%CI:0.44-8.52, p = 0.38) for patients with scores of 3, 4 and 5 respectively. CONCLUSIONS An inverted U-shaped relationship between functional status and fall risk was observed. This is consistent with the complex interplay between decreasing mobility (hence decreased opportunity to fall) and increasing susceptibility to falls. Fall prevention intervention could be targeted accordingly. (263 words).
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Affiliation(s)
- Wycliffe E Wei
- Health Services Research Unit, Singapore General Hospital, Level 4, 226 Outram Road, Singapore, 169039, Singapore
| | - Deirdre A De Silva
- Department of Neurology (Singapore General Hospital Campus), National Neuroscience Institute, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.,Duke-NUS Medical School, Singapore, 8 College Road, Singapore, 169857, Singapore
| | - Hui Meng Chang
- Department of Neurology (Singapore General Hospital Campus), National Neuroscience Institute, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Jiali Yao
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - David B Matchar
- Health Services & Systems Research, Duke-National University of Singapore Medical School, Singapore, 8 College Road, Singapore, 169857, Singapore.,Center for Clinical Health Policy, Duke University Medical Center, Durham, North Carolina, USA.,Duke University Medical Center, Durham, North Carolina, 27710, USA
| | - Sherry H Y Young
- Department of Rehabilitation Medicine, Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore
| | - Siew Ju See
- Department of Neurology (Singapore General Hospital Campus), National Neuroscience Institute, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.,Duke-NUS Medical School, Singapore, 8 College Road, Singapore, 169857, Singapore
| | - Gek Hsiang Lim
- Health Promotion Board, 3 Second Hospital Avenue, Singapore, 168937, Singapore
| | - Ting Hway Wong
- Duke-NUS Medical School, Singapore, 8 College Road, Singapore, 169857, Singapore. .,Department of General Surgery, Singapore General Hospital, General Hospital, Outram Road, Singapore, 169608, Singapore.
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12
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Yadav T, Bhalerao G, Shyam AK. Factors affecting fear of falls in patients with chronic stroke. Top Stroke Rehabil 2019; 27:33-37. [PMID: 31847729 DOI: 10.1080/10749357.2019.1658419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: The aim of this study was to find the factors associated with fear of falls in patients having chronic stroke.Methods: Inclusion criterion was subjects with cerebral stroke for more than 3 months. A structured interview of 82 subjects was conducted with a questionnaire with questions regarding personal factors such as gender, side affected, number of comorbidities, and setting of physical therapy sessions. Depression was assessed using Patient Health Questionnaire-9, lower extremity motor function was assessed using Fugl-Meyer scale, and functional mobility was assessed using Timed Up and Go. Chi-square analysis was done on the above factors to find significant factors followed by logistic regression of the factors found significant in Chi square.Results: Lower extremity Fugl-Meyer score was significantly associated with fear of falls (p value 0.047 with Odds ratio of 1.136, 95% CI 1.002-1.287) in patients having chronic stroke while treatment factors, such as setting of physical therapy sessions, and personal factors, such as gender, side affected, number of comorbidities, depression, functional mobility, or use of walking aid, were not found to have significant association.Conclusion: The lower extremity Fugl-Meyer score is associated with fear of falls in patients having chronic stroke.
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Affiliation(s)
- Trishala Yadav
- Neuro Physiotherapy Department, Sancheti Institute College of Physiotherapy, Pune, India
| | - Gajanan Bhalerao
- Neuro Physiotherapy Department, Sancheti Institute College of Physiotherapy, Pune, India
| | - Ashok K Shyam
- Neuro Physiotherapy Department, Sancheti Institute for Orthopaedics and Rehabilitation, Pune, India
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13
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David SM, Chan K, Inderjeeth C, Raymond WD. Rehabilitation Indices associated with sustaining a minimal trauma fracture within 12 months of a stroke in Western Australia. Australas J Ageing 2019; 38:107-115. [PMID: 30806020 DOI: 10.1111/ajag.12614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 11/13/2018] [Accepted: 11/22/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To identify Rehabilitation Indices associated with a minimal trauma fracture (MTF) within 12 months poststroke. METHODS Retrospective case-control study. Stroke survivors with MTF were matched 5:1 with stroke survivors without MTF. Logistic regression determined whether Rehabilitation Indices, such as Physiotherapy Ambulation score (PhysioAmb), were associated with a MTF within 12 months poststroke. RESULTS Forty-three stroke survivors (mean age: 79.8; 55.81% female) experienced a MTF (median time to MTF of 1.79 years [IQR 0.70, 4.48]). Those with a MTF within 12 months had lower PhysioAmb (4.53 vs 8.29) and Berg Balance Scale (BBS; 12.25 vs 40.57) scores on admission, lower BBS score on discharge (30.33 vs 49.29) and a greater change in PhysioAmb (+5.67 vs +3.24) and BBS scores (+21.50 vs +8.71) after rehabilitation, all P < 0.05. Greater changes in PhysioAmb score increased the odds of a MTF within 12 months by 18%. CONCLUSION Rehabilitation Indices are associated with a MTF within 12 months poststroke.
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Affiliation(s)
- Shivlal M David
- Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,North-West Area Rehabilitation and Aged Care Service - Osborne Park Hospital Campus, Perth, Western Australia, Australia.,Rehabilitation and Aged Care, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Kien Chan
- North-West Area Rehabilitation and Aged Care Service - Osborne Park Hospital Campus, Perth, Western Australia, Australia
| | - Charles Inderjeeth
- Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,North-West Area Rehabilitation and Aged Care Service - Osborne Park Hospital Campus, Perth, Western Australia, Australia.,Rehabilitation and Aged Care, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Warren D Raymond
- Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,Rehabilitation and Aged Care, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,University of the West, Perth, Western Australia, Australia
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14
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A single session of trip-specific training modifies trunk control following treadmill induced balance perturbations in stroke survivors. Gait Posture 2019; 70:222-228. [PMID: 30904789 PMCID: PMC6508877 DOI: 10.1016/j.gaitpost.2019.03.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 02/28/2019] [Accepted: 03/04/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Individuals with stroke are at significant risk of falling. Trip-specific training is a targeted training approach that has been shown to reduce falls in older adults and amputees by enhancing the compensatory stepping response required to prevent a fall. Still, individuals with stroke have unique deficits (e.g. spasticity) which draws into question if this type of training will be effective for this population. OBJECTIVE Evaluate if a single session of trip-specific training can modify the compensatory stepping response (trunk movement, step length/duration, reaction time) of individuals with chronic stroke. METHODS Sixteen individuals with unilateral chronic stroke participated in a single session of trip-specific training consisting of 15 treadmill perturbations. A falls assessment consisting of 3 perturbations was completed before and after training. Recovery step kinematics measured during the pre- and post-test were compared using a repeated measures design. Furthermore, Fallers (those who experienced at least one fall during the pre- or post-test) were compared to Non-fallers. RESULTS Trip-specific training decreased trunk movement post perturbation. Specifically following training, Trunk flexion was 48 and 19 percent smaller on the small and medium perturbations at the end of the first compensatory step. Fallers (9 out of 16 subjects) post-training resembled Non-Fallers pre-training. Specifically, Trunk flexion at the completion of the first step during small and medium perturbations was not different between Fallers post-training and Non-Fallers pre-training. Still enthusiasm was tempered because Trunk flexion at the largest perturbation (where most falls occurred) was not changed and therefore total falls were not reduced as a result of this training. SIGNIFICANCE Our results indicate that trip-specific training modifies the dynamic falls response immediately following trip-like treadmill perturbations. However, the incidence of falls was not reduced with a single training session. Further study of the implications and length of the observed intervention effect are warranted.
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Walsh ME, Galvin R, Williams DJ, Harbison JA, Murphy S, Collins R, McCabe DJ, Crowe M, Horgan NF. Falls-Related EvEnts in the first year after StrokE in Ireland: Results of the multi-centre prospective FREESE cohort study. Eur Stroke J 2019; 3:246-253. [PMID: 31008355 DOI: 10.1177/2396987318764961] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 02/19/2018] [Indexed: 11/16/2022] Open
Abstract
Introduction Falls are common post-stroke adverse events. This study aimed to describe the first-year falls incidence, circumstances and consequences among persons discharged home after stroke in Ireland, and to examine the association between potential risk factors and recurrent falls. Patients and methods Patients with acute stroke and planned home-discharge were recruited consecutively from five hospitals. Variables recorded pre-discharge included: age, stroke severity, co-morbidities, fall history, prescribed medications, hemi-neglect, cognition and functional independence (Barthel index). Falls were recorded with monthly diaries, and 6 and 12-month interviews. The association of pre-discharge factors with recurrent falls (>1 fall) was examined using univariable logistic regression. Results A total of 128 participants (mean age = 68.6, SD = 13.3) were recruited; 110 completed the 12-month follow-up. The first-year falls incidence was 44.5% (95% CI = 35.1-53.6) with 25.6% falling repeatedly (95% CI = 18.5-34.4). Fallers experienced 1-18 falls (median = 2) and five reported fractures; 47% of fallers experienced at least one fall outdoors. Only 10% of recurrent fallers had bone health medication prescribed at discharge. Lower Barthel index scores (<75/100, RR = 4.38, 1.64-11.72) and psychotropic medication prescription (RR = 2.10, 1.13-3.91) were associated with recurrent falls. Discussion This study presents prospectively collected information about falls circumstances. It was not powered for multivariable analysis of risk factors. Conclusion One-quarter of stroke survivors discharged to the community fall repeatedly and mostly indoors in the first year. Specific attention may be required for individuals with poor functional independence or those on psychotropic medication. Future falls-management research in this population should explore falls in younger individuals, outdoor as well as indoor falls and post-stroke bone health status.
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Affiliation(s)
- Mary E Walsh
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland.,HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Rose Galvin
- Department of Clinical Therapies, Faculty of Education and Health Sciences, Health Research Institute, University of Limerick, Ireland
| | - David Jp Williams
- School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Geriatric and Stroke Medicine, Beaumont Hospital, Dublin, Ireland
| | - Joseph A Harbison
- Department of Medicine for the Elderly, St James's Hospital, Dublin, Ireland.,Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Sean Murphy
- School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Medicine for the Older Person and Stroke Service, Mater Misericordiae University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Ronan Collins
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland.,Department of Age-related Healthcare, The Adelaide and Meath Hospital incorporating the National Children's Hospital, Dublin, Ireland
| | - Dominick Jh McCabe
- Department of Neurology, Vascular Neurology Research Foundation and Stroke Service, The Adelaide and Meath Hospital incorporating the National Children's Hospital, Dublin, Ireland.,Department of Clinical Neurosciences, Royal Free Campus, UCL Institute of Neurology, London, UK.,Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Morgan Crowe
- Department of Medicine for the Elderly, St Vincent's University Hospital, Dublin 4, Ireland
| | - N Frances Horgan
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
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16
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Goto Y, Otaka Y, Suzuki K, Inoue S, Kondo K, Shimizu E. Incidence and circumstances of falls among community-dwelling ambulatory stroke survivors: A prospective study. Geriatr Gerontol Int 2019; 19:240-244. [PMID: 30623545 DOI: 10.1111/ggi.13594] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 11/14/2018] [Accepted: 12/04/2018] [Indexed: 11/30/2022]
Abstract
AIM To elucidate the incidences and circumstances of falls and fall-related injuries, and to explore the physical characteristics of community-dwelling ambulatory stroke survivors who experienced falls. METHODS A total of 144 community-dwelling ambulatory survivors of hemiparetic stroke (mean age 68.0 years [SD 10.4 years]) who were undergoing rehabilitation in an adult daycare center participated in this prospective study. The mean duration from stroke onset was 5.21 years (SD 3.15 years). The occurrence of falls was collected for 1 year with a fall diary. The incidence rates of falls and fall-related injuries, and the detailed circumstances of falls were descriptively analyzed. The characteristics of fallers were explored by comparing background information, motor impairments and results of physical function tests, including the 10-m walk test, Timed Up and Go test and five-times-sit-to-stand test, between fallers and non-fallers. RESULTS The incidence rates of falls and fall-related fractures were 0.88 per person-year and 2.8 per 100 person-years, respectively. Falls occurred more frequently during daytime and in winter. Falls were caused most often by losing balance while walking indoors, especially on the way to the toilet. After falling, 34.1% of individuals who fell could not stand up by themselves. The time of the five-times-sit-to-stand test was significantly longer in fallers than in non-fallers (P < 0.05). CONCLUSIONS The incidence rate of falls was high among community-dwelling ambulatory survivors of hemiparetic stroke. Appropriate approaches, including mastering the skills to cope with falling, are required, especially for individuals with reduced lower limb muscle strength. Geriatr Gerontol Int 2019; 19: 240-244.
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Affiliation(s)
- Yuto Goto
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan.,Department of Cognitive Behavioral Physiology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yohei Otaka
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan.,Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Aichi, Japan
| | - Ken Suzuki
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
| | - Seigo Inoue
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
| | - Kunitsugu Kondo
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
| | - Eiji Shimizu
- Department of Cognitive Behavioral Physiology, Chiba University Graduate School of Medicine, Chiba, Japan.,Research Center for Child Mental Development, Chiba University, Chiba, Japan
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17
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Abstract
Stroke, or cerebrovascular accident, involves injury to the central nervous system as a result of a vascular cause, and is a leading cause of disability worldwide. People with stroke often experience sensory, cognitive, and motor sequelae that can lead to difficulty walking, controlling balance in standing and voluntary tasks, and reacting to prevent a fall following an unexpected postural perturbation. This chapter discusses the interrelationships between stroke-related impairments, problems with control of balance and gait, fall risk, fear of falling, and participation in daily physical activity. Rehabilitation can improve balance and walking function, and consequently independence and quality of life, for those with stroke. This chapter also describes effective interventions for improving balance and walking function poststroke, and identifies some areas for further research in poststroke rehabilitation.
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Affiliation(s)
- Avril Mansfield
- Toronto Rehabilitation Institute, University Health Network and Department of Physical Therapy, University of Toronto, Toronto, ON, Canada.
| | - Elizabeth L Inness
- Toronto Rehabilitation Institute, University Health Network and Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - William E Mcilroy
- Department of Kinesiology, University of Waterloo and Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Waterloo, ON, Canada
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18
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Bjartmarz I, Jónsdóttir H, Hafsteinsdóttir TB. Implementation and feasibility of the stroke nursing guideline in the care of patients with stroke: a mixed methods study. BMC Nurs 2017; 16:72. [PMID: 29213212 PMCID: PMC5709925 DOI: 10.1186/s12912-017-0262-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 11/10/2017] [Indexed: 11/14/2022] Open
Abstract
Background Nurses often have difficulties with using interdisciplinary stroke guidelines for patients with stroke as they do not focus sufficiently on nursing. Therefore, the Stroke Nursing Guideline (SNG) was developed and implemented. The aim of this study was to determine the implementation and feasibility of the SNG in terms of changes in documentation and use of the guideline in the care of stroke patients on Neurological and Rehabilitation wards, barriers and facilitators, and nurses’ and auxiliary nurses’ view of the implementation. Methods A sequential explorative mixed method design was used including pre-test post-test measures and post intervention focus groups interviews. For the quantitative part retrospective electronic record data of nursing care was collected from 78 patients and prospective measures with Barriers and Facilitators Assessment Instrument (BFAI) and Quality Indicator Tool (QIT) from 33 nursing staff including nurses and auxiliary nurses. In the qualitative part focus groups interviews were conducted with nursing staff on usefulness of the SNG and experiences with implementation. Results Improved nursing documentation was found for 23 items (N = 37), which was significant for nine items focusing mobility (p = 0.002, p = 0.024, p = 0.012), pain (p = 0.012), patient teaching (p = 0.001, p = 0.000) and discharge planning (p = 0.000, p = 0.002, p = 0.004). Improved guideline use was found for 20 QIT-items (N = 30), with significant improvement on six items focusing on mobility (p = 0.023), depression (p = 0.033, p = 0.025, p = 0.046, p = 0.046), discharge planning (p = 0.012). Facilitating characteristics for change were significantly less for two of four BFAI-subscales, namely Innovation (p = 0.019) and Context (p = 0.001), whereas no change was found for Professional and Patient subscales. The findings of the focus group interviews showed the SNG to be useful, improving and providing consistency in care. The implementation process was found to be successful as essential components of nursing rehabilitation were defined and integrated into daily care. Conclusion Nursing staff found the SNG feasible and implementation successful. The SNG improved nursing care, with increased consistency and more rigorous functional exercises than before. The SNG provides nurses and auxiliary nurses with an important means for evidence based care for patients with stroke. Several challenges of implementing this complex nursing intervention surfaced which mandates ongoing attention. Electronic supplementary material The online version of this article (10.1186/s12912-017-0262-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ingibjörg Bjartmarz
- Clinical Nurse Specialist, Department of Rehabilitation, Landspítali University Hospital, Reykjavík, Iceland
| | - Helga Jónsdóttir
- Faculty of Nursing, University of Iceland, Reykjavík, Iceland.,Nursing Care for Chronically Ill Adults, Landspítali University Hospital, Reykjavík, Iceland
| | - Thóra B Hafsteinsdóttir
- Faculty of Nursing, University of Iceland, Reykjavík, Iceland.,Julius Center for Health Sciences and Primary Care, Nursing Science Department, University Medical Center Utrecht, Utrecht, The Netherlands
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19
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An SH, Jee YJ, Shin HH, Lee GC. Validity of the Original and Short Versions of the Dynamic Gait Index in Predicting Falls in Stroke Survivors. Rehabil Nurs 2017; 42:325-332. [DOI: 10.1002/rnj.280] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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20
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Mansfield A, Schinkel-Ivy A, Danells CJ, Aqui A, Aryan R, Biasin L, DePaul VG, Inness EL. Does Perturbation Training Prevent Falls after Discharge from Stroke Rehabilitation? A Prospective Cohort Study with Historical Control. J Stroke Cerebrovasc Dis 2017; 26:2174-2180. [PMID: 28579506 DOI: 10.1016/j.jstrokecerebrovasdis.2017.04.041] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 04/29/2017] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Individuals with stroke fall frequently, and no exercise intervention has been shown to prevent falls post stroke. Perturbation-based balance training (PBT), which involves practicing reactions to instability, shows promise for preventing falls in older adults and individuals with Parkinson's disease. This study aimed to determine if PBT during inpatient stroke rehabilitation can prevent falls after discharge into the community. METHODS Individuals with subacute stroke completed PBT as part of routine inpatient rehabilitation (n = 31). Participants reported falls experienced in daily life for up to 6 months post discharge. Fall rates were compared to a matched historical control group (HIS) who did not complete PBT during inpatient rehabilitation. RESULTS Five of 31 PBT participants, compared to 15 of 31 HIS participants, reported at least 1 fall. PBT participants reported 10 falls (.84 falls per person per year) whereas HIS participants reported 31 falls (2.0 falls per person per year). When controlled for follow-up duration and motor impairment, fall rates were lower in the PBT group than the HIS group (rate ratio: .36 [.15, .79]; P = .016). CONCLUSIONS These findings suggest that PBT is promising for reducing falls post stroke. While this was not a randomized controlled trial, this study may provide sufficient evidence for implementing PBT in stroke rehabilitation practice.
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Affiliation(s)
- Avril Mansfield
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada; Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Research Institute, Toronto, Ontario, Canada.
| | - Alison Schinkel-Ivy
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada; School of Physical and Health Education, Nipissing University, North Bay, Ontario, Canada
| | - Cynthia J Danells
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada; Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Anthony Aqui
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Raabeae Aryan
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada; Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Louis Biasin
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada; Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Vincent G DePaul
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada; School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Elizabeth L Inness
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada; Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
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21
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Wang D, Wu J, Lin Q. A novel method for designing and optimizing the layout of facilities in bathroom for the elderly in home-based rehabilitation. Disabil Rehabil Assist Technol 2017; 13:333-341. [PMID: 28453365 DOI: 10.1080/17483107.2017.1319426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE The home-based rehabilitation of elderly patients improves their autonomy, independence and reintegration into society. Hence, a suitable environment plays an important role in rehabilitation, as do different assistance technologies. The majority of accidents at home involving elderly people occur in the bathroom. Therefore, the planning of the layout of facilities is important in this potentially dangerous area. This paper proposes an approach towards designing and optimizing the layout of facilities in the bathroom, based on logistical and nonlogistical relationships. METHODOLOGY A fuzzy-based analytical hierarchical process (fuzzy-AHP) is then proposed for a comprehensive evaluation of the alternatives for this layout plan. This approach was applied to the home of a 71 years old female patient, who was experiencing home-based rehabilitation. After the initial designing and optimizing of the layout of the facilities in her bathroom, a plan could then be created for her particular needs. FINDINGS The results of this research could then enable the home-based rehabilitation of elderly patients to be more effective. Value: This paper develops a new approach to design and optimize the layout of facilities in bathroom for the elderly. Implications for Rehabilitation Develop a new approach to design and optimize the layout of facilities in bathroom. Provide a mathematical and more scientific approach to home layout design for home-based rehabilitation. Provide new opportunities for research, for both the therapist and the patient to analyse the home facility layout.
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Affiliation(s)
- Duojin Wang
- a Shanghai Engineering Research Center of Assistive Devices/School of Medical Instrument and Food Engineering , University of Shanghai for Science and Technology , Shanghai , China
| | - Jing Wu
- b School of Economics and Management , Tongji University , Shanghai , China
| | - Qinglian Lin
- c School of Management , Xiamen University , Xiamen , China
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22
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Navigated Transcranial Magnetic Stimulation: A Biologically Based Assay of Lower Extremity Impairment and Gait Velocity. Neural Plast 2017; 2017:6971206. [PMID: 28243474 PMCID: PMC5294370 DOI: 10.1155/2017/6971206] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 10/10/2016] [Accepted: 12/06/2016] [Indexed: 11/18/2022] Open
Abstract
Objectives. (a) To determine associations among motor evoked potential (MEP) amplitude, MEP latency, lower extremity (LE) impairment, and gait velocity and (b) determine the association between the presence of a detectable MEP signal with LE impairment and with gait velocity. Method. 35 subjects with chronic, stable LE hemiparesis were undergone TMS, the LE section of the Fugl-Meyer Impairment Scale (LE FM), and 10-meter walk test. We recorded presence, amplitude, and latency of MEPs in the affected tibialis anterior (TA) and soleus (SO). Results. MEP presence was associated with higher LEFM scores in both the TA and SO. MEP latency was larger in subjects with lower LEFM and difficulty walking. Conclusion. MEP latency appears to be an indicator of LE impairment and gait. Significance. Our results support the precept of using TMS, particularly MEP latency, as an adjunctive LE outcome measurement and prognostic technique.
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23
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Kim KI, Jung HK, Kim CO, Kim SK, Cho HH, Kim DY, Ha YC, Hwang SH, Won CW, Lim JY, Kim HJ, Kim JG. Evidence-based guidelines for fall prevention in Korea. Korean J Intern Med 2017; 32:199-210. [PMID: 28049285 PMCID: PMC5214733 DOI: 10.3904/kjim.2016.218] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Accepted: 07/29/2016] [Indexed: 01/08/2023] Open
Abstract
Falls and fall-related injuries are common in older populations and have negative effects on quality of life and independence. Falling is also associated with increased morbidity, mortality, nursing home admission, and medical costs. Korea has experienced an extreme demographic shift with its population aging at the fastest pace among developed countries, so it is important to assess fall risks and develop interventions for high-risk populations. Guidelines for the prevention of falls were first developed by the Korean Association of Internal Medicine and the Korean Geriatrics Society. These guidelines were developed through an adaptation process as an evidence-based method; four guidelines were retrieved via systematic review and the Appraisal of Guidelines for Research and Evaluation II process, and seven recommendations were developed based on the Grades of Recommendation, Assessment, Development, and Evaluation framework. Because falls are the result of various factors, the guidelines include a multidimensional assessment and multimodal strategy. The guidelines were developed for primary physicians as well as patients and the general population. They provide detailed recommendations and concrete measures to assess risk and prevent falls among older people.
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Affiliation(s)
- Kwang-Il Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hye-Kyung Jung
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Chang Oh Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Soo-Kyung Kim
- Division of Endocrinology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Hyun-Ho Cho
- Korean Physicians’ Association, Seoul, Korea
| | - Dae Yul Kim
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Sung-Hee Hwang
- Department of Neurology, Hallym University College of Medicine, Chuncheon, Korea
| | - Chang Won Won
- Department of Family Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jae-Young Lim
- Department of Rehabilitation, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyun Jung Kim
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jae Gyu Kim
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
- Correspondence to Jae Gyu Kim, M.D. Department of Internal Medicine, Chung-Ang University College of Medicine, 84 Heukseok-ro, Dongjak-gu, Seoul 06974, Korea Tel: +82-2-6299-3147 Fax: +82-2-825-7571 E-mail:
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24
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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; 43:154-9. [PMID: 26482234 PMCID: PMC5045898 DOI: 10.1016/j.gaitpost.2015.09.015] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 09/16/2015] [Accepted: 09/18/2015] [Indexed: 02/02/2023]
Abstract
Fear of falling is common in individuals with stroke; however, the associations between fear of falling, balance confidence, and the control of balance and gait are not well understood for this population. This study aimed to determine whether, at the time of admission to in-patient rehabilitation, specific features of balance and gait differed between individuals with stroke who did and did not report fear of falling, and whether these features were related to balance confidence. Individuals with stroke entering in-patient rehabilitation were asked if they were afraid of falling, and completed the Activities-Specific Balance Confidence Scale. Participants performed quiet standing, gait, and reactive stepping tasks, and specific measures were extracted for each (quiet standing: centre of pressure amplitude, between-limb synchronization, and Romberg quotients; gait: walking velocity, double support time, and variability measures; reactive stepping: number of steps, frequency of grasp reactions, and frequency of assists). No significant differences were identified between individuals with and without fear of falling. Balance confidence was negatively related to centre of pressure amplitude, double support time, and step time variability, and positively related to walking velocity. Low balance confidence was related to poor quiet standing balance control and cautious behavior when walking in individuals with sub-acute stroke. While the causal relationship between balance confidence and the control of balance and gait is unclear from the current work, these findings suggest there may be a role for interventions to increase balance confidence among individuals with stroke, in order to improve functional mobility.
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Affiliation(s)
- Alison Schinkel-Ivy
- Toronto Rehabilitation Institute, University Health Network, 550 University Ave., Toronto, ON, Canada M5G 2A2,Corresponding author. Tel.: +1 416 597 3422x7820.
| | - Elizabeth L. Inness
- Toronto Rehabilitation Institute, University Health Network, 550 University Ave., Toronto, ON, Canada M5G 2A2,University of Toronto, 500 University Ave., Toronto, ON, Canada M5G 1V7
| | - Avril Mansfield
- Toronto Rehabilitation Institute, University Health Network, 550 University Ave., Toronto, ON, Canada M5G 2A2,University of Toronto, 500 University Ave., Toronto, ON, Canada M5G 1V7,Evaluative Clinical Sciences, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, 2075 Bayview Ave., Toronto, ON, Canada M4 N 3M5 1
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25
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Arya KN, Pandian S, Abhilasha CR, Verma A. Does the motor level of the paretic extremities affect balance in poststroke subjects? Rehabil Res Pract 2014; 2014:767859. [PMID: 24967104 PMCID: PMC4055229 DOI: 10.1155/2014/767859] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 03/28/2014] [Accepted: 04/23/2014] [Indexed: 12/03/2022] Open
Abstract
Background. Poststroke impairment may lead to fall and unsafe functional performance. The underlying mechanism for the balance dysfunction is unclear. Objective. To analyze the relation between the motor level of the affected limbs and balance in poststroke subjects. Method. A prospective, cross-sectional, and nonexperimental design was conducted in a rehabilitation institute. A convenience sample of 44 patients was assessed for motor level using Brunnstrom recovery stage (BRS) and Fugl-Meyer Assessment: upper (FMA-UE) and lower extremities (FMA-LE). The balance was measured by Berg Balance Scale (BBS), Postural Assessment Scale for Stroke Patients (PASS), and Functional Reach Test (FRT). Results. BRS showed moderate correlation with BBS (ρ = 0.54 to 0.60; P < 0.001), PASS (r = 0.48 to 0.64; P < 0.001) and FRT (ρ = 0.48 to 0.59; P < 0.001). FMA-UE also exhibited moderate correlation with BBS (ρ = 0.59; P < 0.001) and PASS (ρ = 0.60; P < 0.001). FMA-LE showed fair correlation with BBS (ρ = 0.50; P = 0.001) and PASS (ρ = 0.50; P = 0.001). Conclusion. Motor control of the affected limbs plays an important role in balance. There is a moderate relation between the motor level of the upper and lower extremities and balance. The findings of the present study may be applied in poststroke rehabilitation.
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Affiliation(s)
- Kamal Narayan Arya
- Pandit Deendayal Upadhyaya Institute for the Physically Handicapped (University of Delhi), Ministry of Social Justice and Empowerment, Government of India, 4 VD Marg, New Delhi 110002, India
| | - Shanta Pandian
- Pandit Deendayal Upadhyaya Institute for the Physically Handicapped (University of Delhi), Ministry of Social Justice and Empowerment, Government of India, 4 VD Marg, New Delhi 110002, India
| | - C. R. Abhilasha
- Pandit Deendayal Upadhyaya Institute for the Physically Handicapped (University of Delhi), Ministry of Social Justice and Empowerment, Government of India, 4 VD Marg, New Delhi 110002, India
| | - Ashutosh Verma
- Pandit Deendayal Upadhyaya Institute for the Physically Handicapped (University of Delhi), Ministry of Social Justice and Empowerment, Government of India, 4 VD Marg, New Delhi 110002, India
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Roman de Mettelinge T, Cambier D, Calders P, Van Den Noortgate N, Delbaere K. Understanding the relationship between type 2 diabetes mellitus and falls in older adults: a prospective cohort study. PLoS One 2013; 8:e67055. [PMID: 23825617 PMCID: PMC3692422 DOI: 10.1371/journal.pone.0067055] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 05/13/2013] [Indexed: 02/01/2023] Open
Abstract
Background Older adults with type 2 Diabetes Mellitus are at increased risk of falling. The current study aims to identify risk factors that mediate the relationship between diabetes and falls. Methods 199 older adults (104 with diabetes and 95 healthy controls) underwent a medical screening. Gait (GAITRite®), balance (AccuGait® force plate), grip strength (Jamar®), and cognitive status (Mini-Mental State Examination and Clock Drawing Test) were assessed. Falls were prospectively recorded during a 12-month follow-up period using monthly calendars. Results Compared to controls, diabetes participants scored worse on all physical and cognitive measures. Sixty-four participants (42 diabetes vs. 22 controls) reported at least one injurious fall or two non-injurious falls (“fallers”). Univariate logistic regression identified diabetes as a risk factor for future falls (Odds Ratio 2.25, 95%CI 1.21–4.15, p = 0.010). Stepwise multiple regressions defined diabetes and poor balance as independent risk factors for falling. Taking more medications, slower walking speed, shorter stride length and poor cognitive performance were mediators that reduced the Odds Ratio of the relationship between diabetes and faller status relationship the most followed by reduced grip strength and increased stride length variability. Conclusions Diabetes is a major risk factor for falling, even after controlling for poor balance. Taking more medications, poorer walking performance and reduced cognitive functioning were mediators of the relationship between diabetes and falls. Tailored preventive programs including systematic medication reviews, specific balance exercises and cognitive training might be beneficial in reducing fall risk in older adults suffering from diabetes.
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Affiliation(s)
- Tine Roman de Mettelinge
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
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Womack JA, Goulet JL, Gibert C, Brandt CA, Skanderson M, Gulanski B, Rimland D, Rodriguez-Barradas MC, Tate J, Yin MT, Justice AC. Physiologic frailty and fragility fracture in HIV-infected male veterans. Clin Infect Dis 2013; 56:1498-504. [PMID: 23378285 DOI: 10.1093/cid/cit056] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The Veterans Aging Cohort Study (VACS) Index is associated with all-cause mortality in individuals infected with human immunodeficiency virus (HIV). It is also associated with markers of inflammation and may thus reflect physiologic frailty. This analysis explores the association between physiologic frailty, as assessed by the VACS Index, and fragility fracture. METHODS HIV-infected men from VACS were included. We identified hip, vertebral, and upper arm fractures using ICD-9-CM codes. We used Cox regression models to assess fragility fracture risk factors including the VACS Index, its components (age, hepatitis C status, FIB-4 score, estimated glomerular filtration rate, hemoglobin, HIV RNA, CD4 count), and previously identified risk factors for fragility fractures. RESULTS We included 40 115 HIV-infected male Veterans. They experienced 588 first fragility fractures over 6.0 ± 3.9 years. The VACS Index score (hazard ratio [HR], 1.15; 95% confidence interval [CI], 1.11-1.19), white race (HR, 1.92; 95% CI, 1.63-2.28), body mass index (HR, 0.94; 95% CI, .92-.96), alcohol-related diagnoses (HR, 1.65; 95% CI, 1.26-2.17), cerebrovascular disease (HR, 1.95; 95% CI, 1.14-3.33), proton pump inhibitor use (HR, 1.87; 95% CI, 1.54-2.27), and protease inhibitor use (HR, 1.25; 95% CI, 1.04-1.50) were associated with fracture risk. Components of the VACS Index score most strongly associated with fracture risk were age (HR, 1.40; 95% CI, 1.27-1.54), log HIV RNA (HR, 0.91; 95% CI, .88-.94), and hemoglobin level (HR, 0.82; 95% CI, .78-.86). CONCLUSIONS Frailty, as measured by the VACS Index, is an important predictor of fragility fractures among HIV-infected male Veterans.
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Affiliation(s)
- Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Stroke and Cerebrovascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
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