Deans' stroke musings: Exploring the association between activities of daily living ability and injurious falls in older stroke patients with different activity ranges

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Monday, August 26, 2024

Exploring the association between activities of daily living ability and injurious falls in older stroke patients with different activity ranges

What is your competent? doctors EXACT FALL PREVENTION PROTOCOL? Including numerous perturbations. Does your doctor at least have a protocol on how to fall without getting injured? Or is your doctor setting you up with a protocol to strengthen your bones so when you fall nothing breaks? Oh, your doctor is doing nothing, so you don't have a functioning stroke doctor, do you?

Exploring the association between activities of daily living ability and injurious falls in older stroke patients with different activity ranges

Scientific Reports volume 14, Article number: 19731 (2024) Cite this article

Metrics details

Abstract

Injurious falls pose a significant threat to the safety of stroke patients, particularly among older adults. While the influence of activities of daily living (ADL) on falls is acknowledged, the precise connection between ADL ability and fall-related injuries in older stroke patients undergoing rehabilitation, particularly those with varying mobility levels, remains unclear. This multicenter cross-sectional study in China recruited 741 stroke patients aged 65 years and above, categorized into bedridden, domestic, and community groups based on their mobility levels using the Longshi Scale. ADL ability was assessed using the Barthel Index. Logistic regression models, generalized additive models, smoothed curve-fitting, and threshold effect analysis were employed to explore the relationship between ADL ability and injurious falls across the three mobility groups. Results revealed an inverted U-shaped relationship between ADL ability and injurious falls among patients in the domestic group (p = 0.011). Below the inflection point of 35 on the Barthel Index, the likelihood of injurious falls increased by 14% with each unit increase in ADL ability (OR = 1.14, 95% CI 1.010–1.29, p = 0.0331), while above the inflection point, it decreased by 3% per unit increase (OR = 0.97, 95% CI 0.95–0.99, p = 0.0013). However, no significant association between ADL ability and injurious falls was observed in either the bedridden or community groups (p > 0.05). These findings suggest that only older stroke patients capable of engaging in activities at home demonstrate a correlation between ADL ability and injurious falls. The identified inverted U-shaped relationship may aid in identifying fall injury risk in this population.

Introduction

Injurious falls are among the reasons for mortality and morbidity in older adults¹. The risk of falls is higher among survivors of stroke, persisting even years after the stroke occurrence^2,3. During inpatient rehabilitation, stroke patients have a fall rate of up to 48%, with nearly one-third of these falls resulting in potentially severe injuries⁴. Fall-related injuries encompass abrasions, contusions, sprains, fractures, and, in severe cases, fatalities, with these consequences intricately linked to clinical deterioration, increased caregiving dependency, and additional economic burdens^5,6. Therefore, preventing falls and fall-related injuries is crucial for older stroke patients in the rehabilitation department.

Several studies have indicated that injurious falls were associated with a loss of independence on activities of daily living (ADL)^7,8,9. However, the precise correlation between ADL ability and the risk of fall-related injuries remains unclear among older stroke patients with different ranges of mobility. Their mobility range, determined by their ADL ability and functional level, potentially restrict the locations where injurious falls may occur. Additionally, stroke patients with different functional abilities have distinctive social roles and experience diverse daily living environments, which may influence their functional performance and, consequently, their risk of injurious falls^10,11. Therefore, a stratified analysis of these individuals based on their range of activities allows for a more comprehensive and accurate understanding of the relationship between their ADL abilities and the occurrence of injurious falls. Our research team has developed the Longshi Scale (LS), a novel pictorial-based self-care assessment tool that categorizes patients into bedridden, domestic, and community groups based on the range of activities they can perform¹². In previous research, we observed that stroke patients in different LS subgroups demonstrate varying fall risk levels¹³. However, the correlation between ADL ability and the risk of injurious falls remains unclear within these three subgroups, necessitating further in-depth research.

The purpose of this study was to investigate the relationship between ADL ability and the risk of occurrence of injurious falls in older stroke patients based on the population classification criteria of LS and to provide a basis for more accurately assessing and predicting the occurrence of injurious falls.