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Abou L, Rice LA. Functional balance assessment for predicting future recurrent falls in non-ambulatory individuals with spinal cord injury: a prospective pilot study. Physiother Theory Pract 2023:1-10. [PMID: 37801067 DOI: 10.1080/09593985.2023.2266741] [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: 07/24/2023] [Accepted: 09/30/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Functional assessments easy to administer within the clinic to identify non-ambulatory individuals with spinal cord injury at risk of recurrent falls are needed. PURPOSE To examine the ability of functional balance and transfer quality to predict recurrent falls. METHODS This 6-month prospective study examined remote assessments of transfer quality using the Transfer Assessment Instrument and functional sitting balance with the Function in Sitting Test and the Trunk Control Test. Then, participants prospectively monitored their falls for 6-month using fall diaries. Frequency of falls was categorized as infrequent fallers (≤2 falls) and recurrent fallers (>2 falls). A multivariable logistic regression analysis was conducted. A Receiver Operating Characteristic curve was performed to determine the area under the curve, the sensitivity, and the specificity of the model. RESULTS Eighteen non-ambulatory individuals (mean age = 44 ± 16 years, mean time since injury = 7.8 ± 32.6 years) participated in the study. Poor balance (lower Function in Sitting Test score) was associated with higher odds of future recurrent falls (Odds Ratio = 0.70, 95% CI, 0.48 to 1.00, p = 0.05), area under the receiving operating curve = 0.87, sensitivity = 88%, and specificity = 70%. CONCLUSIONS A comprehensive sitting balance assessment that includes the static, proactive, and reactive components of balance with the integration of sensorial functions as evaluated within the Function in Sitting Test may be useful for predicting recurrent falls among non-ambulatory individuals with spinal cord injury. Replication of the findings in a larger sample is warranted.
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Affiliation(s)
- Libak Abou
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Laura A Rice
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Center for Health, Aging and Disability, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Champaign, IL, USA
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Falls During Inpatient Rehabilitation After Spinal Cord Injury: Characterization, Clock-Hour Visualization, and Time to Event Predictors. Arch Phys Med Rehabil 2023:S0003-9993(23)00085-0. [PMID: 36736805 DOI: 10.1016/j.apmr.2023.01.010] [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: 07/25/2022] [Revised: 12/29/2022] [Accepted: 01/05/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To (1) determine fall characteristics (eg, cause, location, witnesses) of inpatients with spinal cord injury (SCI) and whether they were different for ambulatory persons vs wheelchair users; (2) visualize the total number of daily falls per clock-hour for different inpatients' features (eg, cause of injury, age); (3) compare clinical and demographic characteristics of inpatients who experienced a first fall event vs inpatients who did not experience such event; and (4) identify first fall event predictors. DESIGN Retrospective observational cohort study. SETTING Institution for inpatient neurologic rehabilitation. PARTICIPANTS Persons with SCI (N=1294) admitted to a rehabilitation facility between 2005 and 2022. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Functional independence measure (FIM), Hospital Anxiety and Depression Scale (HADS), American Spinal Injury Association Impairment Scale (AIS), and Spinal Cord Independence Measure (SCIM) at admission. Kaplan-Meier survival curves and Cox proportional hazards models were used. RESULTS A total of 502 fall events were experienced by 369 ambulatory inpatients (19.8%) and wheelchair users (80.2%) in 63.9% of cases being alone, with cause, situation, and location significantly different in both groups. Clock-hour visualizations revealed an absolute peak at 12 AM (complete or incomplete injuries, with paraplegia or tetraplegia) but a relative peak at 9 AM mainly including incomplete patients with paraplegia. Of the (n=1294) included patients, 16.8% experienced at least 1 fall. Fallen patients reported higher levels of HADS depression, lower total SCIM, and longer time since injury to admission, with no differences in age, sex, educational level, FIM (quasi-significant), and AIS grade. Multivariable Cox proportional hazards identified time since injury to admission and AIS grade D as significant predictors of first fall event. CONCLUSIONS Falls identification, characterization, and clock-hour visualization can support decisions for mitigation strategies specifically addressed to inpatients with SCI. Fall predictors were identified as a first step for future research.
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Frechette ML, Abou L, Rice LA, Sosnoff JJ. Relationship Between Lower Limb Function and Fall Prevalence in Ambulatory Adults With Spinal Cord Injury: A Systematic Review. Top Spinal Cord Inj Rehabil 2022; 28:153-175. [PMID: 35521058 PMCID: PMC9009199 DOI: 10.46292/sci21-00026] [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] [Indexed: 11/19/2022]
Abstract
Background Falls are common, detrimental events among ambulatory individuals with spinal cord injury (SCI). Following SCI, changes to lower limb function are probable and likely to impact an individual's fall risk, yet no comprehensive review has been completed on the topic. Objectives This study systematically reviewed data on the relationship between lower limb function and fall prevalence in ambulatory individuals with SCI. Methods A literature search was conducted in PubMed, Web of Science, Scopus, and CINAHL. Two independent reviewers screened abstracts/titles and then full articles. Study details, participants' characteristics, lower limb function assessed, and fall-related data were extracted from the studies. A qualitative analysis of the relationship between lower limb function and fall prevalence was performed. The risk of bias was evaluated using the Newcastle-Ottawa Quality Assessment Scale. Results The search yielded 1553 articles. Eight prospective, two retrospective, and three cross-sectional studies met the eligibility criteria. These studies ranged from low to high risk of bias. Overall, the qualitative analysis provided little evidence to support the relationship between lower limb function recorded by clinical measures and fall prevalence. Conclusion This review highlights the inconsistent relationship between lower limb function and falls prevalence in ambulatory adults with SCI. Greater uniformity in methodology and consistent categorization of fallers and nonfallers among researchers is necessary to move the field forward. Investigating additional factors such as behavior traits, assistive device use, and environmental risk factors may be appropriate in understanding fall prevalence in this population.
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Affiliation(s)
- Mikaela L. Frechette
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign
| | - Libak Abou
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign
| | - Laura A. Rice
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign
- Center on Health, Aging, and Disability, University of Illinois at Urbana-Champaign
| | - Jacob J. Sosnoff
- Department of Physical Therapy, Rehabilitation Science and Athletic Training, University of Kansas Medical Center, Kansas City, Kansas
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Singh H, Cheung L, Chan K, Flett HM, Hitzig SL, Kaiser A, Musselman KE. Comparing the causes, circumstances and consequences of falls across mobility statuses among individuals with spinal cord injury: A secondary analysis. J Spinal Cord Med 2021; 44:S193-S202. [PMID: 34779733 PMCID: PMC8604457 DOI: 10.1080/10790268.2021.1956252] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To compare the occurrence of falls and fall-related injuries, and the circumstances of falls among individuals with spinal cord injury (SCI) who ambulate full-time, use a wheelchair full-time and ambulate part-time. DESIGN A secondary analysis. SETTING Community. PARTICIPANTS Adults with SCI. INTERVENTION None. OUTCOME MEASURES The occurrence and circumstances of falls and fall-related injuries were tracked over six-months using a survey. Participants were grouped by mobility and fall status. A chi-square test compared the occurrence of falls and fall-related injuries, and the time and location of falls, and a negative binomial regression was used to predict the likelihood of falls by mobility status. Kaplan-Meier analysis was used to determine differences in the time to first fall based on mobility status. Group characteristics and causes of falls were described. RESULTS Data from individuals who ambulated full-time (n = 30), used a wheelchair full-time (n = 27) and ambulated part-time (n = 8) were analyzed. Mobility status was a significant predictor of falls (P < 0.01); individuals who used a wheelchair full-time had a third of the likelihood of falling than those who ambulated full-time (P < 0.01). Type of fall-related injuries differed by mobility status. Those who ambulated full-time fell more in the daytime (P < 0.01). Individuals who ambulated full-time and part-time commonly fell while walking due to poor balance, and their legs giving out, respectively. Those who used a wheelchair full-time typically fell while transferring when rushed. CONCLUSION Mobility status influences the likelihood and circumstances of falls. Mobility status should be considered when planning fall prevention education/training for individuals with SCI.
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Affiliation(s)
- Hardeep Singh
- KITE, Toronto Rehab-University Health Network, Toronto, Canada,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada,Bridgepoint Collaboratory for Research & Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
| | - Lovisa Cheung
- KITE, Toronto Rehab-University Health Network, Toronto, Canada,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Katherine Chan
- KITE, Toronto Rehab-University Health Network, Toronto, Canada
| | - Heather M. Flett
- KITE, Toronto Rehab-University Health Network, Toronto, Canada,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Sander L. Hitzig
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada,Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada,St. John’s Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Anita Kaiser
- KITE, Toronto Rehab-University Health Network, Toronto, Canada,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada,Canadian Spinal Research Organization, Toronto, Canada
| | - Kristin E. Musselman
- KITE, Toronto Rehab-University Health Network, Toronto, Canada,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada,Correspondence to: Kristin E. Musselman, SCI Mobility Lab, KITE, Toronto Rehab-University Health Network, 520 Sutherland Drive, TorontoM4G 3V9, Canada.
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Abstract
INTRODUCTION Falls remain one of the most prevalent adverse events in hospitals and are associated with substantial negative health impacts and costs. Approaches to assess patients' fall risk have been implemented in hospitals internationally, ranging from brief screening questions to multifactorial risk assessments and complex prediction models, despite a lack of clear evidence of effect in reducing falls in acute hospital environments. The increasing digitisation of hospital systems provides new opportunities to understand and predict falls using routinely recorded data, with potential to integrate fall prediction models into real-time or near-real-time computerised decision support for clinical teams seeking to mitigate fall risk. However, the use of non-traditional approaches to fall risk prediction, including machine learning using integrated electronic medical records, has not yet been reviewed relative to more traditional fall prediction models. This scoping review will summarise methodologies used to develop existing hospital fall prediction models, including reporting quality assessment. METHODS AND ANALYSIS This scoping review will follow the Arksey and O'Malley framework and its recent advances, and will be reported using Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews recommendations. Four electronic databases (CINAHL via EBSCOhost, PubMed, IEEE Xplore and Embase) will be initially searched for studies up to 12 November 2020, and searches may be updated prior to final reporting. Additional studies will be identified by reference list review and citation analysis of included studies. No restriction will be placed on the date or language of identified studies. Screening of search results and extraction of data will be performed by two independent reviewers. Reporting quality will be assessed by the adherence to the Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis. ETHICS AND DISSEMINATION Ethical approval is not required for this study. Findings will be disseminated through peer-reviewed publication and scientific conferences.
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Affiliation(s)
- Rex Parsons
- Australian Centre for Health Services Innovation and Centre for Healthcare Translation, School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Susanna M Cramb
- Australian Centre for Health Services Innovation and Centre for Healthcare Translation, School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, Queensland, Australia
- Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Metro North Health, Herston, Queensland, Australia
| | - Steven M McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Translation, School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, Queensland, Australia
- Clinical Informatics Directorate, Metro South Health, Woolloongabba, Queensland, Australia
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Marshall K, Gustafsson L, McKittrick A, Fleming J. Falls Occurring After a Spinal Cord Injury: A Scoping Review. Am J Occup Ther 2021; 75:12500. [PMID: 34781344 DOI: 10.5014/ajot.2021.043695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Falls have a considerable physical and psychological impact on people with spinal cord injury (SCI). Occupational therapy practitioners require evidence to support the timely development of occupation-based programs that can be applied to fall prevention in daily life. OBJECTIVE To determine what is known about falls after SCI, including wheelchair users and people who are ambulatory, and to understand elements of fall prevention to be addressed by occupational therapy practitioners. We applied the Canadian Measure of Occupational Performance and Engagement to understand elements to be addressed in fall education and prevention with this population. DATA SOURCES We searched eight databases using the key words falls and spinal cord injury with no limit set on dates. Study Selection and Data Collection: Studies were included that reported on falls among adults with SCI and measured one or more of the following: incidence of falls, consequences of falls, contributing factors for falls, the person's experience of falls, and strategies to prevent falls. FINDINGS Thirty-five articles were included. The majority of the articles included information on the incidence (n = 20), consequences (n = 26), and contributing factors (n = 30) of falls. Two articles analyzed the person's experience of falls, and 1 study reviewed a fall prevention program for people with SCI specifically. CONCLUSIONS AND RELEVANCE Research on participants' experience of falls and fall prevention programs used in spinal cord rehabilitation is extremely limited. Future research on the lived experience of falls for people with SCI is warranted. What This Article Adds: This review of evidence on falls after SCI highlights gaps in the current available evidence.
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Affiliation(s)
- Kathryn Marshall
- Kathryn Marshall, BOccThy, is PhD Student, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia, and Occupational Therapist, Department of Occupational Therapy, Princess Alexandra Hospital, Brisbane, Queensland, Australia;
| | - Louise Gustafsson
- Louise Gustafsson, PhD, BOccThy(Hons), is Professor, School of Allied Health Sciences, Griffith University, Brisbane, Queensland, Australia, and Honorary Professor, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Andrea McKittrick
- Andrea McKittrick, BSc(Hons) CurrOcc, is PhD Student, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia, and Occupational Therapist, Department of Occupational Therapy, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Jennifer Fleming
- Jennifer Fleming, PhD, BOccThy(Hons), FOTARA, is Professor and Head of Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
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Singh H, Collins K, Flett HM, Jaglal SB, Musselman KE. Therapists' perspectives on fall prevention in spinal cord injury rehabilitation: a qualitative study. Disabil Rehabil 2021; 44:4351-4360. [PMID: 33789064 DOI: 10.1080/09638288.2021.1904013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE Therapists play a key role in delivering fall prevention/management education to individuals with spinal cord injury/disease, yet their perspectives on this topic remain understudied. Here, we described the perspectives of physical and occupational therapists who routinely provided rehabilitation to patients with spinal cord injury/disease on: (1) how fall risk was assessed, (2) what fall prevention education, interventions or strategies were provided, and (3) opportunities to improve fall risk assessment and the delivery of fall prevention education, strategies and interventions. MATERIALS AND METHODS Twenty-one therapists completed an individual interview or focus group that was analyzed using an inductive thematic analysis. RESULTS Four main themes were identified: (1) policy and procedures impact practice (i.e., policy and procedures positively and negatively impact practice), (2) assessing and managing fall risk/falls in patients with spinal cord injury/disease (i.e., discipline-specific roles in fall risk assessments and fall management processes in rehabilitation), (3) fall prevention and management education (i.e., helicopter therapists and challenges with fall prevention and management education), (4) building insight into fall risk and management (e.g., building insight into fall risk for patients and therapists). CONCLUSIONS This study revealed opportunities to improve the delivery of fall prevention education and training to individuals with spinal cord injury/disease.IMPLICATIONS FOR REHABILITATIONFall prevention education should be initiated in spinal cord injury rehabilitation and then reinforced in community rehabilitation.Barriers and challenges faced by therapists when delivering fall prevention and management education/training in spinal cord injury rehabilitation include their perceptions of a patient's readiness to receive fall prevention education, short length of stay in rehabilitation, organization's expectations of zero falls and a lack of spinal cord injury-specific fall prevention resources.Therapists who work in spinal cord injury rehabilitation may benefit from information about fall risk factors encountered by individuals with spinal cord injury/disease in the community.
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Affiliation(s)
- Hardeep Singh
- KITE, Toronto Rehab-University Health Network, Toronto, Canada.,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada.,Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
| | - Kyla Collins
- KITE, Toronto Rehab-University Health Network, Toronto, Canada.,School of Rehabilitation Sciences, University of Saskatchewan, Saskatoon, Canada
| | - Heather M Flett
- KITE, Toronto Rehab-University Health Network, Toronto, Canada.,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Susan B Jaglal
- KITE, Toronto Rehab-University Health Network, Toronto, Canada.,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada.,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada.,Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Canada
| | - Kristin E Musselman
- KITE, Toronto Rehab-University Health Network, Toronto, Canada.,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada.,School of Rehabilitation Sciences, University of Saskatchewan, Saskatoon, Canada.,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
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Predicting falls and injuries in people with multiple sclerosis using machine learning algorithms. Mult Scler Relat Disord 2021; 49:102740. [PMID: 33450500 DOI: 10.1016/j.msard.2021.102740] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 12/31/2020] [Accepted: 01/04/2021] [Indexed: 11/22/2022]
Abstract
Falls in people with Multiple Sclerosis (PwMS) is a serious issue. It can lead to a lot of problems including sustaining injuries, losing consciousness and hospitalization. Having a model that can predict the probability of these falls and the factors correlated with them and can help caregivers and family members to have a clearer understanding of the risks of falling and proactively minimizing them. We used historical data and machine learning algorithms to predict three outcomes: falling, sustaining injuries and injury types caused by falling in PwMS. The training dataset for this study includes 606 examples of monthly readings. The predictive attributes are the following: Expanded Disability Status Scale (EDSS), years passed since the diagnosis of MS, age of participants in the beginning of the experiment, participants' gender, type of MS and season (or month). Two types of algorithms, decision tree and gradient boosted trees (GBT) algorithm, were used to train six models to answer these three outcomes. After the models were trained their accuracy was evaluated using cross-validation. The models had a high accuracy with some exceeding 90%. We did not limit model evaluation to one-number assessments and studied the confusion matrices of the models as well. The GBT had a higher class recall and smaller number of underestimations, which make it a more reliable model. The methodology proposed in this study and its findings can help in developing better decision-support tools to assist PwMS.
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Abou L, Alluri A, Fliflet A, Du Y, Rice LA. Effectiveness of Physical Therapy Interventions in Reducing Fear of Falling Among Individuals With Neurologic Diseases: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2020; 102:132-154. [PMID: 32745544 DOI: 10.1016/j.apmr.2020.06.025] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 06/23/2020] [Accepted: 06/30/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To summarize the effectiveness of physical therapy interventions to reduce fear of falling (FOF) among individuals living with neurologic diseases. DATA SOURCES PubMed, Physiotherapy Evidence Database, Scopus, Web of Science, PsycINFO, Cumulative Index to Nursing and Allied Health, and SportDiscuss were searched from inception until December 2019. STUDY SELECTION Clinical trials with either the primary or secondary aim to reduce FOF among adults with neurologic diseases were selected. DATA EXTRACTION Potential articles were screened for eligibility, and data were extracted by 2 independent researchers. Risk of bias was assessed by the Cochrane Risk of Bias tool for randomized controlled trials and the National Institutes of Health Quality Assessment Tool for pre-post studies. A meta-analysis was performed among trials presenting with similar clinical characteristics. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was used to rate the overall quality of evidence. RESULTS Sixty-one trials with 3954 participants were included in the review and 53 trials with 3524 participants in the meta-analysis. The included studies presented, in general, with a low to high risk of bias. A combination of gait and balance training was significantly more effective compared with gait training alone in reducing FOF among individuals with Parkinson disease (PD) (mean difference [MD]=11.80; 95% CI, 8.22-15.38; P<.001). Home-based exercise and leisure exercise demonstrated significant improvement in reducing FOF over usual care in multiple sclerosis (MS) (MD=15.27; 95% CI, 6.15-24.38; P=.001). No statistically significant between-groups differences were reported among individuals with stroke and spinal cord injury. The overall quality of evidence presented in this review ranges from very low to moderate according to the assessment with the GRADE approach. CONCLUSIONS Gait with lower limb training combined with balance training is effective in reducing FOF in individuals with PD. Also, home-based or leisure exercise is effective among individuals with MS. However, because of several limitations of the included studies, further research is needed to examine the effectiveness of FOF intervention among individuals with neurologic diseases.
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Affiliation(s)
- Libak Abou
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Aditya Alluri
- Department of Molecular and Cellular Biology, College of Liberal Arts & Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Alexander Fliflet
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Yiting Du
- Department of Interdisciplinary Health Sciences, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Laura A Rice
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois.
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Do clinical balance measures have the ability to predict falls among ambulatory individuals with spinal cord injury? A systematic review and meta-analysis. Spinal Cord 2019; 57:1001-1013. [PMID: 31477809 DOI: 10.1038/s41393-019-0346-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 07/09/2019] [Accepted: 07/29/2019] [Indexed: 12/29/2022]
Abstract
STUDY DESIGN Systematic review and meta-analysis. BACKGROUND AND PURPOSE Fall prevalence is high among individuals with spinal cord injury (SCI) and falls may lead to serious consequences. The objective of this study was to investigate the ability of clinical balance measures to predict falls among ambulatory individuals with SCI. METHODS We searched the online databases MEDLINE, Web of Science, Scopus, SportDiscuss, and CINAHL. Two reviewers independently selected prospective and cross-sectional studies of ambulatory adults with SCI, with a method of falls tracking and a clinical balance evaluation. Risk of bias was assessed using the Newcastle-Ottawa Quality Assessment Scale. A meta-analysis of prospective and cross-sectional studies was performed using Review Manager 5.3. RESULTS Ten studies from the 2672 studies identified were included in the qualitative synthesis. Nine studies were included in the meta-analyses. The Berg Balance Scale (BBS) and the Timed Up and Go Test demonstrate ability to differentiate between fallers and non-fallers, mean difference 5.25 (95% CI, 0.29 to 10.20) and 6.65 (95% CI, 0.17 to 13.12) respectively. The BBS presents moderate predictive ability (area under the receiver operating characteristic curve of 0.61 and sensitivity of 65%). Individuals with a BBS score ≥ 40 are likely at risk of falls. CONCLUSION The BBS is the most appropriate and specific clinical balance measure with the ability to discriminate between ambulatory fallers and non-fallers. However, the fall predictive abilities of the measure need to be further explored and improved for this population.
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