http://www.archives-pmr.org/article/S0003-9993(17)30408-2/abstract
DOI:
Abstract
Objective
To
identify factors predicting falls and limited mobility in people with
stroke at 12 months after returning home from rehabilitation.
Design
Observational cohort study with 12 month follow-up.
Setting
Community.
Participants
People with stroke (n=144) and increased falls risk discharged home from rehabilitation.
Interventions
Not applicable.
Main Outcome Measures
Falls
were measured using monthly calendars completed by participants, and
mobility was assessed using gait speed over five metres (high mobility
(>0.8m/s) versus low mobility (≤0.8m/s). Both measures were assessed
at 12 months post-discharge. Demographics and functional measures
including balance, strength, visual or spatial deficits, disability,
physical activity level, executive function, functional independence and
falls risk were analysed to determine factors significantly predicting
falls and mobility levels after 12 months.
Results
Those
assessed as being at high falls risk (Falls Risk for Older People in
the Community (FROP-Com) score ≥19) were 4.5 times more likely to fall
by 12 months (OR:4.506, 95% CI:1.71-11.86, p-value:0.002). Factors
significantly associated with lower usual gait speed (<0.8m/s) at 12
months in the multivariable analysis were age (OR:1.07, 95%
CI=1.01–1.14, p-value=0.033), physical activity (OR:1.09, 95% CI
=1.03-1.17, p-value=0.007) and functional mobility (OR:0.83, 95% CI
=0.75-0.93, p-value=0.001).
Conclusion
Several
factors predicted falls and limited mobility for patients with stroke
12 months after rehabilitation discharge. These results suggest that
clinicians should include assessment of falls risk (FROP-Com), physical
activity, and dual task Timed Up and Go during rehabilitation to
identify those most at risk of falling and experiencing limited mobility
outcomes at 12 months, and target these areas during in-patient and
out-patient rehabilitation to optimise long term outcomes.
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