Determining fall risk change throughout pregnancy: the accuracy of postpartum survey and relationship to fall efficacy

All epidemiological studies on pregnancy fall risk to date have relied on postpartum recall. This study investigated the accuracy of postpartum recall of falls that were reported during pregnancy, including assessment of fall efficacy as a possible reason for recall inaccuracy. Twenty participants reported fall experiences weekly during pregnancy, but one participant was excluded as an outlier. A fall efficacy questionnaire was completed every six weeks during pregnancy. A postpartum survey to mimic previous studies (Dunning, Lemasters, and Bhattacharya 2010; Dunning et al. 2003) was delivered to determine recall accuracy. Postpartum recall of fall events each gestational month matches the previous study (Dunning, Lemasters, and Bhattacharya 2010). However, recall of falls is 16% underestimated and recall of all fall events is 30% overestimated in postpartum survey. There is a slight relationship between fall efficacy and true falls, but not between fall efficacy and fall recall. Our study suggests fall risk needs to be intermittently surveyed throughout pregnancy rather than assessed via postpartum survey.Practitioner summary: This study investigated the accuracy of postpartum survey of fall risk during pregnancy and the possibility of fall efficacy as a covariate. We used three corresponding surveys. We found inaccuracies in postpartum survey, not explain by fall efficacy.

Functional status as a predictor of the incidence of falls in 10-year follow-up: results from the RAC-OST-POL study

INTRODUCTION

The aim of this prospective study was to establish the influence of baseline functional status on the incidence of falls.

MATERIAL AND METHODS

The study was performed in an epidemiological sample of postmenopausal women from the RAC-OST-POL study. At baseline there were 978 postmenopausal women with a mean age of 65.9 ± 7.6 years, and at the end of 10-year follow-up 640 patients with a mean age of 65.04 ± 6.95 years remained in observation. Functional status was established at baseline using a stand up and go test (SAG) and the Lawton Instrumental Activities of Daily Living (IADL) scale. Afterwards, data on fall incidence were updated annually using phone interviews.

RESULTS

In a 10-year period of observation, in 384 (60%) women at least one fall occurred. At baseline, 90% of subjects achieved maximal value in the IADL scale (24 points). Although the difference between mean IADL score in those who fell and did not fall was noticeable (23.50 ± 1.68 vs. 23.65 ± 1.47, respectively), the category of any IADL score below 24 points was significantly more frequent in women with falls (71.9% vs. 28.1%; chi-square 4.2, p < 0.05). The SAG score in the subgroup with falls was (10.75 ± 3.39) and did not differ in comparison to subgroup without falls (10.27 ± 2.72).

CONCLUSION

The baseline result of the IADL scale but not that of the SAG test are related to the incidence of falls in a 10-year prospective observation. Adequate correction of functional status may benefit patients and reduce the fall rate.

The U-shaped association between hospitalization time and fall incidence in inpatients using publicly available data: A cross-sectional study in Japan

AIM

To examine the association between the hospitalization time and fall incidence.

DESIGN

A secondary analysis using the Dryad Digital Repository public database.

METHODS

Data were extracted from the Fukushima Medical University Hospital cohort study between August 2008 and September 2009. The final analytic sample included 8,598 participants, 156 of who fell. The risk of fall incidents according to hospitalization time was estimated using logistic proportional hazards models, and restricted cubic splines with four knots model were developed.

RESULTS

The median hospitalization time was 9.00 (4.00, 17.00) days. The incidence of falls was 1.81% (N = 156). A U-shaped association between the hospitalization time and fall incidence, with an inflextion point of 8 days. We found a decreasing fall incidence as the hospitalization time increased from 0 to 8 days (OR 0.72 [0.62 ~ 0.83], p < .001); beyond 8 days, the fall incidence increased as the hospitalization time increased (OR 1.06 [1.04 ~ 1.09]).

Occlusal support and postural stability in children: An observational study

BACKGROUND

The relationship between uneven occlusal contact and fall risk has been described in elderly participants; however, multiple confounding factors, such as systemic disease or deterioration in vestibular function, have not been well considered. This study aimed to investigate this relationship in pediatric participants at the age of approximately 9-12, where these confounding factors are absent and the replacement of primary molars by permanent ones generally occurs and transiently results in uneven occlusal contact.

METHODS

Sixty-five children (36 boys and 29 girls, mean age: 9.5 ± 1.5 years) were enrolled in this study. Participants were asked whether they had experienced at least two falls within the past 1 year. The occlusal contact area ratio was calculated by dividing the greater half (right or left dental arch) by the smaller half (the other half) with U-shaped pressure sensor sheet. The total length and rectangular area of the center of pressure while standing upright for 10 s were measured with a stabilometer and used as postural sway parameters.

RESULTS

The occlusal contact area ratio significantly correlated with the postural sway parameters. Comparison between those who had experienced the fall incidences and those who had not after propensity score matching that adjusts their overall physical function revealed that there were no significant differences in the postural sway parameters and occlusal contact area ratio regardless of the history of fall incidence.

CONCLUSIONS

Uneven occlusal contact leads to an increase in postural sway in children; however, this may not be associated with fall incidence.

Effects of combined physical and cognitive training on fall prevention and risk reduction in older persons with mild cognitive impairment: a randomized controlled study

OBJECTIVE

The aim of this study is to investigate the effects of combined physical and cognitive training on fall rate and risks of falling in older adults with mild cognitive impairment.

DESIGN

The design of this study was an assessor-blinded, randomized controlled trial.

SETTING

The setting for this study is the community from Manila, Philippines.

SUBJECTS

In total, 92 community-dwelling older persons with mild cognitive impairment (aged 60-83) were randomly allocated to three intervention groups and one waitlist control group.

INTERVENTIONS

The physical training, cognitive training, and combined physical and cognitive training intervention programs were delivered for 60 to 90 minutes, one to three times per week for 12 weeks with six-month follow-up.

MAIN MEASURES

Participants were assessed at baseline, 12 weeks after baseline, and 36 weeks after baseline for fall incidence, overall fall risk, dynamic balance, walking speed, and lower limb strength.

RESULTS

No significant difference was observed across time and groups on fall incidence rate at 12 weeks (P = 0.152) and at 36 weeks (P = 0.954). The groups did not statistically differ in other measures except for a significant improvement in dynamic balance based on Timed Up and Go Test in the combined physical and cognitive training group (9.0 seconds with P = 0.001) and in the cognitive training alone group (8.6 seconds with P = 0.012) compared to waitlist group (11.1 seconds) at 36 weeks.

CONCLUSION

There was no significant difference among groups on fall rate and risks of falling post-intervention. Dynamic balance was improved with combined physical and cognitive training and cognitive training alone. Further research with a larger sample size is needed to establish whether or not the interventions are effective.

Incidence and Circumstances of Falls in Women Before and After Total Hip Arthroplasty: A Prospective Cohort Study

BACKGROUND

We investigated the incidence and circumstances related to falls in patients before and after total hip arthroplasty (THA), and compared them with those in an age-matched control group.

METHODS

This is a prospective cohort study. A total of 140 women with severe hip osteoarthritis (OA) who underwent THA (OA group) and a control cohort of 319 age-matched healthy women were analyzed. We investigated the incidence and circumstances of falls before THA and during the first year after surgery. We assessed the Harris Hip Score and investigated hip pain and ambulatory ability using a self-administered questionnaire.

RESULTS

The incidence of at least one fall during the first year after THA in the OA group (30.0%) was significantly higher than that in the control group (13.5%) (P < .001), as were the rates of indoor falls (50.0%) and falls during daytime (66.2%). Although the incidence of fall-induced injuries after THA (37.8%) was significantly lower than that in the control group (62.5%), 5.9% of patients who experienced a fall developed a fracture. No significant differences were found in the number and circumstances of falls before and after THA, with 31.4% and 30.0% of the OA group reporting at least one fall in the 12 months before and after surgery, respectively. Self-reported pain, ambulation, and Harris Hip Score significantly improved after THA.

CONCLUSION

Women undergoing THA have an increased risk of falls during the first year after surgery. Clinicians should suggest preventive measures during rehabilitation to prevent falling in post-THA women.

Fall incidence and associated risk factors among people with a lower limb amputation during various stages of recovery - a systematic review

Purpose: The objective of this study was to estimate fall incidence and describe associated risk factors among people with a lower limb amputation (LLA) during various stages of recovery: the surgical ward, in-patient rehabilitation and return to community life. Materials and methods: A systematic search of relevant English language articles was performed using PubMed and EMBASE. Out of 310 initial "hits," six retrospective cohort studies, one prospective cohort study and eleven cross-sectional studies from which fall incidence and risk factors could be extracted, were selected for critical review. Fall incidence and associated risk factors were extracted and analyzed in the context of various clinical stages of recovery after amputation. The studies were evaluated for quality using the "Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies." Results: Results showed that during all stages of recovery, people with a LLA are at increased risk of falling compared with able-bodied individuals, as well as other clinical populations. Each stage of recovery is associated with different fall risk factors. The current review is limited mainly by the paucity of studies on the topic. Conclusions: Specialised care focusing on the most relevant risk factors for each stage of recovery may enhance fall prevention during post-fall recovery. Implications for rehabilitation •  People with a lower limb amputation are at a high risk of falling in all stages of their clinical course.      •  Health professionals should be aware that people with a lower limb amputation in the first 4 years ofamputation or with four or more health-related problems are at an increased risk.      •  Health professionals should also be aware that increased gait variability, excess confidence in balance andwalking abilities and less cautious stair walking, impose an elevated risk of falling and should focus theirefforts in reducing these factors.