1
|
Hirai H, Fujishiro T, Yano T, Obo T, Mizutani M, Usami Y, Hayama S, Nakaya Y, Nakano A, Neo M. Studies in the Falls Efficacy Scale-International for patients with cervical compressive myelopathy: Reliability, validity, and minimum clinically important difference. J Spinal Cord Med 2024; 47:712-722. [PMID: 36977312 DOI: 10.1080/10790268.2023.2192849] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
CONTEXT Patients with cervical compressive myelopathy (CCM) often complain of body balance problems, such as fear of falling and bodily unsteadiness. However, no accepted patient-reported outcome measures (PROMs) for this symptomatology exist. The Falls Efficacy Scale-International (FES-I) is one of the most widely used PROMs for evaluating impaired body balance in various clinical fields. OBJECTIVE To examine reliability, validity, and minimum clinically important difference (MCID) of the FES-I for the evaluation of impaired body balance in patients with CCM. METHODS Patients who underwent surgery for CCM were retrospectively reviewed. The FES-I was administered preoperatively and at 1 year postoperatively. Further, cJOA-LE score (subscore for lower extremities in the Japanese Orthopaedic Association score for cervical myelopathy) and stabilometric data, obtained at the same time points of the FES-I administration, were analyzed. Reliability was examined through internal consistency with Cronbach's alpha. Convergent validity was studied using correlation analysis. The MCID was estimated using anchor- and distribution-based methods. RESULTS Overall, 151 patients were included for analysis. Cronbach's alpha coefficient was the acceptable value of 0.97 at both baseline and 1 year postoperatively. As for convergent validity, the FES-I had significant correlations with the cJOA-LE score and stabilometric parameters both at baseline and 1 year postoperatively. The MCID calculated using anchor- and distribution-based methods was 5.5 and 10, respectively. CONCLUSION FES-I is a reliable and valid PROM to evaluate body balance problems for the CCM population. The established thresholds of MCID can help clinicians recognize the clinical significance of changes in patient status.
Collapse
Affiliation(s)
- Hiromichi Hirai
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Takashi Fujishiro
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Toma Yano
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Takuya Obo
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Masahiro Mizutani
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Yoshitada Usami
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Sachio Hayama
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Yoshiharu Nakaya
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Atsushi Nakano
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| |
Collapse
|
2
|
Ryan M, Rössler R, Rommers N, Iendra L, Peters EM, Kressig RW, Schmidt-Trucksäss A, Engelter ST, Peters N, Hinrichs T. Lower extremity physical function and quality of life in patients with stroke: a longitudinal cohort study. Qual Life Res 2024:10.1007/s11136-024-03713-0. [PMID: 38916661 DOI: 10.1007/s11136-024-03713-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2024] [Indexed: 06/26/2024]
Abstract
PURPOSE Lower extremity physical function (LEPF) is a key component for mobility and is impacted in stroke-related disability. A reduction in LEPF can have a significant impact on an individual's Quality of Life (QoL). The aim of this study is to characterise the relationship between LEPF and QoL. METHODS The MOBITEC-Stroke Study is a longitudinal cohort-study including patients with their first occurrence of ischaemic stroke. Using a linear mixed-effects model, the relationship between LEPF (timed up-and-go performance (TUG); predictor) and QoL (Stroke Specific Quality of Life scale (SS-QoL); outcome) at 3 and 12 months post stroke was investigated and adjusted for sex, age, Instrumental Activities of Daily Living (IADL), fear of falling (Falls Efficacy Scale-International Version, FES-I), and stroke severity (National Institute of Stroke Severity scale, NIHSS), accounting for the repeated measurements. RESULTS Data of 51 patients (65 % males, 35% females) were analysed. The mean age was 71.1 (SD 10.4) years, median NIHSS score was 2.0. SS-QoL was 201.5 (SD 20.5) at 3 months and 204.2 (SD 17.4) at 12 months; the mean change was 2.7 (95% CI -2.4 to 7.7), p= 0.293. A positive association was found between baseline TUG performance (estimate log score -13.923; 95% CI -27.495 to -0.351; p=0.048) and change in SS-QoL score in multivariate regression analysis. CONCLUSION Higher LEPF (i.e better TUG performance) at baseline, was associated with an improvement in QoL from 3- to 12-months post stroke. These results highlight the critical role of physical function, particularly baseline LEPF, in influencing the QoL of stroke survivors.
Collapse
Affiliation(s)
- Michelle Ryan
- University Department of Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland
| | - Roland Rössler
- University Department of Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland.
| | - Nikki Rommers
- Department of Clinical Research, University of Basel, University Hospital Basel, Basel, Switzerland
| | - Laura Iendra
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Eva-Maria Peters
- University Department of Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland
| | - Reto W Kressig
- University Department of Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland
| | - Arno Schmidt-Trucksäss
- Division of Sport and Exercise Medicine, Department of Sport, Exercise, and Health, University of Basel, Grosse Allee 6, Basel, 4052, Switzerland
| | - Stefan T Engelter
- University Department of Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Nils Peters
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Neurology and Stroke Center, Klinik Hirslanden, Zurich, Switzerland
| | - Timo Hinrichs
- University Department of Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland
| |
Collapse
|
3
|
Ghrouz A, Guillen-Sola A, Morgado-Perez A, Muñoz-Redondo E, Ramírez-Fuentes C, Curbelo Peña Y, Duarte E. The effect of a motor relearning on balance and postural control in patients after stroke: An open-label randomized controlled trial. Eur Stroke J 2024; 9:303-311. [PMID: 38158722 PMCID: PMC11318422 DOI: 10.1177/23969873231220218] [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: 10/07/2023] [Accepted: 11/24/2023] [Indexed: 01/03/2024] Open
Abstract
INTRODUCTION Balance and postural control impairments are common in stroke patients, increasing fall risk and limiting their daily and social activities. Current research lacks comprehensive studies evaluating the efficacy and long-term effects of task-specific training on balance and postural control among stroke patients, especially when considering biomechanical and posturographic assessments. PATIENTS AND METHODS A randomized controlled trial included 63 subacute stroke patients recruited from the outpatient rehabilitation department. Participants were randomly assigned to the MRP group (n=32), receiving task-specific training based on MRP, or the CPT group (n=31), receiving conventional physical therapy. Both groups completed an 8-week intervention (3 sessions/week; 1 h./session). Balance and postural control were assessed at baseline, post-intervention, and 3-month follow-up using the Berg Balance Scale (BBS) and posturography. RESULTS The MRP group exhibited significantly larger improvements than the CPT group in both BBS scores (p=0.001, d=2.98, 95% CI [2.25, 3.70]) and Balance Index scores (p=0.001, d=2.83, 95% CI [2.12, 3.53]) after the intervention. These improvements were sustained at 3-month follow-up. DISCUSSION The findings suggest that task-specific training based on MRP is more effective than CPT for improving balance and postural control. The MRP intervention may enhance the motor learning and neural plasticity of the patients, leading to better functional outcomes. However, the study's open-label design represents a limitation, and further research with adequate blinding is needed. CONCLUSION Task-specific training based on MRP was superior to CPT for improving balance and postural control in subacute stroke patients. Participants undergoing MRP exhibited significant and clinically relevant improvements that were sustained at follow-up.
Collapse
Affiliation(s)
- Amer Ghrouz
- Department of Physical Medicine and Rehabilitation, Hospitals del Mar i l’Esperança, Parc de Salut Mar, Barcelona, Spain
- Rehabilitation Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Applied Medical Sciences, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Anna Guillen-Sola
- Rehabilitation Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Neurorehabilitation Unit, Physical Medicine and Rehabilitation Department, Hospital del Mar, Barcelona, Spain
| | - Andrea Morgado-Perez
- Department of Physical Medicine and Rehabilitation, Hospitals del Mar i l’Esperança, Parc de Salut Mar, Barcelona, Spain
- Rehabilitation Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Elena Muñoz-Redondo
- Department of Physical Medicine and Rehabilitation, Hospitals del Mar i l’Esperança, Parc de Salut Mar, Barcelona, Spain
- Rehabilitation Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Cindry Ramírez-Fuentes
- Department of Physical Medicine and Rehabilitation, Hospitals del Mar i l’Esperança, Parc de Salut Mar, Barcelona, Spain
- Rehabilitation Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Yulibeth Curbelo Peña
- Department of Physical Medicine and Rehabilitation, Hospitals del Mar i l’Esperança, Parc de Salut Mar, Barcelona, Spain
| | - Esther Duarte
- Department of Physical Medicine and Rehabilitation, Hospitals del Mar i l’Esperança, Parc de Salut Mar, Barcelona, Spain
- Rehabilitation Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| |
Collapse
|
4
|
González-Castro A, Leirós-Rodríguez R, Prada-García C, Benítez-Andrades JA. The Applications of Artificial Intelligence for Assessing Fall Risk: Systematic Review. J Med Internet Res 2024; 26:e54934. [PMID: 38684088 DOI: 10.2196/54934] [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: 11/28/2023] [Revised: 01/30/2024] [Accepted: 02/13/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Falls and their consequences are a serious public health problem worldwide. Each year, 37.3 million falls requiring medical attention occur. Therefore, the analysis of fall risk is of great importance for prevention. Artificial intelligence (AI) represents an innovative tool for creating predictive statistical models of fall risk through data analysis. OBJECTIVE The aim of this review was to analyze the available evidence on the applications of AI in the analysis of data related to postural control and fall risk. METHODS A literature search was conducted in 6 databases with the following inclusion criteria: the articles had to be published within the last 5 years (from 2018 to 2024), they had to apply some method of AI, AI analyses had to be applied to data from samples consisting of humans, and the analyzed sample had to consist of individuals with independent walking with or without the assistance of external orthopedic devices. RESULTS We obtained a total of 3858 articles, of which 22 were finally selected. Data extraction for subsequent analysis varied in the different studies: 82% (18/22) of them extracted data through tests or functional assessments, and the remaining 18% (4/22) of them extracted through existing medical records. Different AI techniques were used throughout the articles. All the research included in the review obtained accuracy values of >70% in the predictive models obtained through AI. CONCLUSIONS The use of AI proves to be a valuable tool for creating predictive models of fall risk. The use of this tool could have a significant socioeconomic impact as it enables the development of low-cost predictive models with a high level of accuracy. TRIAL REGISTRATION PROSPERO CRD42023443277; https://tinyurl.com/4sb72ssv.
Collapse
Affiliation(s)
- Ana González-Castro
- Nursing and Physical Therapy Department, Universidad de León, Ponferrada, Spain
| | - Raquel Leirós-Rodríguez
- SALBIS Research Group, Nursing and Physical Therapy Department, Universidad de León, Ponferrada, Spain
| | - Camino Prada-García
- Department of Preventive Medicine and Public Health, Universidad de Valladolid, Valladolid, Spain
| | | |
Collapse
|
5
|
Xiong W, Wang D, Ren W, Liu X, Wen R, Luo Y. The global prevalence of and risk factors for fear of falling among older adults: a systematic review and meta-analysis. BMC Geriatr 2024; 24:321. [PMID: 38580924 PMCID: PMC10998426 DOI: 10.1186/s12877-024-04882-w] [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: 09/23/2023] [Accepted: 03/08/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND As a common psychological problem among older adults, fear of falling was found to have a wide range prevalence in different studies. However, the global prevalence of it was unknown and a lack of the large sample confirmed its risk factors. OBJECTIVES To report the global prevalence of fear of falling and to explore its risk factors among older adults for further developing precise interventions to systematically manage FOF. DESIGN A systematic review and meta-analysis was conducted by PRISMA guidelines. METHODS Searches were conducted in PubMed, Web of Science, EMBASE, the Cochrane Library and the manual search in August 20, 2022, updated to September 2, 2023. Observational studies published in English were included and two researchers independently screened and extracted the data. Fixed or random effects mode was used to estimate the pooled prevalence of and risk factors for fear of falling. Heterogeneity resources were analyzed by subgroup and sensitivity analysis. Publication bias was assessed through funnel plots, Egger's test and Begg's test. RESULTS A total of the 153 studies with 200,033 participants from 38 countries worldwide were identified. The global prevalence of fear of falling was 49.60%, ranging from 6.96-90.34%. Subgroup analysis found the estimates pooled prevalence of it was higher in developing countries (53.40%) than in developed countries (46.7%), and higher in patients (52.20%) than in community residents (48.40%). In addition, twenty-eight risk factors were found a significant associations with fear of falling, mainly including demographic characteristics, physical function, chronic diseases and mental problems. CONCLUSION The global prevalence of FOF was high, especially in developing countries and in patients. Demographic characteristics, Physical function, chronic diseases and mental problems were a significant association with FOF. Policy-makers, health care providers and government officials should comprehensively evaluate these risk factors and formulate precise intervention measures to reduce FOF. TRIAL REGISTRATION The study was registered in the International Database of Prospectively Registered Systematic Reviews (PROSPERO): CRD42022358031.
Collapse
Affiliation(s)
- Wanhong Xiong
- School of Nursing, Third Military University / Army Medical University, No. 30 Gaotanyan Street, Shapingba District, Chongqing, P.R. China
- Department of Oncology, Zigong First People's Hospital, Zigong, Sichuan, China
| | - Dan Wang
- School of Nursing, Third Military University / Army Medical University, No. 30 Gaotanyan Street, Shapingba District, Chongqing, P.R. China
| | - Wei Ren
- School of Nursing, Third Military University / Army Medical University, No. 30 Gaotanyan Street, Shapingba District, Chongqing, P.R. China
| | - Xinyi Liu
- School of Nursing, Third Military University / Army Medical University, No. 30 Gaotanyan Street, Shapingba District, Chongqing, P.R. China
| | - Renhui Wen
- School of Nursing, Third Military University / Army Medical University, No. 30 Gaotanyan Street, Shapingba District, Chongqing, P.R. China
| | - Yu Luo
- School of Nursing, Third Military University / Army Medical University, No. 30 Gaotanyan Street, Shapingba District, Chongqing, P.R. China.
| |
Collapse
|
6
|
Tian X, Mai YH, Guo ZJ, Chen JW, Zhou LJ. Contributing factors and interventions for fear of falling in stroke survivors: a systematic review. Top Stroke Rehabil 2024:1-16. [PMID: 38566465 DOI: 10.1080/10749357.2024.2333172] [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: 10/23/2023] [Accepted: 03/17/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVES The purpose of this study was to provide a comprehensive overview of the prevalence, measurement tools, influencing factors, and interventions for fear of falling (FOF) in stroke survivors. METHODS A PRISMA-guided systematic literature review was conducted. PubMed, EMBASE, Cochrane, and Web of Science were systematically searched. The search time was up to February 2023. All observational and experimental studies investigating FOF in stroke patients were included. The assessment tool of the Joanna Briggs Institute was used to assess the quality of the included studies and the risk of bias assessment. (PROSPERO: CRD42023412522). RESULT A total of 25 observational studies and 10 experimental studies were included. The overall quality of the included studies was "low" to "good." The most common tool used to measure the FOF was the Falls Efficacy Scale-International (FES-I). The prevalence of FOF was 42%- 93.8%. Stroke survivors with physical impairments have the highest prevalence of FOF. The main risk factors for the development of FOF in stroke survivors were female gender, use of assistive devices, balance, limb dysfunction, and functional mobility. The combination of cognitive behavioral and exercise interventions is the most effective strategy. CONCLUSIONS This review suggests that the prevalence of FOF in stroke survivors is high and that understanding the factors associated with FOF in stroke patients can help develop multifactorial prevention strategies to reduce FOF and improve quality of life. In addition, a uniform FOF measurement tool should be used to better assess the effectiveness of interventions for stroke survivors. ETHICS APPROVAL PROSPERO registration (CRD42023412522).
Collapse
Affiliation(s)
- Xue Tian
- School of Nursing, School of Public Health, Yangzhou University, Yangzhou, China
| | - Ying-Hong Mai
- School of Nursing, School of Public Health, Yangzhou University, Yangzhou, China
| | - Zai-Jin Guo
- School of Nursing, School of Public Health, Yangzhou University, Yangzhou, China
| | - Jia-Wen Chen
- School of Nursing, School of Public Health, Yangzhou University, Yangzhou, China
| | - Luo-Jing Zhou
- Science and Technology Division, North Jiangsu People's Hospital of Jiangsu province, Yangzhou, China
| |
Collapse
|
7
|
Peng X, Srivastava S, Sutton F, Zhang Y, Badran BW, Kautz SA. Compensatory increase in ipsilesional supplementary motor area and premotor connectivity is associated with greater gait impairments: a personalized fMRI analysis in chronic stroke. Front Hum Neurosci 2024; 18:1340374. [PMID: 38487103 PMCID: PMC10937543 DOI: 10.3389/fnhum.2024.1340374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 02/16/2024] [Indexed: 03/17/2024] Open
Abstract
Background Balance and mobility impairments are prevalent post-stroke and a large number of survivors require walking assistance at 6 months post-stroke which diminishes their overall quality of life. Personalized interventions for gait and balance rehabilitation are crucial. Recent evidence indicates that stroke lesions in primary motor pathways, such as corticoreticular pathways (CRP) and corticospinal tract (CST), may lead to reliance on alternate motor pathways as compensation, but the current evidence lacks comprehensive knowledge about the underlying neural mechanisms. Methods In this study, we investigate the functional connectivity (FC) changes within the motor network derived from an individualized cortical parcellation approach in 33 participants with chronic stroke compared to 17 healthy controls. The correlations between altered motor FC and gait deficits (i.e., walking speed and walking balance) were then estimated in the stroke population to understand the compensation mechanism of the motor network in motor function rehabilitation post-stroke. Results Our results demonstrated significant FC increases between ipsilesional medial supplementary motor area (SMA) and premotor in stroke compared to healthy controls. Furthermore, we also revealed a negative correlation between ipsilesional SMA-premotor FC and self-selected walking speed, as well as the Functional Gait Assessment (FGA) scores. Conclusion The increased FC between the ipsilesional SMA and premotor regions could be a compensatory mechanism within the motor network following a stroke when the individual can presumably no longer rely on the more precise CST modulation of movements to produce a healthy walking pattern. These findings enhance our understanding of individualized motor network FC changes and their connection to gait and walking balance impairments post-stroke, improving stroke rehabilitation interventions.
Collapse
Affiliation(s)
- Xiaolong Peng
- Department of Psychiatry and Behavioral Sciences, Neuro-X Lab, Medical University of South Carolina, Charleston, SC, United States
| | - Shraddha Srivastava
- Ralph H. Johnson VA Medical Center, Charleston, SC, United States
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, United States
| | - Falon Sutton
- Department of Psychiatry and Behavioral Sciences, Neuro-X Lab, Medical University of South Carolina, Charleston, SC, United States
| | - Yongkuan Zhang
- Department of Psychiatry and Behavioral Sciences, Neuro-X Lab, Medical University of South Carolina, Charleston, SC, United States
| | - Bashar W. Badran
- Department of Psychiatry and Behavioral Sciences, Neuro-X Lab, Medical University of South Carolina, Charleston, SC, United States
| | - Steven A. Kautz
- Ralph H. Johnson VA Medical Center, Charleston, SC, United States
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, United States
- Division of Physical Therapy, Department of Rehabilitation Sciences, College of Health Professions, Medical University of South Carolina, Charleston, SC, United States
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Bazzi H, Cacace AT. Altered gait parameters in distracted walking: a bio-evolutionary and prognostic health perspective on passive listening and active responding during cell phone use. Front Integr Neurosci 2023; 17:1135495. [PMID: 38027460 PMCID: PMC10668124 DOI: 10.3389/fnint.2023.1135495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 08/21/2023] [Indexed: 12/01/2023] Open
Abstract
The underpinnings of bipedal gait are reviewed from an evolutionary biology and prognostic health perspective to better understand issues and concerns related to cell phone use during ambulation and under conditions of distraction and interference. We also consider gait-related health issues associated with the fear of or risk of falling and include prognostic dimensions associated with cognitive decline, dementia, and mortality. Data were acquired on 21 healthy young adults without hearing loss, vestibular, balance, otological or neurological dysfunction using a computerized walkway (GAITRite® Walkway System) combined with specialized software algorithms to extract gait parameters. Four experimental conditions and seven temporo-spatial gait parameters were studied: gait velocity, cadence, stride length, ambulatory time, single-support time, double-support time, and step count. Significant main effects were observed for ambulation time, velocity, stride velocity, and double-support time. The greatest impact of distraction and interference occurred during the texting condition, although other significant effects occurred when participants were verbally responding to queries and passively listening to a story. These experimental observations show that relatively simple distraction and interference tasks implemented through the auditory sensory modality can induce significant perturbations in gait while individuals were ambulating and using a cell phone. Herein, emphasis is placed on the use of quantifiable gait parameters in medical, psychological, and audiological examinations to serve as a foundation for identifying and potentially averting gait-related disturbances.
Collapse
Affiliation(s)
- Hassan Bazzi
- Department of Biological Sciences, Wayne State University, Detroit, MI, United States
| | - Anthony T. Cacace
- Department of Communication Sciences and Disorders, Wayne State University, Detroit, MI, United States
| |
Collapse
|
10
|
Zak M, Wasik M, Sikorski T, Aleksandrowicz K, Miszczuk R, Courteix D, Dutheil F, Januszko-Szakiel A, Brola W. Rehabilitation in Older Adults Affected by Immobility Syndrome, Aided by Virtual Reality Technology: A Narrative Review. J Clin Med 2023; 12:5675. [PMID: 37685741 PMCID: PMC10488935 DOI: 10.3390/jcm12175675] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 08/22/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
Individual mobility deficit in older adults induces a variety of medical conditions, diminishing their functional capacity in pursuing activities of daily living. In immobility syndrome patients, such conditions are prone further deterioration through a drastically reduced scope of physical activity, owing mostly to poor self-motivation and the monotonous character of conventional rehabilitation regimens. As evidenced by published research, virtual reality technology solutions in rehabilitation management actually add significantly to patients' self-motivation, while promoting their active involvement in therapy through visual, auditory, and kinaesthetic stimuli. Effective rehabilitation training aided by virtual reality solutions helps patients acquire specific physical and cognitive skills to be subsequently emulated in the real-world environment. The extra added advantage lies in facilitating such training within patients' own home environments, combined with online monitoring of their progress, when not personally supervised by a physiotherapist, which also boosts the overall cost effectiveness of the therapeutic management itself. This narrative review appears to be the very first one principally focused on critically comparing individual immobilisation with immobility syndrome, especially through the application of the Authors' own substantial hands-on therapeutic experience in managing various rehabilitation schemes, specifically aided by diverse virtual reality technology solutions.
Collapse
Affiliation(s)
- Marek Zak
- Institute of Health Sciences, Collegium Medicum, Jan Kochanowski University, Zeromskiego 5, 25-369 Kielce, Poland;
| | - Magdalena Wasik
- Doctoral School, Collegium Medicum, Jan Kochanowski University, Zeromskiego 5, 25-369 Kielce, Poland; (M.W.); (T.S.)
| | - Tomasz Sikorski
- Doctoral School, Collegium Medicum, Jan Kochanowski University, Zeromskiego 5, 25-369 Kielce, Poland; (M.W.); (T.S.)
| | - Krzysztof Aleksandrowicz
- Department of Physiotherapy, Faculty of Health Sciences, Wroclaw Medical University, T. Chałubińskiego 3, 50-368 Wroclaw, Poland;
- Institute of Heart Diseases, University Hospital, Borowska 213, 50-556 Wroclaw, Poland
| | - Renata Miszczuk
- Institute of Pedagogy, Jan Kochanowski University, Zeromskiego 5, 25-369 Kielce, Poland;
| | - Daniel Courteix
- Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions (AME2P), Université Clermont Auvergne, 63000 Clermont-Ferrand, France;
| | - Frederic Dutheil
- Occupational and Environmental Medicine, CHU, 63000 Clermont-Ferrand, France;
- Physiological and Psychosocial Stress, Université Clermont Auvergne, CNRS, LaPSCo, 63000 Clermont-Ferrand, France
| | - Aneta Januszko-Szakiel
- Institute of Information Studies, Faculty of Managment and Social Communication, Jagiellonian University, ul. Lojasiewicza 4, 30-348 Krakow, Poland;
| | - Waldemar Brola
- Institute of Health Sciences, Collegium Medicum, Jan Kochanowski University, Zeromskiego 5, 25-369 Kielce, Poland;
| |
Collapse
|
11
|
Ashizawa R, Honda H, Kameyama Y, Yoshimoto Y. Effect of Pre-Hospitalization Fall History on Physical Activity and Sedentary Behavior After the Implementation of a Behavioral Change Approach in Patients with Minor Ischemic Stroke: A Secondary Analysis of a Randomized Controlled Trial. Int J Behav Med 2023:10.1007/s12529-023-10202-0. [PMID: 37587353 DOI: 10.1007/s12529-023-10202-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND We aimed to determine whether a history of falls before admission affected physical activity levels and sedentary behavior negatively after implementing a behavior modification approach in patients with minor ischemic stroke. METHODS This study constituted a secondary analysis of an intervention trial. In the intervention study, patients with minor ischemic stroke were randomly assigned to two groups: intervention and control groups. The intervention group was encouraged to reduce sedentary behavior during hospitalization and after discharge, while the control group was encouraged to increase physical activity levels solely during hospitalization. The study included 52 patients who completed the intervention trial. The exposure factor examined was a history of falls. Upon admission, patients were queried about any falls experienced in the year preceding admission and subsequently classified into fall and non-fall groups based on their responses. The primary outcome of interest focused on changes in physical activity levels (step count, light-intensity physical activity, and moderate-to-vigorous-intensity physical activity) and sedentary behavior. Measurements were obtained at two time points: before the intervention, during hospitalization (baseline), and 3 months after discharge (post-intervention). RESULTS Only a significantly lower change in the number of steps taken in the fall group than in the non-fall group was found. CONCLUSION Those with a history of falls showed a lesser change in the number of steps taken before and after implementing a behavior change approach compared with those without a history of falls. Those with a history of falls may have engaged in activities other than walking.
Collapse
Affiliation(s)
- Ryota Ashizawa
- Department of Rehabilitation, Seirei Mikatahara General Hospital, 3453 Mikatahara-Cho, Kita-Ku, Hamamatsu-Shi, Shizuoka, 433-8558, Japan.
| | - Hiroya Honda
- Division of Rehabilitation Science, Seirei Christopher University Graduate School, Hamamatsu, Japan
- Department of Rehabilitation, Hanadaira Care Center, Hamamatsu, Japan
| | - Yuto Kameyama
- Division of Rehabilitation Science, Seirei Christopher University Graduate School, Hamamatsu, Japan
- Department of Rehabilitation, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | - Yoshinobu Yoshimoto
- Division of Rehabilitation Science, Seirei Christopher University Graduate School, Hamamatsu, Japan
| |
Collapse
|
12
|
Chiu CY, Ng MYH, Lam SC, Hui KY, Keung CH, Ouyang H, Li X, Pang MYC. Effect of physical exercise on fear of falling in patients with stroke: A systematic review and meta-analysis. Clin Rehabil 2023; 37:294-311. [PMID: 36444416 DOI: 10.1177/02692155221135028] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
OBJECTIVE To consolidate the evidence on the effect of physical exercise on fear of falling in individuals with stroke. DATA SOURCES PubMed, CINAHL, Cochrane Database and MEDLINE. METHODS An extensive database search was conducted to identify the randomised controlled trials that examined the effect of physical exercise on fear of falling post-stroke. Grading of Recommendation, Assessment, Development and Evaluation (GRADE) was used to assess the quality of evidence for each meta-analysis. RESULTS Fourteen trials totalling 1211 participants were included in this review. Thirteen of these (1180 participants) were included in the meta-analyses. In the primary analysis, very low-quality evidence suggested that exercise reduced fear of falling post-stroke (standardized mean difference (SMD) 0.48; 95% confidence interval (CI) 0.23 to 0.72). The effect was diminished at three- to six-month follow-up after exercise training ended (SMD -0.09; 95% CI -0.27 to 0.10; high-quality evidence). In the sensitivity analyses, the treatment effect was more pronounced in individuals with a lower baseline Berg balance score (BBS ≤45; SMD 0.53; 95%CI 0.17 to 0.88) and for those trials with exercise frequency of ≥3 sessions per week (SMD 0.70; 95%CI 0.39 to 1.01). Compared with circuit-based training consisting of a combination of walking, balance and strengthening exercises (SMD 0.27; 95% CI -0.09 to 0.63), walking programmes seemed to generate a larger effect on fear of falling (SMD 1.06; 95%CI 0.43 to 1.70). CONCLUSION Physical exercise was beneficial for reducing fear of falling in individuals with stroke, particularly those with poorer balance ability.
Collapse
Affiliation(s)
- Chi Yat Chiu
- Department of Rehabilitation Sciences, 26680The Hong Kong Polytechnic University, Hong Kong, China
| | - Michael Yu-Hin Ng
- Department of Rehabilitation Sciences, 26680The Hong Kong Polytechnic University, Hong Kong, China
| | - Sum Chung Lam
- Department of Rehabilitation Sciences, 26680The Hong Kong Polytechnic University, Hong Kong, China
| | - Ka Yan Hui
- Department of Rehabilitation Sciences, 26680The Hong Kong Polytechnic University, Hong Kong, China
| | - Chun Ho Keung
- Department of Rehabilitation Sciences, 26680The Hong Kong Polytechnic University, Hong Kong, China
| | - Huixi Ouyang
- Department of Rehabilitation Sciences, 26680The Hong Kong Polytechnic University, Hong Kong, China
| | - Xun Li
- Department of Rehabilitation Sciences, 26680The Hong Kong Polytechnic University, Hong Kong, China
| | - Marco Yiu-Chung Pang
- Department of Rehabilitation Sciences, 26680The Hong Kong Polytechnic University, Hong Kong, China
| |
Collapse
|
13
|
Dada OO, Akingbesote JJ. Fear of falling, meaningful activity participation and community reintegration among stroke survivors in southwest Nigeria: a cross-sectional study. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2023. [DOI: 10.12968/ijtr.2022.0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Background/Aims Community reintegration remains one of the most important goals of rehabilitation. The aim of this study was to investigate the relationships between fear of falling, meaningful activity participation and community reintegration of community-dwelling stroke survivors. Methods The Fall Efficacy Scale-International, Engagement in Meaningful Activities Survey and Reintegration to Normal Living Index were used to assess fear of falling, meaningful activity participation and community reintegration respectively among self-ambulant stroke survivors receiving treatment in physiotherapy outpatient clinics. The study was a cross-sectional survey. Tests of relationships, regression and association were performed with a level of significance set at P<0.05. Results A significant relationship was found between fear of falling and community reintegration (r=−0.27; P=0.01; 95% confidence interval=−0.53 to 0.04); meaningful activity participation and community reintegration (r=0.72; P=0.001; 95% CI=0.48 to 0.89) and fear of falling and meaningful activity participation (r=−0.71; P=0.53; 95% CI=−0.32 to 0.24). Older participants had lower levels of community reintegration and meaningful activity participation. A significant association was found between fear of falling and fall history (P=0.02); increased falls meant higher levels of fear of falling. Sex and duration of stroke had no significant impact on fear of falling, meaningful activity participation and community reintegration. Meaningful activity participation was the strongest predictor of community reintegration (β=1.7; 95% CI=1.30 to 2.11; P=0.001). Conclusions Fear of falling might limit participation in meaningful activity and community integration among stroke survivors. These parameters should be assessed by allied health professionals during stroke rehabilitation.
Collapse
|
14
|
Kim KI, Im SC, Kim K. Effects of trunk stabilization exercises using laser pointer visual feedback in patients with chronic stroke: A randomized controlled study. Technol Health Care 2023; 31:471-483. [PMID: 36120797 DOI: 10.3233/thc-220100] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Many previous studies have cited the importance of trunk stabilization exercises in patients with stroke. However, the evidence for optimal trunk stabilization exercises for patients with stroke is still lacking. OBJECTIVE To investigate the effects of laser pointer visual feedback in trunk stabilization exercises that are important for improving trunk dysfunction in patients with stroke. METHODS In total, 30 patients with chronic stroke were randomly assigned to experimental and control groups. The experimental group underwent a traditional stroke rehabilitation program and trunk stabilization exercises using laser pointer visual feedback. The control group underwent a traditional stroke rehabilitation program and trunk stabilization exercises without visual feedback. Pre- and postintervention results after 6 weeks were evaluated using the Berg Balance Scale, static and dynamic plantar pressure, 10-m walk test, and the Korean version of the Fall Efficacy Scale. The results were analyzed using a general linear repeated measurement model. RESULTS Both groups showed significant improvements in BBS scores, static plantar pressure, dynamic plantar pressure, 10 MWT, and K-FES scores after 6 weeks of intervention (P< 0.05). Compared to the control group, significant improvements were observed in the experimental group in the Berg Balance Scale scores, dynamic paretic posterior plantar pressure, 10-m walk test, and Korean version of the Fall Efficacy Scale scores (P< 0.025). CONCLUSION Our results demonstrated the effectiveness of visual feedback during trunk stabilization exercises for resolving trunk dysfunction in patients with stroke. Trunk stabilization exercises using laser pointer visual feedback have been found to be more effective in balance, walking, and fall efficacy in patients with stroke.
Collapse
|
15
|
Wang I, Li PC, Lee SC, Lee YC, Wang CH, Hsieh CL. Development of a Berg Balance Scale Short-Form Using a Machine Learning Approach in Patients With Stroke. J Neurol Phys Ther 2023; 47:44-51. [PMID: 36047823 DOI: 10.1097/npt.0000000000000417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND PURPOSE The Berg Balance Scale (BBS) is frequently used in routine clinical care and research settings and has good psychometric properties. This study was conducted to develop a short form of the BBS using a machine learning approach (BBS-ML). METHODS Data of 408 individuals poststroke were extracted from a published database. The initial (ie, 4-, 5-, 6-, 7-, and 8-item) versions were constructed by selecting top-ranked items based on the feature selection algorithm in the artificial neural network model. The final version of the BBS-ML was chosen by selecting the short form that used a smaller number of items to achieve a higher predictive power R2 , a lower 95% limit of agreement (LoA), and an adequate possible scoring point (PSP). An independent sample of 226 persons with stroke was used for external validation. RESULTS The R2 values for the initial 4-, 5-, 6-, 7-, and 8-item short forms were 0.93, 0.95, 0.97, 0.97, and 0.97, respectively. The 95% LoAs were 14.2, 12.2, 9.7, 9.6, and 8.9, respectively. The PSPs were 25, 35, 34, 35, and 36, respectively. The 6-item version was selected as the final BBS-ML. Preliminary external validation supported its performance in an independent sample of persons with stroke ( R2 = 0.99, LoA = 10.6, PSP = 37). DISCUSSION AND CONCLUSIONS The BBS-ML seems to be a promising short-form alternative to improve administrative efficiency. Future research is needed to examine the psychometric properties and clinical usage of the 6-item BBS-ML in various settings and samples.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A402 ).
Collapse
Affiliation(s)
- Inga Wang
- Department of Rehabilitation Sciences & Technology (I.W.), University of Wisconsin-Milwaukee, Milwaukee, Wisconsin; School of Occupational Therapy (P.-C.L., S.-C.L., C.-L.H.), College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Occupational Therapy (S.-C.L.), College of Medicine, National Cheng Kung University, Tainan City, Taiwan; Department of Occupational Therapy (Y.-C.L., C.-L.H.), College of Medical and Health Science, Asia University, Taichung, Taiwan; Institute of Long-Term Care (S.-C.L.), MacKay Medical College, New Taipei City, Taiwan; Department of Physical Therapy (C.-H.W.) and Physical Therapy Room (C.-H.W.), Chung Shan Medical University Hospital, Taichung, Taiwan; and Department of Physical Medicine and Rehabilitation (C.-L.H.), National Taiwan University Hospital, Taipei, Taiwan
| | | | | | | | | | | |
Collapse
|
16
|
Liu K, Peng W, Ge S, Li C, Zheng Y, Huang X, Liu M. Longitudinal associations of concurrent falls and fear of falling with functional limitations differ by living alone or not. Front Public Health 2023; 11:1007563. [PMID: 37124793 PMCID: PMC10131081 DOI: 10.3389/fpubh.2023.1007563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 02/22/2023] [Indexed: 05/02/2023] Open
Abstract
Background Falls and fear of falling (FOF) are independent risk factors for functional limitations in older adults. However, the combined effect of falls and FOF on functional limitations and the moderating role of living alone or not is unclear. We aimed to examine (1) the independent and combined effect of falls and FOF on functional limitations in older adults and (2) whether living alone moderates these associations. Methods We used data from the National Health and Aging Trends Study (NHATS) and included 5,950 U.S. community-dwelling older adults aged 65 and older from Round 1 (Year 2011) and Round 2 (Year 2012). Falls and FOF were ascertained by asking participants whether they had any falls in the last year and whether they had worried about falling in the previous month at R1. Assessed functional limitations included any difficulties with mobility, self-care, or household activities at R2. Poisson regression models were used to examine the longitudinal associations of falls and FOF with functional limitations and the moderation effects of baseline living alone. Results Of the 5,950 participants, 16.3% had falls only; 14.3% had FOF only; 14.3% had both, and 55.1% had neither at baseline. In the adjusted model, those who experienced concurrent falls and FOF in R1 had a higher risk of functional limitations at R2 than those with neither (Mobility: Incidence risk ratio [IRR] = 1.34, 95% CI: 1.24-1.45; Self-care: IRR = 1.18, 95% CI: 1.11-1.26; Household: IRR = 1.20, 95% CI: 1.11-1.30). Moreover, living alone significantly moderated the longitudinal associations of concurrent falls and FOF with mobility activity limitations. Conclusion The findings suggest that strategies to improve falls and FOF together could potentially help prevent functional limitations. Older adults who live with others and have falls or FOF should receive interventions to promote their mobility activities.
Collapse
Affiliation(s)
- Kehan Liu
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Wenting Peng
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Song Ge
- Department of Natural Sciences, University of Houston-Downtown, Houston, TX, United States
| | - Chunxiao Li
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Yu Zheng
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Xiaoting Huang
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Minhui Liu
- Xiangya School of Nursing, Central South University, Changsha, China
- *Correspondence: Minhui Liu ; @MinhuiLiu2
| |
Collapse
|
17
|
Kudelka J, Geritz J, Welzel J, Hildesheim H, Maetzler C, Emmert K, Niemann K, Hobert MA, Pilotto A, Bergmann P, Maetzler W. What contributes most to the SPPB and its subscores in hospitalized geriatric patients: an ICF model-based approach. BMC Geriatr 2022; 22:668. [PMID: 35963992 PMCID: PMC9375907 DOI: 10.1186/s12877-022-03358-z] [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: 04/23/2022] [Accepted: 08/02/2022] [Indexed: 11/26/2022] Open
Abstract
Background Mobility deficits are highly prevalent among geriatric patients and have serious impact on quality of life, hospitalizations, and mortality. This study aims to capture predictors of mobility deficits in hospitalized geriatric patients using the International Classification of Functioning, Disability and Health (ICF) model as a framework. Methods Data were obtained from n = 397 patients (78 ± 7 years, 15 ± 7 ICD-11 diagnoses) on a geriatric ward at time of admission. Mobility was assessed using the Short Physical Performance Battery (SPPB) total score and gait, static balance and transfer subscores. Parameters from an extensive assessment including medical history, neuropsychological and motor examination, and questionnaires were assigned to the five components of the ICF model. Spearman’s Correlation and multiple linear regression analyses were calculated to identify predictors for the SPPB total score and subscores. Results Use of walking aid, fear of falling (FOF, but not occurrence of previous falls), participation in society, ADL and grip strength were strongly associated with the SPPB total score and all subscores (p < .001). FOF and grip strength were significant predictors for the SPPB total score as well as for gait and transfer subscores. FOF also showed a strong association with the static balance subscore. The clinical parameters of the ICF model could only partially explain the variance in the SPPB total score (24%) and subscores (12–23%), with no parameter from the activities and participation component being significantly predictive. Conclusions FOF and reduced grip strength are associated with mobility deficits in a hospitalized geriatric cohort. Further research should focus on interventions to reduce FOF and increase muscle strength in geriatric patients. Moreover, there is a need for ICF-based assessments instruments (especially in the activities and participation components) that allow a holistic view on mobility and further daily life-relevant health aspects in geriatric patients.
Collapse
Affiliation(s)
- Jennifer Kudelka
- Department of Neurology, University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, 24105, Kiel, Germany.
| | - Johanna Geritz
- Department of Neurology, University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Julius Welzel
- Department of Neurology, University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Hanna Hildesheim
- Department of Neurology, University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Corina Maetzler
- Department of Neurology, University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Kirsten Emmert
- Department of Neurology, University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Katharina Niemann
- Department of Neurology, University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Markus A Hobert
- Department of Neurology, University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Andrea Pilotto
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy
| | - Philipp Bergmann
- Department of Internal Medicine I, University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Walter Maetzler
- Department of Neurology, University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| |
Collapse
|
18
|
Ares-Benitez I, Billot M, Rigoard P, Cano-Bravo F, David R, Luque-Moreno C. Feasibility, acceptability and effects of dance therapy in stroke patients: A systematic review. Complement Ther Clin Pract 2022; 49:101662. [DOI: 10.1016/j.ctcp.2022.101662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 08/06/2022] [Accepted: 08/18/2022] [Indexed: 11/03/2022]
|
19
|
Receiver Operating Characteristic Curve Analysis of the Somatosensory Organization Test, Berg Balance Scale, and Fall Efficacy Scale–International for Predicting Falls in Discharged Stroke Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159181. [PMID: 35954533 PMCID: PMC9368624 DOI: 10.3390/ijerph19159181] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/13/2022] [Accepted: 07/24/2022] [Indexed: 11/30/2022]
Abstract
Background: Although fall prevention in patients after stroke is crucial, the clinical validity of fall risk assessment tools is underresearched in this population. The study aim was to determine the cut-off scores and clinical validity of the Sensory Organization Test (SOT), the Berg Balance Scale (BBS), and the Fall Efficacy Scale–International (FES-I) in patients after stroke. Methods: In this prospective cross-sectional study, we analyzed data for patients admitted to a rehabilitation unit after stroke from 2018 through 2021. Participants underwent SOT, BBS, and FES-I pre-discharge, and the fall incidence was recorded for 6 months. We used an area under the receiver operating characteristic curve (AUC) to calculate predictive values. Results: Of 84 included patients (median age 68.5 (interquartile range 67–71) years), 32 (38.1%) suffered a fall. All three tests were significantly predictive of fall risk. Optimal cut-off scores were 60 points for SOT (AUC 0.686), 35 and 42 points for BBS (AUC 0.661 and 0.618, respectively), and 27 and 29 points for FES-I (AUC 0.685 and 0.677, respectively). Conclusions: Optimal cut-off scores for SOT, BBS, and FES-I were determined for patients at risk for falls after a stroke, which all three tools classified with a good discriminatory ability.
Collapse
|
20
|
Xie Q, Pei J, Gou L, Zhang Y, Zhong J, Su Y, Wang X, Ma L, Dou X. Risk factors for fear of falling in stroke patients: a systematic review and meta-analysis. BMJ Open 2022; 12:e056340. [PMID: 35772831 PMCID: PMC9247667 DOI: 10.1136/bmjopen-2021-056340] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Even though 32%-83% for fear of falling (FoF) in patients with stroke, very little is known about the predictors of the problems. Therefore, we systematically reviewed the literature on risk factors for FoF in patients with stroke. DESIGN A systematic review and meta-analysis DATA SOURCES: PubMed, Embase, Cochrane Library database, Web of Science, CINAHL, PsycINFO, Grey literature and other relevant databases for related publications were searched (from inception to 17 July 2021). RESULTS Eight studies involving 1597 participants were selected to analyse risk factors for patients with stroke with FoF. The quality of all included studies was assessed and categorised as medium or high quality. Review Manager V.5.3 merged the OR value and 95% CI of the potential risk factors. Meta-regression and Egger's test were performed by Stata V.15.1. The risk factors for FoF in patients with stroke were women (OR=2.13, 95% CI 1.47 to 3.09), impaired balance ability (OR=5.54; 95% CI 3.48 to 8.81), lower mobility (OR=1.12; 95% CI 1.05 to 1.19), history of falls (OR=2.33; 95% CI 1.54 to 3.53) and walking aid (OR=1.98; 95% CI 1.37 to 2.88), anxiety (OR=2.29; 95% CI 1.43 to 3.67), depression (OR=1.80; 95% CI 1.22 to 2.67), poor lower limb motor function (OR=1.14; 95% CI 1.00 to 1.29) and physically inactiveness (OR=2.04; 95% CI 1.01 to 4.12). Measurement of heterogeneity between studies was high for all outcomes (I2 =0%-93%), indicating that the substantial interstudy heterogeneity in estimated proportions was not attributed to the sampling error. Sensitivity analysis (leave-one-out method) showed that the pooled estimate was stable. CONCLUSION This meta-analysis indicated that female population, impaired balance ability, lower mobility, history of falls and walking aid in patients with stroke might be at greater risk for FoF. Future studies are recommended to determine other risk factors specific to patients with stroke.
Collapse
Affiliation(s)
- Qi Xie
- School of Nursing, Lanzhou University, Lanzhou, Gansu, China
| | - Juhong Pei
- The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China
| | - Ling Gou
- Department of Nursing, Qinghai Provincial People's Hospital, Xining, Qinghai, China
| | - Yabin Zhang
- Neurological Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Juanping Zhong
- School of Nursing, Lanzhou University, Lanzhou, Gansu, China
- Medical Department of Neurology, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Yujie Su
- School of Nursing, Lanzhou University, Lanzhou, Gansu, China
| | - Xinglei Wang
- Department of Liver Diseases Branch, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Li Ma
- School of Nursing, Lanzhou University, Lanzhou, Gansu, China
| | - Xinman Dou
- School of Nursing, Lanzhou University, Lanzhou, Gansu, China
- Department of Nursing, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| |
Collapse
|
21
|
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.
Collapse
|
22
|
Fukata K, Amimoto K, Inoue M, Sekine D, Fujino Y, Makita S, Takahashi H. Immediate effect of standing and sit-to-stand training on postural vertical for backward disequilibrium following stroke: a case report. Physiother Theory Pract 2022:1-9. [DOI: 10.1080/09593985.2022.2037031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Kazuhiro Fukata
- Department of Rehabilitation Center, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Kazu Amimoto
- Department of Physical Therapy, Faculty of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Masahide Inoue
- Department of Rehabilitation Center, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
- Department of Physical Therapy, Faculty of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Daisuke Sekine
- Department of Rehabilitation Center, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
- Department of Physical Therapy, Faculty of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Yuji Fujino
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo, Japan
| | - Shigeru Makita
- Department of Rehabilitation, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Hidetoshi Takahashi
- Department of Rehabilitation, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| |
Collapse
|
23
|
Risk Factors and Characteristics of Falls Among Hospitalized Stroke Patients. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2022. [DOI: 10.2478/sjecr-2019-0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Falls and fall-related injuries during hospitalization may cause serious problems and consequences for patients, their quality of life as well as increased healthcare expenses. The aim of the paper were to assess fall risks and identify risk factors, related to falls among stroke patients. This was a retrospective cohort study that included 217 neurological patients with acute stroke who have experienced fall during hospitalization. Morse Fall Scale was used to estimate a likelihood of falling for hospitalized patients. In total, 1.4% patients with acute stroke experienced a fall during hospitalization. According to the fall risk assessment, 77% of the patients presented a high risk for falls. Women, older respondents and those who were hospitalized for period longer than 22 days and who had higher levels of care, had higher values of Morse score. The most common risk factors for falls are: the presence of other medical diagnosis, the use of disability aids while walking, the use of intravenous therapy, disorientation in time and space, and the largest contribution to Morse score comes from using disability aids while walking and transferring patients. Greater risk of falling was observed in older neurological patients with ischemic type of stroke and weakness on the left side of the body, patients with longer hospitalization period and those with higher level of care.
Collapse
|
24
|
Taryudi T, Lindayani L, Purnama H, Mutiar A. Smart bed notification system base on Internet of Things for fall prevention in patients with stroke. J Med Eng Technol 2022; 46:89-94. [DOI: 10.1080/03091902.2021.2002447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Taryudi Taryudi
- Depertment of Electrical Engineering, Faculty of Engineering, Univeristas Negeri Jakarta, Jakarta, Indonesia
| | - Linlin Lindayani
- Department of Nursing, Sekolah Tinggi Ilmu Keperawatan PPNI Jawa Barat, Bandung, Indonesia
| | - Heni Purnama
- Department of Nursing, Sekolah Tinggi Ilmu Keperawatan PPNI Jawa Barat, Bandung, Indonesia
| | - Astri Mutiar
- Department of Nursing, Sekolah Tinggi Ilmu Keperawatan PPNI Jawa Barat, Bandung, Indonesia
| |
Collapse
|
25
|
Su Q, Gao Y, Zhang J, Tang J, Song M, Song J, Mao Y, Pi H. Prevalence of Fear of Falling and Its Association With Physical Function and Fall History Among Senior Citizens Living in Rural Areas of China. Front Public Health 2022; 9:766959. [PMID: 35004579 PMCID: PMC8733240 DOI: 10.3389/fpubh.2021.766959] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/29/2021] [Indexed: 10/28/2022] Open
Abstract
Background: Fear of falling (FOF) is as significant as a fall, leading to limited physical activity and poor quality of life among senior citizens. This study aimed to investigate the prevalence of FOF and its association with physical function and fall history among the senior citizens (≥75 years old) living in rural areas of China. Methods: This was a cross-sectional study conducted in eastern China from June to October 2019. All elderly participants were recruited during their attendance for the free health examinations in villages and towns organized by the local healthcare authorities. Data on sociodemographics, fall history, FOF conditions, self-reported comorbidity and regular medications were collected by face-to-face interview, and the physical function status was evaluated through a field test. Univariate and multivariate analyses were performed to compare the differences in physical function and fall history of senior citizens with/without FOF. Results: A total of 753 senior citizens (mean age = 79.04) participated in this study. Of these, 63.5% were aged 75-80. FOF was reported in 22.8% of the participants, while 18.5% had a fall in the past year. Among the senior citizens with and without a fall history, the prevalences of FOF were 38.8 and 19.2%, respectively. On multivariate analyses, FOF was independently associated with the Time Up and Go Test (TUG) duration (OR = 1.080; 95% CI: 1.034-1.128), 4-Stage Balance Test score (OR = 0.746; 95% CI: 0.597-0.931), fall history (OR = 2.633; 95% CI: 1.742-3.980), cerebral apoplexy (OR = 2.478; 95% CI: 1.276-4.813) and comorbidities (≥2) (OR = 1.637; 95% CI: 1.066-2.514), while the correlation between FOF and the 30-s chair stand test was only statistically significant in univariate analysis (Z = -3.528, p < 0.001). Conclusion: High prevalence of FOF is observed among the senior citizens living in rural areas of China. FOF is strongly correlated with physical function performance and fall history. Therefore, the implementation of targeted FOF prevention measures is key to improve the physical activity of the senior citizens, which would ultimately lead to fall prevention and improved quality of life.
Collapse
Affiliation(s)
- Qingqing Su
- Medical School of Chinese PLA, Beijing, China
| | - Yuan Gao
- Department of Nursing, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jie Zhang
- Department of Nursing, The Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jingping Tang
- Department of Rheumatology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Mi Song
- Medical School of Chinese PLA, Beijing, China
| | - Jie Song
- Medical School of Chinese PLA, Beijing, China
| | - Yazhan Mao
- Medical School of Chinese PLA, Beijing, China
| | - Hongying Pi
- Medical Service Training Center, Chinese PLA General Hospital, Beijing, China
| |
Collapse
|
26
|
Kjeverud A, Andersson S, Lerdal A, Schanke AK, Østlie K. A cross-sectional study exploring overlap in post-stroke fatigue caseness using three fatigue instruments: Fatigue Severity Scale, Fatigue Questionnaire and the Lynch's Clinical Interview. J Psychosom Res 2021; 150:110605. [PMID: 34517302 DOI: 10.1016/j.jpsychores.2021.110605] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/27/2021] [Accepted: 08/30/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Post stroke fatigue (PSF) is a frequent symptom affecting 25-73% of stroke survivors. The variability in estimates of prevalence found across studies reflects differences in fatigue measures and use of different cut-offs for defining clinically significant fatigue. The main aim of this study is to explore the frequency and overlap in caseness of fatigue using three different fatigue measures in a sample of patients at 3 months post stroke. Furthermore, we wanted to explore the instrument's associations with demographic and clinical characteristics. METHODS The sample consists of 93 patients with new onset stroke. This cross-sectional study includes three measurements of fatigue, The Fatigue Severity Scale (FSS), The Chalder Fatigue Questionnaire (FQ) and the Lynch Interview. Medical, physical, psychological data and estimates of pre-stroke fatigue were collected 3 months post stroke. RESULTS The FQ using the bimodal scoring yielded about 2.5 more fatigue cases (n = 57) than the FSS with a cut-off mean score of 5 (n = 22). The Lynch interview identified 48 patients as fatigue cases. Conducting multivariate analyses, the three instruments were differently associated with predictor variables such as prestroke fatigue, reduced balance and burden of symptoms reported post stroke. CONCLUSION The use of different instruments leads to a large variability in identifying fatigue cases in a sample of stroke patients. Scientifically and clinically a clarification and consensus on how to measure fatigue is warranted. Without correct identification of PSF-cases, knowledge about the causes of fatigue and development of tailored and interdisciplinary interventions are further delayed.
Collapse
Affiliation(s)
- Anita Kjeverud
- Department of Physical Medicine and Rehabilitation, Innlandet Hospital Trust, Ottestad, Norway.
| | | | - Anners Lerdal
- Research Department, Lovisenberg Diaconal Hospital, Oslo, Norway; Department of Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Norway
| | - Anne-Kristine Schanke
- Department of Psychology, University of Oslo, Norway; Research Department, Sunnaas Rehabilitation Hospital, Nesodden, Norway
| | - Kristin Østlie
- Department of Physical Medicine and Rehabilitation, Innlandet Hospital Trust, Ottestad, Norway
| |
Collapse
|
27
|
Lee JT, Park E, Jung TD. Machine Learning-Based Classification of Dependence in Ambulation in Stroke Patients Using Smartphone Video Data. J Pers Med 2021; 11:jpm11111080. [PMID: 34834432 PMCID: PMC8623599 DOI: 10.3390/jpm11111080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 10/21/2021] [Accepted: 10/22/2021] [Indexed: 01/12/2023] Open
Abstract
The goal of this study was to develop a framework to classify dependence in ambulation by employing a deep model in a 3D convolutional neural network (3D-CNN) using video data recorded by a smartphone during inpatient rehabilitation therapy in stroke patients. Among 2311 video clips, 1218 walk action cases were collected from 206 stroke patients receiving inpatient rehabilitation therapy (63.24 ± 14.36 years old). As ground truth, the dependence in ambulation was assessed and labeled using the functional ambulatory categories (FACs) and Berg balance scale (BBS). The dependent ambulation was defined as a FAC score less than 4 or a BBS score less than 45. We extracted patient-centered video and patient-centered pose of the target from the tracked target’s posture keypoint location information. Then, the extracted patient-centered video was input in the 3D-CNN, and the extracted patient-centered pose was used to measure swing time asymmetry. Finally, we evaluated the classification of dependence in ambulation using video data via fivefold cross-validation. When training the 3D-CNN based on FACs and BBS, the model performed with 86.3% accuracy, 87.4% precision, 94.0% recall, and 90.5% F1 score. When the 3D-CNN based on FACs and BBS was combined with swing time asymmetry, the model exhibited improved performance (88.7% accuracy, 89.1% precision, 95.7% recall, and 92.2% F1 score). The proposed framework for dependence in ambulation can be useful, as it alerts clinicians or caregivers when stroke patients with dependent ambulatory move alone without assistance. In addition, monitoring dependence in ambulation can facilitate the design of individualized rehabilitation strategies for stroke patients with impaired mobility and balance function.
Collapse
Affiliation(s)
- Jong Taek Lee
- Artificial Intelligence Application Research Section, Electronics and Telecommunications Research Institute (ETRI), Daegu 42994, Korea;
| | - Eunhee Park
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Korea;
- Department of Rehabilitation Medicine, Kyungpook National University Chilgok Hospital, Daegu 41404, Korea
| | - Tae-Du Jung
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Korea;
- Department of Rehabilitation Medicine, Kyungpook National University Chilgok Hospital, Daegu 41404, Korea
- Correspondence: ; Tel.: +82-53-200-2167
| |
Collapse
|
28
|
Driver S, Douglas M, Reynolds M, McShan E, Swank C, Dubiel R. A narrative review of biopsychosocial factors which impact overweight and obesity for individuals with acquired brain injury. Brain Inj 2021; 35:1075-1085. [PMID: 34324396 DOI: 10.1080/02699052.2021.1953596] [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: 10/20/2022]
Abstract
Primary Objective: To discuss the biopsychosocial factors that affect being overweight or obese after acquired brain injury (ABI)Research Design: Narrative reviewMethods and Procedures: Based on the biopsychosocial model, we discuss the unique injury-specific factors that can affect bring overweight or obese among individuals with ABI including: (1) biological, (2) psychological and (3) social/ecological factors.Main Outcomes and Results: Injury-specific factors that impact being overweight or obese following ABI include endocrine dysfunction, pain, bowel and bladder incontinence, balance problems and motor impairment, medications, sleep quality and fatigue, alcohol and tobacco use, psychological disorders and symptoms, cognitive changes, social support, isolation, participation, transportation, independence, and knowledge. These factors may also compound general factors impacting weight management, making it difficult for individuals with ABI to maintain a healthy lifestyle.Conclusions: It is important to recognize the biopsychosocial factors that impact weight-loss and lifestyle change after ABI so that interventions can be tailored to meet individuals' unique needs. Empirical research is needed to better understand how biopsychosocial factors interact and impact overweight/ obesity after ABI.
Collapse
Affiliation(s)
- Simon Driver
- Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation, Dallas, Texas, United States of America
| | - Megan Douglas
- Rehabilitation Research Department, Baylor Scott and White Research Institute, Dallas, Texas
| | - Megan Reynolds
- Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation, Dallas, Texas, United States of America
| | - Evan McShan
- Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation, Dallas, Texas, United States of America
| | - Chad Swank
- Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation, Dallas, Texas, United States of America
| | - Randi Dubiel
- Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation, Dallas, Texas, United States of America
| |
Collapse
|
29
|
Ghorbanpour Z, Taghizadeh G, Hosseini SA, Pishyareh E, Ghomsheh FT, Bakhshi E, Mehdizadeh H. Overload of anxiety on postural control impairments in chronic stroke survivors: The role of external focus and cognitive task on the automaticity of postural control. PLoS One 2021; 16:e0252131. [PMID: 34292945 PMCID: PMC8297887 DOI: 10.1371/journal.pone.0252131] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 05/10/2021] [Indexed: 11/23/2022] Open
Abstract
Background Despite the high prevalence of anxiety among chronic stroke survivors and evidence of its negative effects on postural control in healthy subjects, it is unclear whether anxiety also affects postural control in these patients. Recent evidence of improved postural control of healthy subjects by distracting the attention using an external focus (EF) or cognitive task, raises the question of whether similar benefits would be observed in stroke survivors. Thus, the current study aimed to investigate the effects of anxiety and distracting the attention on postural control of chronic stroke survivors in terms of both postural sway measures and neuromuscular regulation. Methods Postural sway measures and ankle muscle activity of chronic stroke survivors with the high and low level of anxiety (HA-stroke (n = 17), and LA-stroke (n = 17), respectively) and age-, sex-, height-, and weight-matched healthy subjects (n = 17) were assessed while standing on rigid and foam surfaces under following conditions: baseline, internal focus (IF), EF, simple and hard cognitive tasks (SC and HC, respectively). Results Stroke survivors, particularly HA-stroke participants, showed greater postural sway measures (i.e. postural instability) and enhanced co-contraction of ankle muscles (i.e. stiffening of the neuromuscular system) compared with healthy subjects. As opposed to baseline and IF conditions, postural instability and neuromuscular stiffening significantly reduced in EF condition and decreased more in cognitive task conditions, particularly HC condition. Conclusions The results suggest that anxiety enhances stroke-induced postural instability promoting improper neuromuscular control of posture with stiffening strategy, which can be alleviated by EF and cognitive tasks.
Collapse
Affiliation(s)
- Zahra Ghorbanpour
- Department of Occupational Therapy, School of Rehabilitation Sciences, University of Social Welfare and Rehabilitation Sciences (USWR), Tehran, Iran
| | - Ghorban Taghizadeh
- Department of Occupational Therapy, Rehabilitation Research Center, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Ali Hosseini
- Department of Occupational Therapy, School of Rehabilitation Sciences, University of Social Welfare and Rehabilitation Sciences (USWR), Tehran, Iran
| | - Ebrahim Pishyareh
- Department of Occupational Therapy, School of Rehabilitation Sciences, University of Social Welfare and Rehabilitation Sciences (USWR), Tehran, Iran
- * E-mail:
| | - Farhad Tabatabai Ghomsheh
- Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences (USWR), Tehran,Iran
| | - Enayatollah Bakhshi
- Department of Biostatistics and Epidemiology, University of Social Welfare and Rehabilitation Sciences (USWR), Tehran,Iran
| | - Hajar Mehdizadeh
- Department of Neurosciences, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| |
Collapse
|
30
|
Hussain N, Hansson PO, Persson CU. Prediction of fear of falling at 6 months after stroke based on 279 individuals from the Fall Study of Gothenburg. Sci Rep 2021; 11:13503. [PMID: 34188105 PMCID: PMC8241879 DOI: 10.1038/s41598-021-92546-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 06/07/2021] [Indexed: 12/14/2022] Open
Abstract
The early identification of individuals at risk of fear of falling after stroke is crucial in order to individualise preventive actions and interventions. The aim of this study was to identify the incidence of, and baseline factors in acute stroke that are associated with fear of falling at 6 months after stroke. Fear of falling was assessed by one question, which was answered by 279 of 452 eligible individuals. Univariable and multivariable logistic regression analyses were performed to determine the factors that were associated with fear of falling. The dependent variable was fear of falling at 6 months after stroke. The independent variables were related to function, activity and participation, including personal and environmental factors. Fear of falling was reported by 117 (41.9%) individuals. Poor postural control in acute stroke, measured using the modified version of the Postural Assessment Scale for Stroke Patients (odds ratio [OR]: 2.60, 95% confidence interval [CI]: 1.26–5.36), and being physically inactive prior to the stroke, measured using the Saltin-Grimby Physical Activity Scale (OR: 2.04, 95% CI: 1.01–4.12), were found to be associated with fear of falling at 6 months after stroke. The findings in this study are useful in clinical practice to optimise rehabilitation after stroke.
Collapse
Affiliation(s)
- Netha Hussain
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital/Östra, Gothenburg, Region Västra Götaland, Sweden.
| | - Per-Olof Hansson
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden and Sahlgrenska University Hospital, Gothenburg, Region Västra Götaland, Sweden
| | - Carina U Persson
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital/Östra, Gothenburg, Region Västra Götaland, Sweden.,Department of Clinical Neuroscience, Rehabilitation Medicine, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Region Västra Götaland, Sweden
| |
Collapse
|
31
|
Tan GJ, Tan MP, Luben RN, Wareham NJ, Khaw KT, Myint PK. The relationship between alcohol intake and falls hospitalization: Results from the EPIC-Norfolk. Geriatr Gerontol Int 2021; 21:657-663. [PMID: 34156750 DOI: 10.1111/ggi.14219] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 05/24/2021] [Accepted: 06/07/2021] [Indexed: 01/10/2023]
Abstract
AIM To evaluate the relationship between habitual alcohol consumption and the risk of falls hospitalization. METHODS The EPIC-Norfolk is a prospective population-based cohort study in Norfolk, UK. In total, 25 637 community dwelling adults aged 40-79 years were recruited. Units of alcohol consumed per week were measured using a validated Food Frequency Questionnaire. The main outcome was the first hospital admission following a fall. RESULTS Over a median follow-up period of 11.5 years (299 211 total person years), the cumulative incidence function (95% confidence interval) of hospitalized falls at 121-180 months for non-users, light (>0 to ≤7 units/week), moderate (>7 to ≤28 units/week) and heavy (>28 units/week) were 11.08 (9.94-12.35), 7.53 (7.02-8.08), 5.91 (5.29-6.59) and 8.20 (6.35-10.56), respectively. Moderate alcohol consumption was independently associated with a reduced risk of falls hospitalization after adjustment for most major confounders (hazard ratio = 0.88; 95% confidence interval 0.79-0.99). The relationship between light alcohol consumption and falls hospitalization was attenuated by gender differences. Alcohol intake higher than the recommended threshold of 28 units/week was associated with an increased risk of falls hospitalization (hazard ratio 1.40 [1.14-1.73]). CONCLUSIONS Moderate alcohol consumption appears to be associated with a reduced risk of falls hospitalization, and intake above the recommended limit is associated with an increased risk. This provides incentive to limit alcohol consumption within the recommended range and has important implications for public health policies for aging populations. Geriatr Gerontol Int 2021; 21: 657-663.
Collapse
Affiliation(s)
- Guo Jeng Tan
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Maw Pin Tan
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Department of Medical Sciences, Faculty of Healthcare and Medical Sciences, Sunway University, Bandar Sunway, Malaysia
| | - Robert N Luben
- Clinical Gerontology Unit, Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge
- Cambridge, UK
| | | | - Kay-Tee Khaw
- Clinical Gerontology Unit, Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge
- Cambridge, UK
| | - Phyo Kyaw Myint
- Ageing Clinical & Experimental Research (ACER) Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| |
Collapse
|
32
|
Ahmad Ainuddin H, Romli MH, Hamid TA, SF Salim M, Mackenzie L. An Exploratory Qualitative Study With Older Malaysian Stroke Survivors, Caregivers, and Healthcare Practitioners About Falls and Rehabilitation for Falls After Stroke. Front Public Health 2021; 9:611814. [PMID: 33987161 PMCID: PMC8110702 DOI: 10.3389/fpubh.2021.611814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 03/23/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Studies on rehabilitation for falls after a stroke remain limited despite its impact being profound. This scenario justifies a deeper understanding of why falls in stroke rehabilitation received less attention. Current investigations on the perception of falls and stroke also proved inadequate. Therefore, this study aims to explore the perceptions and experiences of older Malaysian stroke survivors, spousal caregivers, and healthcare practitioners on falls in stroke rehabilitation. Method: A qualitative study of three focus groups with 18 individuals from one community-based stroke rehabilitation center was conducted. The discussions were audio-recorded, video-recorded, transcribed, summarized, and analyzed using thematic analysis. Results: Three themes emerged from the analysis: (i) perceived factors and consequences of falls after stroke, (ii) physical-based interventions predominate in rehabilitation for falls after stroke, and (iii) the role of home hazards in fall prevention is taken for granted. Although, awareness of falls is high, they are regarded as a peripheral issue in stroke. Rehabilitation interventions such as improved functionality are believed to be adequate and can indirectly prevent falls. Other interventions for fall prevention such as home hazards management are relatively less known. Conclusion: There is a need for more attention regarding home environment risk assessment and intervention among healthcare professionals, and more education for clients and caregivers is required. Although, other stroke interventions may also benefit stroke survivors, falls prevention should be a central component in stroke rehabilitation. As this study focused on a specific population, the findings should be validated with larger populations, and in diverse settings.
Collapse
Affiliation(s)
- Husna Ahmad Ainuddin
- Department of Rehabilitation Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
- Centre of Occupational Therapy Studies, Faculty of Health Sciences, Universiti Teknologi MARA, Selangor, Malaysia
| | - Muhammad Hibatullah Romli
- Department of Rehabilitation Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
- Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Selangor, Malaysia
| | - Tengku Aizan Hamid
- Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Selangor, Malaysia
| | - Mazatulfazura SF Salim
- Department of Rehabilitation Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Lynette Mackenzie
- Discipline of Occupational Therapy, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
33
|
Ahmad Ainuddin H, Romli MH, Hamid TA, Salim MSF, Mackenzie L. Stroke Rehabilitation for Falls and Risk of Falls in Southeast Asia: A Scoping Review With Stakeholders' Consultation. Front Public Health 2021; 9:611793. [PMID: 33748063 PMCID: PMC7965966 DOI: 10.3389/fpubh.2021.611793] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/27/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Research on rehabilitation for falls after stroke is warranted. However, published evidence on fall interventions with stroke survivors is limited and these are mainly international studies that may be less relevant for Southeast Asia. Objective: This review aims to systematically identify literature related to stroke rehabilitation for falls and risk of falls in Southeast Asia. Methods: A scoping review with stakeholders' consultation was implemented. An electronic search was conducted up to December 2020 on 4 databases (Medline, CINAHL, Scopus, ASEAN Citation Index). Only original studies conducted in Southeast Asia were selected. Results: The initial search yielded 3,112 articles, however, only 26 were selected in the final analysis. Most of the articles focused on physical rehabilitation and implemented conventional therapies. While the literature may reflect practice in Southeast Asia, stakeholders perceived that the literature was inadequate to show true practice, was not informative and missed several aspects such as functional, cognitive, and psychological interventions in managing falls. Individual-centric interventions dominated the review while community-based and environmental-focused studies were limited. Majority of the articles were written by physiotherapists while others were from physicians, occupational therapists, and an engineer but few from other healthcare practitioners (i.e., speech therapists, psychologists) or disciplines interested in falls. Conclusions: Falls prevention among stroke survivors has received a lack of attention and is perceived as an indirect goal in stroke rehabilitation in Southeast Asia. More innovative research adopted from falls research with older people is needed to advance falls prevention and intervention practice with stroke survivors.
Collapse
Affiliation(s)
- Husna Ahmad Ainuddin
- Center of Occupational Therapy Studies, Faculty of Health Sciences, Universiti Teknologi MARA Selangor, Selangor, Malaysia
- Department of Rehabilitation Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Muhammad Hibatullah Romli
- Department of Rehabilitation Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
- Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Serdang, Malaysia
| | - Tengku Aizan Hamid
- Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Serdang, Malaysia
| | - Mazatulfazura S. F. Salim
- Department of Rehabilitation Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Lynette Mackenzie
- Discipline of Occupational Therapy, Faculty of Medicine and Health, School of Health Sciences, University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
34
|
Abstract
Neuropsychiatric disturbances represent a common and uniquely challenging consequence of stroke. These disorders arise at the intersection of lesion-related brain dysfunction and psychological distress related to the event and its aftermath, making it difficult to identify what symptom is a direct physiological consequence of the stroke. Depression, anxiety, fatigue, apathy, emotionalism, and anger are the most common of these syndromes, and posttraumatic stress disorder related to the stroke event has become increasingly recognized as a relevant entity. Mania, obsessive-compulsive disorder, and psychosis are less commonly encountered but potentially highly debilitating conditions that may be underrecognized. Early identification and treatment may mitigate functional impairment and improve quality of life. Evidence-based guidelines from the general population are often relied upon to guide treatment. Further research is needed to understand and tailor treatment of these disorders in the poststroke population.
Collapse
Affiliation(s)
- Katlyn Nemani
- Departments of Neurology and Psychiatry, NYU Langone Health, New York, New York
| | - Lindsey Gurin
- Departments of Neurology, Psychiatry, and Rehabilitation Medicine, NYU Langone Health, New York, New York
| |
Collapse
|
35
|
Romli MH, Mackenzie L, Lovarini M, Clemson L, Tan MP. Home Hazards With Fear of Falling: Findings From the Baseline Study of the Malaysian Elders Longitudinal Research (MELoR). Front Public Health 2021; 8:612599. [PMID: 33511098 PMCID: PMC7835712 DOI: 10.3389/fpubh.2020.612599] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/09/2020] [Indexed: 01/18/2023] Open
Abstract
Background: Fear of falling (FoF) is a common issue among older people, impacting on psychological health, functional performance and mortality. Many factors associated with fear of falling have been investigated but little is known about the role of home hazards. Home hazards can be due to unsafe environmental and functional features. This study is aims to evaluate the association between home hazards with fear of falling among community-dwelling individuals aged 55 years and over. Methods: Baseline data with 1,489 older individuals from the Malaysian Elders Longitudinal Research (MELoR) study were analyzed. Home visits for interview and observations in the home were conducted with the participants. FoF was established with a single-item question and home hazards with the Home Falls and Accidents Screening Tool (HOME FAST). Results: The majority (76.4%) of older participants experienced FoF. The history of falls was not associated with FoF (p = 0.868), but FoF was associated with participants limiting their daily activities (p < 0.001). Home hazards were less likely (p = 0.023) and functional issues were more likely (p < 0.001) to be associated with a high degree of FoF. However, both home hazards domains were not associated with activity restriction due to FoF. Conclusions: Education about home hazards from the perspective of person-environment interaction may encourage home hazards management and reduce FoF which should be evaluated in future studies.
Collapse
Affiliation(s)
- Muhammad Hibatullah Romli
- Department of Rehabilitation Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
- Malaysian Research Institute on Ageing (MyAgeing), Universiti Putra Malaysia, Serdang, Malaysia
| | - Lynette Mackenzie
- Discipline of Occupational Therapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Meryl Lovarini
- Discipline of Occupational Therapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Lindy Clemson
- Discipline of Occupational Therapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Maw Pin Tan
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Department of Medical Sciences, Faculty of Healthcare and Medical Sciences, Sunway University, Petaling Jaya, Malaysia
| |
Collapse
|
36
|
Recovery of mobility function and life-space mobility after ischemic stroke: the MOBITEC-Stroke study protocol. BMC Neurol 2020; 20:348. [PMID: 32938425 PMCID: PMC7493846 DOI: 10.1186/s12883-020-01920-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 09/07/2020] [Indexed: 11/10/2022] Open
Abstract
Background Stroke is a major cause of disability and stroke incidence increases with age. Stroke frequently results in permanent limitations of mobility, and, consequently, the need for the help of others in activities of daily living. In order to optimize rehabilitative efforts and their functional outcomes, detailed knowledge of the functional recovery process, regarding mobility, is needed. Objectives of the MOBITEC-Stroke study are: 1.) To characterize mobility, including lower extremity physical function (LEPF) and life space (the geospatial extent of all of a person’s movements), and changes in mobility within the first year after stroke. 2.) To identify and characterize subgroups with different mobility trajectories. 3.) To evaluate whether changes in LEPF are associated with changes in life-space. 4.) To evaluate participants’ reasons for going outdoors, transportation use, and assistance needed for outdoor movement. Methods Patients with incident first stroke who live in their own homes (target N = 59, based on sample size calculation) will be included in this cohort study. At 3, 6, 9, and 12 months after stroke a battery of mobility tests will be performed at the study centre, including laboratory-based tests of balance and strength, and quantitative gait analysis. Life-space assessment (including 1-week GPS measurements) will be performed in participants’ real life. Semantic information on visited locations (reasons for going outdoors, transportation use, assistance needed) will be collected by using interactive digital maps. Linear mixed effects models will be used to model the trajectories of mobility measures for the total sample and for predefined subgroups. As an exploratory analysis, growth mixture models (GMMs) will be used to identify relevant subgroups with different trajectories. Linear mixed effect models will be used to test whether changes in LEPF parameters are associated with changes in life-space. Participants’ motivation for going outdoors, transportation use, and assistance needed for outdoor mobility will be analysed descriptively. Discussion A comprehensive and detailed knowledge of recovery patterns will enable the planning of targeted and adaptively tailored rehabilitation measures. Information about patients’ reasons for outdoor mobility will provide the opportunity to define individualized and patient-oriented rehabilitation goals. Trial registration ISRCTN85999967 (on 13 August 2020; retrospectively).
Collapse
|
37
|
Koh JSG, Hill AM, Hill KD, Etherton-Beer C, Francis-Coad J, Bell E, Bainbridge L, de Jong LD. Evaluating a Novel Multifactorial Falls Prevention Activity Programme for Community-Dwelling Older People After Stroke: A Mixed-Method Feasibility Study. Clin Interv Aging 2020; 15:1099-1112. [PMID: 32764897 PMCID: PMC7360420 DOI: 10.2147/cia.s251516] [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: 03/15/2020] [Accepted: 06/17/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose The overall purpose of this study was to explore participants’ and physiotherapists’ experiences regarding the acceptability, implementation, and practicality of a novel group-based multifactorial falls prevention activity programme for community-dwelling older people after stroke. Specifically, the purpose was to explore if and how participating could impact on the participants’ health-related quality of life (HRQoL) in terms of their daily lived experience regarding physical, mental, emotional and social well-being. A secondary purpose was to explore whether participating in the programme could positively influence participants’ balance, strength, falls efficacy, mobility and motor impairment of the trunk. Materials and Methods This was an exploratory mixed-method Phase I feasibility study. A convenience sample of five older community-dwelling people after stroke participated in a novel eight-week multifactorial activity programme which included falls education, a mix of individually tailored and group-based strength and balance exercises, exploring limits of stability and safe landing techniques and a social element. Qualitative data from post-intervention interview transcripts with the participants and the physiotherapists who delivered the programme were thematically analysed using both deductive and inductive approaches to explore the participants’ and therapists’ experiences with the programme. Quantitative outcomes included balance, strength, falls efficacy, mobility and motor impairment of the trunk. Results The programme was deemed feasible in terms of acceptability, implementation and practicality by the participants as well as the physiotherapists delivering the programme. The overarching theme regarding HRQoL identified that participating in the programme was perceived to empower the participants living with stroke and positively influenced their daily physical, mental, emotional and social well-being. Participant outcomes showed a change in the direction of improvements in balance, strength, mobility, motor impairment of the trunk and reduced concerns about falling. Subjectively, participants only reported perceived improvements in balance and strength. Conclusion Running a novel multifactorial falls prevention activity programme for older community-dwelling people after stroke was feasible. Participating in the programme helped participants to perceive improved balance, strength and empower them to make meaningful changes, improving their daily lived experiences. A future fully powered study could build on these results to investigate physical improvements, prevention of falls and improvements to domains of HRQoOL.
Collapse
Affiliation(s)
- Jun Sheng Gary Koh
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Bentley, Perth, WA 6102, Australia
| | - Anne-Marie Hill
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Bentley, Perth, WA 6102, Australia
| | - Keith D Hill
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Bentley, Perth, WA 6102, Australia.,Rehabilitation, Ageing and Independent Living Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Christopher Etherton-Beer
- WA Centre for Health and Ageing, Royal Perth Hospital Unit, School of Medicine and Pharmacology and Centre for Medical Research, University of Western Australia, Perth, Western Australia, Australia
| | - Jacqueline Francis-Coad
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Bentley, Perth, WA 6102, Australia
| | - Elizabeth Bell
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Bentley, Perth, WA 6102, Australia
| | - Liz Bainbridge
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Bentley, Perth, WA 6102, Australia
| | - Lex D de Jong
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Bentley, Perth, WA 6102, Australia
| |
Collapse
|
38
|
Cognitive behavior therapy-based intervention for a subacute stroke patient with severe fear of falling: a case report. Int J Rehabil Res 2020; 43:383-385. [PMID: 32658024 DOI: 10.1097/mrr.0000000000000425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We present the case of a 42-year-old man with subacute stroke who developed remarkable fear of falling and eventually recovered with an approach based on cognitive behavioral therapy (CBT). The CBT-based approach was implemented after the patient developed significant fear of falling with exacerbated obsessive-compulsive symptoms appeared immediately after a fall. The patient's anxiety decreased over time, and his ability to perform these tasks and activities of daily living improved accordingly. After 6 weeks of intervention, his anxiety toward gait and stairs almost disappeared; additionally, he achieved modified independence for gait and supervision for stairs and was discharged home successfully. These findings in the present case suggest the effectiveness of an evaluation and interventional approach based on CBT for stroke patients with a severe fear of falling.
Collapse
|
39
|
Poststroke Fatigue Is Related to Motor and Cognitive Performance: A Secondary Analysis. J Neurol Phys Ther 2020; 43:233-239. [PMID: 31436613 PMCID: PMC8130858 DOI: 10.1097/npt.0000000000000290] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND PURPOSE Poststroke fatigue (PSF) is a common debilitating and persistent symptom after stroke. The relationship between PSF and motor and cognitive function remains inconclusive partly due to lack of control for effects of depression and use of insensitive measures. We examined the relationship between PSF and motor and cognitive performance using a comprehensive set of behavioral measures and excluding individuals with depression. METHODS Fifty-three individuals poststroke (16 female) were included (median age: 63 years, median months poststroke: 20 months). Poststroke fatigue was quantified using the Fatigue Severity Scale (FSS) and cognitive performance was measured with the Montreal Cognitive Assessment, simple and choice reaction time (SRT and CRT) tasks. Lower extremity motor performance included Fugl-Meyer Motor Assessment, 5 times sit-to-stand test (5 × STS), Berg Balance Scale, Functional Ambulation Category, and gait speed. Upper extremity motor performance was indexed with Fugl-Meyer, grip strength, and Box and Block test. Spearman correlation and stepwise linear regression analyses were performed to examine relationships. RESULTS Two motor performance measures, Berg Balance Scale and Functional Ambulation Category, were significantly correlated with FSS (ρ = -0.31 and -0.27, respectively) while all cognitive measures were significantly correlated with FSS (ρ = -0.28 for Montreal Cognitive Assessment, 0.29 for SRT, and 0.29 for CRT). Regression analysis showed that Berg Balance Scale was the only significant determinant for FSS (R = 0.11). DISCUSSION AND CONCLUSIONS Functional gait, balance, and cognitive performance are associated with PSF. Fatigue should be considered when planning and delivering interventions for individuals with stroke. Future studies are needed to explore the potential efficacy of balance and cognitive training in PSF management.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A287).
Collapse
|
40
|
Samuelsson CM, Hansson PO, Persson CU. Determinants of Recurrent Falls Poststroke: A 1-Year Follow-up of the Fall Study of Gothenburg. Arch Phys Med Rehabil 2020; 101:1541-1548. [PMID: 32497600 DOI: 10.1016/j.apmr.2020.05.010] [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: 03/29/2020] [Accepted: 05/17/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To identify the occurrence of recurrent falls and the determinants in the acute phase poststroke that are associated with recurrent falls within the first year poststroke. DESIGN Prospective follow-up study. SETTING Stroke unit and community. PARTICIPANTS Patients (N=504) with acute stroke. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The dependent variable was recurrent falls, defined as ≥2 falls, within the first year poststroke. The independent baseline variables were related to function, activity, participation, personal and environmental factors, and comorbidity and were assessed within 4 days after admission to a stroke unit. Fall data were registered at the stroke unit, and self-reported fall data were collected during follow-up using a standardized questionnaire. Determinants of recurrent falls were identified using univariable and multivariable logistic regression analyses. RESULTS Within 12 months poststroke, 95 of 348 participants (27%) had experienced recurrent falls. Poor postural control (odds ratio [OR] 5.85; 95% confidence interval [CI], 2.84-12.02; P<.0001), moderate postural control (OR 2.41; 95% CI, 1.21-4.80; P=.012), and using a walking aid in the acute phase (OR 2.51; 95% CI, 1.45-4.36; P=.0010) are statistically significant determinants that are associated with recurrent falls within the first year poststroke. The determinant of using a walking aid appears to be primarily driven by those younger than 80 years. In addition to impaired postural control and using a walking aid, a fall at the stroke unit is a determinant associated with recurrent falls after discharge within 6 months poststroke. CONCLUSIONS More than 1 in 4 individuals with stroke experienced recurrent falls within the first year poststroke. Impaired postural control, using a walking aid in the acute phase, and fall during hospitalization are determinants associated with recurrent falls during follow-up. The determinants differ somewhat at different ages.
Collapse
Affiliation(s)
- Carina M Samuelsson
- Region Västra Götaland, Department of Physiotherapy, Sahlgrenska University Hospital/Östra, Gothenburg; Rehabilitation Medicine, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg.
| | - Per-Olof Hansson
- Region Västra Götaland, Department of Medicine, Geriatrics and Emergency Medicine, Sahlgrenska University Hospital/Östra, Gothenburg; Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Carina U Persson
- Region Västra Götaland, Department of Physiotherapy, Sahlgrenska University Hospital/Östra, Gothenburg; Rehabilitation Medicine, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg
| |
Collapse
|
41
|
Abstract
OBJECTIVES Late-life depression, falls, and fall worry are public health problems. While previous research confirms the cross-sectional relationship between depression and fall worry, few longitudinal studies have examined whether changes in fall worry are associated with changes in depressive illness and vice versa. This study examined longitudinal relationships between probable major depression (PMD) and activity-limiting fall worry (ALW). DESIGN, SETTING, PARTICIPANTS, MEASUREMENTS This longitudinal panel observational study used data from the National Health and Aging Trends Study (NHATS) waves 5 (referred to as T1 in this study) and 6 (T2), conducted in 2015 and 2016, respectively (N = 6,299, aged 65 and older). We examined associations of new and continued ALW between T1 and T2 with T2 PMD, controlling for T1 PMD; and associations of new and continued PMD between T1 and T2 with T2 ALW, controlling for T1 ALW. We used χ2 and t tests for descriptive statistics and logistic regression for multivariable analysis. RESULTS Those with new ALW at T2 had significantly greater odds of T2 PMD compared to those without ALW at both time points (AOR = 2.64, 95% CI = 1.98-3.51), and those with new PMD at T2 had significantly greater odds of T2 ALW (AOR = 2.42, 95% CI = 1.66-3.52). Those with continued PMD also had greater odds of T2 ALW compared to those without PMD at either time point (AOR = 2.31, 95% CI = 1.62-3.29). CONCLUSIONS The findings add to knowledge about bidirectional (mutually reinforcing) relationships between depression and activity-limiting fall worry. Innovative interventions are needed to reduce both late-life depression and activity-limiting fall worry.
Collapse
|
42
|
Kannan L, Vora J, Bhatt T, Hughes SL. Cognitive-motor exergaming for reducing fall risk in people with chronic stroke: A randomized controlled trial. NeuroRehabilitation 2019; 44:493-510. [PMID: 31256084 DOI: 10.3233/nre-182683] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Dual-task (simultaneous motor and cognitive task) (DT) training via virtual-reality exergaming is known to benefit balance control post-stroke. However, the efficacy of such training on DT balance control (volitional and reactive) and cognitive (executive function and attention) domains associated with fall risk remains unclear. OBJECTIVE We evaluated the efficacy of cognitive-motor exergame training (CMT) (Wii-fit games in conjunction with cognitive tasks) for improving balance control (volitional and reactive) and cognition (executive function and attention) among people with chronic stroke (PwCS). METHODS Hemiparetic, ambulatory PwCS were randomly assigned to either CMT (n = 12) or conventional training (CT) (n = 12) and underwent six weeks of high-intensity, tapered balance training. The CMT group performed Wii-fit games in conjunction with cognitive tasks, while CT group underwent customized, progressive balance training. Performance under DT conditions on Limits of Stability (volitional) and Slip-Perturbation (reactive) tests, and letter-number sequencing (cognition) determined the efficacy of CMT. RESULTS Post-intervention, under DT reactive conditions, CMT group improved both motor and cognition, while the CT group improved motor alone. Under DT volitional conditions, motor performance improved only in CMT group. CONCLUSION Cognitive-motor exergaming appears to be effective for improving balance control and cognition and could be implemented in clinical stroke rehabilitation settings.
Collapse
Affiliation(s)
- Lakshmi Kannan
- Department of Physical Therapy, Cognitive-Motor Behavior and Balance Rehabilitation Laboratory, University of Illinois at Chicago, Chicago, IL, USA
| | - Jinal Vora
- Department of Physical Therapy, Cognitive-Motor Behavior and Balance Rehabilitation Laboratory, University of Illinois at Chicago, Chicago, IL, USA
| | - Tanvi Bhatt
- Department of Physical Therapy, Cognitive-Motor Behavior and Balance Rehabilitation Laboratory, University of Illinois at Chicago, Chicago, IL, USA
| | - Susan L Hughes
- Institute for Health Research and Policy, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| |
Collapse
|
43
|
Kumar D, Sinha N, Dutta A, Lahiri U. Virtual reality-based balance training system augmented with operant conditioning paradigm. Biomed Eng Online 2019; 18:90. [PMID: 31455355 PMCID: PMC6712808 DOI: 10.1186/s12938-019-0709-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 08/16/2019] [Indexed: 11/27/2022] Open
Abstract
Background Stroke-related sensory and motor deficits often steal away the independent mobility and balance from stroke survivors. Often, this compels the stroke survivors to rely heavily on their non-paretic leg during weight shifting to execute activities of daily living (ADL), with reduced usage of the paretic leg. Increased reliance on non-paretic leg often leads to learned nonuse of the paretic leg. Therefore, it is necessary to measure the contribution of individual legs toward one’s overall balance. In turn, techniques can be developed to condition the usage of both the legs during one’s balance training, thereby encouraging the hemiplegic patients for increased use of their paretic leg. The aim of this study is to (1) develop a virtual reality (VR)-based balance training platform that can estimate the contribution of each leg during VR-based weight-shifting tasks in an individualized manner and (2) understand the implication of operant conditioning paradigm during balance training on the overall balance of hemiplegic stroke patients. Result Twenty-nine hemiplegic patients participated in a single session of VR-based balance training. The participants maneuvered virtual objects in the virtual environment using two Wii Balance Boards that measured displacement in the center of pressure (CoP) due to each leg when one performed weight-shifting tasks. For operant conditioning, the weight distribution across both the legs was conditioned (during normal trial) to reward participants for increased usage of the paretic leg during the weight-shifting task. The participants were offered multiple levels of normal trials with intermediate catch trial (with equal weight distribution between both legs) in an individualized manner. The effect of operant conditioning during the normal trials was measured in the following catch trials. The participants showed significantly improved performance in the final catch trial compared to their initial catch trial task. Also, the enhancement in CoP displacement of the paretic leg was significant in the final catch trial compared to the initial catch trial. Conclusion The developed system was able to encourage participants for improved usage of their paretic leg during weight-shifting tasks. Such an approach has the potential to address the issue of learned nonuse of the paretic leg in stroke patients.
Collapse
Affiliation(s)
- Deepesh Kumar
- Indian Institute of Technology Gandhinagar, Gandhinagar, India. .,National University of Singapore, The N.1 Institute for Health, 28 Medical Dr., Singapore, 117456, Singapore.
| | - Nirvik Sinha
- Indian Institute of Technology Kharagpur, Kharagpur, India
| | | | - Uttama Lahiri
- Indian Institute of Technology Gandhinagar, Gandhinagar, India
| |
Collapse
|
44
|
Resnick B, Galik E, Boltz M, Zhu S, Fix S, Vigne E. Impact of Function Focused Care and Physical Activity on Falls in Assisted Living Residents. Can J Nurs Res 2019; 52:45-53. [PMID: 31225738 DOI: 10.1177/0844562119856224] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BackgroundThere continues to be a belief among nurses, patients, and families that physical activity increases the risk of falling.PurposeThe purpose of this study was to test the hypothesis that controlling for age, function, cognition, medication use, gender, comorbidities, and cognition, residents who are exposed to Function Focused Care for Assisted Living (FFC-AL-EIT) and engage in moderate levels of physical activity would not be more likely to fall.MethodsThis was a secondary data analysis using data from the first two cohorts of a randomized trial testing FFC-AL-EIT in the United States.ResultsThe study included 381 residents, the majority of whom were female (70%), white (97%), with a mean age of 87.72 (standard deviation = 7.47). Those who engaged in more moderate-intensity physical activity were 1% less likely to fall (odds ratio = .99, p = .03). There was no significant association between exposure to function focused care and falling (odds ratio = 1.58, p = .09).ConclusionThere was no indication that those who were exposed to function focused care or those who engaged in moderate-level physical activity were more likely to fall. In fact, engaging in moderate-level physical activity was noted to be slightly protective of falling.
Collapse
Affiliation(s)
- Barbara Resnick
- Department of Gerontology, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Elizabeth Galik
- Department of Gerontology, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Marie Boltz
- Pennsylvania State University, College Station, PA, USA
| | - Shijun Zhu
- Department of Gerontology, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Steven Fix
- Department of Gerontology, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Erin Vigne
- Department of Gerontology, University of Maryland School of Nursing, Baltimore, MD, USA
| |
Collapse
|
45
|
Oh J, Choi CK, Kim SA, Kweon SS, Lee YH, Nam HS, Park KS, Ryu SY, Choi SW, Shin MH. Association of Falls and Fear of Falling with Mortality in Korean Adults: The Dong-gu Study. Chonnam Med J 2019; 55:104-108. [PMID: 31161122 PMCID: PMC6536433 DOI: 10.4068/cmj.2019.55.2.104] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 03/21/2019] [Accepted: 03/26/2019] [Indexed: 11/10/2022] Open
Abstract
This study evaluated the association between falls and the fear of falling (FOF) with the risk of all-cause mortality in Korean adults. The study enrolled 4,386 subjects aged 50 years and over who participated in the Dong-gu Study. Falls in the past year were categorized as yes or no. Injurious falls were defined as falls that resulted in fractures, head injuries, sprains or strains, bruising or bleeding, or other unspecified injuries. FOF was classified as low or high. The associations of falls and fall-related characteristics with mortality were assessed using Cox proportional hazards models. The average follow-up was 7.8 years. During this period, 255 men and 146 women died. In a fully adjusted model, falls in the past year were not associated with an increased risk of all-cause mortality (hazard ratio [HR] 1.16, 95% confidence interval [CI] 0.85–1.58), but a history of injurious falls was associated with an increased risk of mortality (HR 1.36, 95% CI 1.04–1.79). Compared with subjects without a FOF, subjects who were moderately or very afraid of falling had a higher mortality rate (HR 1.26, 95% CI 0.97–1.63). In conclusion, injurious falls and a high FOF increased the risk of all-cause mortality in Koreans. This study suggests that injurious falls and FOF can predict mortality in the general population.
Collapse
Affiliation(s)
- Jinkyu Oh
- Department of Public Health, Graduate School Chonnam National University Medical School, Gwangju, Korea
| | - Chang Kyun Choi
- Department of Preventive Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Sun A Kim
- Department of Preventive Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Sun-Seog Kweon
- Department of Preventive Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Young-Hoon Lee
- Department of Preventive Medicine & Institute of Wonkwang Medical Science, Wonkwang University College of Medicine, Iksan, Korea
| | - Hae-Sung Nam
- Department of Preventive Medicine, Chungnam National University Medical School, Daejeon, Korea
| | - Kyeong-Soo Park
- Cardiocerebrovascular Center, Mokpo Jung-Ang Hospital, Mokpo, Korea
| | - So-Yeon Ryu
- Department of Preventive Medicine, Chosun University Medical School, Gwangju, Korea
| | - Seong-Woo Choi
- Department of Preventive Medicine, Chosun University Medical School, Gwangju, Korea
| | - Min-Ho Shin
- Department of Preventive Medicine, Chonnam National University Medical School, Gwangju, Korea
| |
Collapse
|
46
|
Investigating post-stroke fatigue: An individual participant data meta-analysis. J Psychosom Res 2018; 113:107-112. [PMID: 30190042 DOI: 10.1016/j.jpsychores.2018.08.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 06/19/2018] [Accepted: 08/13/2018] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The prevalence of post-stroke fatigue differs widely across studies, and reasons for such divergence are unclear. We aimed to collate individual data on post-stroke fatigue from multiple studies to facilitate high-powered meta-analysis, thus increasing our understanding of this complex phenomenon. METHODS We conducted an Individual Participant Data (IPD) meta-analysis on post-stroke fatigue and its associated factors. The starting point was our 2016 systematic review and meta-analysis of post-stroke fatigue prevalence, which included 24 studies that used the Fatigue Severity Scale (FSS). Study authors were asked to provide anonymised raw data on the following pre-identified variables: (i) FSS score, (ii) age, (iii) sex, (iv) time post-stroke, (v) depressive symptoms, (vi) stroke severity, (vii) disability, and (viii) stroke type. Linear regression analyses with FSS total score as the dependent variable, clustered by study, were conducted. RESULTS We obtained data from 14 of the 24 studies, and 12 datasets were suitable for IPD meta-analysis (total n = 2102). Higher levels of fatigue were independently associated with female sex (coeff. = 2.13, 95% CI 0.44-3.82, p = 0.023), depressive symptoms (coeff. = 7.90, 95% CI 1.76-14.04, p = 0.021), longer time since stroke (coeff. = 10.38, 95% CI 4.35-16.41, p = 0.007) and greater disability (coeff. = 4.16, 95% CI 1.52-6.81, p = 0.010). While there was no linear association between fatigue and age, a cubic relationship was identified (p < 0.001), with fatigue peaks in mid-life and the oldest old. CONCLUSION Use of IPD meta-analysis gave us the power to identify novel factors associated with fatigue, such as longer time since stroke, as well as a non-linear relationship with age.
Collapse
|
47
|
Larén A, Odqvist A, Hansson PO, Persson CU. Fear of falling in acute stroke: The Fall Study of Gothenburg (FallsGOT). Top Stroke Rehabil 2018; 25:256-260. [DOI: 10.1080/10749357.2018.1443876] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Amanda Larén
- Department of Clinical Neuroscience, Rehabilitation Medicine, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Amanda Odqvist
- Department of Clinical Neuroscience, Rehabilitation Medicine, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Per-Olof Hansson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Carina U. Persson
- Department of Clinical Neuroscience, Rehabilitation Medicine, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
48
|
Factors Predicting Falls and Mobility Outcomes in Patients With Stroke Returning Home After Rehabilitation Who Are at Risk of Falling. Arch Phys Med Rehabil 2017. [DOI: 10.1016/j.apmr.2017.05.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
49
|
Cummings SR, Eastell R. Risk and Prevention of Fracture in Patients With Major Medical Illnesses: A Mini-Review. J Bone Miner Res 2016; 31:2069-2072. [PMID: 27813155 DOI: 10.1002/jbmr.3030] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 10/26/2016] [Accepted: 11/02/2016] [Indexed: 12/11/2022]
Abstract
Patients with several medical conditions, including Parkinson's disease, recent stroke, HIV, and heart failure, have a high risk of hip fracture. These patients will also have more severe consequences of a hip fracture, including a greater chance of dying and more prolonged disability. Together, there are nearly as many patients with medical conditions that substantially increase the risk of hip fracture as there are people with osteoporosis by femoral neck bone mineral density (BMD). The contributions of falling and decreased bone mass to the increased risks with these conditions are not certain. Although there are few data about whether and what type of treatments these patients receive to prevent fracture, it is likely that few receive pharmacologic treatments that have been shown to reduce the risk of hip fracture. There is a need to show that drug treatments that strengthen bone also reduce fracture risk in patients whose risk may be owing in greater part to traumatic falls than osteoporosis. Assuming that treatments are efficacious in these patients, there is a major opportunity to substantially reduce the incidence and consequences of hip fracture by reaching more of them with drug treatments to reduce the risk of hip fracture. This will require engagement of specialists who have little expertise and perhaps limited interest in preventing fractures, or new approaches to delivering drug treatments to prevent fracture directly to the patients at risk. © 2016 American Society for Bone and Mineral Research.
Collapse
Affiliation(s)
- Steven R Cummings
- San Francisco Coordinating Center, CPMC Research Institute and the University of California, San Francisco, CA, USA
| | - Richard Eastell
- Academic Unit of Bone Metabolism, University of Sheffield, Sheffield, UK
| |
Collapse
|
50
|
Tan KM, Tan MP. Stroke and Falls-Clash of the Two Titans in Geriatrics. Geriatrics (Basel) 2016; 1:geriatrics1040031. [PMID: 31022824 PMCID: PMC6371176 DOI: 10.3390/geriatrics1040031] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 11/20/2016] [Accepted: 11/26/2016] [Indexed: 12/12/2022] Open
Abstract
Both stroke and falls are common conditions affecting the older adult. Despite stroke being considered a well-established major risk factor for falls, there remains no evidence for effective prevention strategies for falls specifically for stroke survivors. Previous observational studies evaluating falls risk factors in stroke have mainly been uncontrolled and found similar risk factors for stroke populations compared to general older populations. Specific risk factors, however, are likely to play a greater role in stroke survivors including unilateral weakness, hemisensory or visual neglect, impaired coordination, visual field defects, perceptual difficulties and cognitive issues. In addition, individuals with stroke are also more likely to have other associated risk factors for falls including diabetes, falls risk increasing drugs, atrial fibrillation, and other cardiovascular risk factors. While anticoagulation is associated with increased risk of intracranial bleeding after a fall, the risk of suffering a further stroke due to atrial fibrillation outweigh the risk of bleeding from a recurrent fall. Similarly, while blood pressure lowering medications may be linked to orthostatic hypotension which in turn increases the risk of falls, the benefit of good blood pressure control in terms of secondary stroke prevention outweighs the risk of falls. Until better evidence is available, the suggested management approach should then be based on local resources, and published evidence for fall prevention. Multicomponent exercise and individually tailored multifactorial interventions should still be considered as published evidence evaluating the above have included stroke patients in their study population.
Collapse
Affiliation(s)
- Kit Mun Tan
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia.
- Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia.
| | - Maw Pin Tan
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia.
- Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia.
| |
Collapse
|