Journal of Rehabilitation Research & Development (JRRD)

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Volume 47 Number 6, 2010
   Pages 553 — 562

Abstract ??? Prevalence, predictors, and outcomes of poststroke falls in acute hospital setting

Arlene A. Schmid, PhD, OTR;1-3* Carolyn K. Wells, MPH;4 John Concato, MD;4-6 Mary I. Dallas, PT, PhD;5 Albert C. Lo, MD, PhD;7-8 Steven E. Nadeau, MD;9-10 Linda S. Williams, MD;1,3,11-12 Aldo J. Peixoto, MD;5-6 Mark Gorman, MD;13 John L. Boice, MD;14 Frederick Struve, PhD;4 Vincent McClain, MD;4 Dawn M. Bravata, MD1,12,15

1Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D) Center of Excellence on Implementing Evidence-Based Practice and HSR&D Stroke Quality Enhancement Research Initiative, Richard L. Roudebush VA Medical Center (VAMC), Indianapolis, IN; 2Department of Occupational Therapy, Indiana University School of Health and Rehabilitation Sciences, Indianapolis, IN; 3Indiana University Center for Aging Research, Indianapolis, IN; 4Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven, CT; 5VA Connecticut Healthcare System, West Haven, CT; 6Department of Internal Medicine, Yale School of Medicine, New Haven, CT; 7Departments of Neurology, Engineering, Neuroscience, and Community Health, Warren Alpert Medical School of Brown University, Providence, RI; 8Providence VAMC, Providence, RI; 9Neurology Service, Malcom Randall VAMC, Gainesville, FL; 10Department of Neurology, College of Medicine, University of Florida, Gainesville, FL; 11Department of Neurology, Indiana University School of Medicine, Indianapolis, IN; 12Regenstrief Institute, Inc, Indianapolis, IN; 13Department of Neurology, University of Vermont College of Medicine, Burlington, VT; 14Medicine Service, Boise VAMC, Boise, ID; 15Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN

Abstract — Falls are a serious medical complication following stroke. The objectives of this study were to (1) confirm the prevalence of falls among patients with stroke during acute hospitalization, (2) identify factors associated with falls during the acute stay, and (3) examine whether in-hospital falls were associated with loss of function after stroke (new dependence at discharge). We completed a secondary analysis of data from a retrospective cohort study of patients with ischemic stroke who were hospitalized at one of four hospitals. We used logistic regression to identify factors associated with inpatient falls and examine the association between falls and loss of function. Among 1,269 patients with stroke, 65 (5%) fell during the acute hospitalization period. We found two characteristics independently associated with falls: greater stroke severity (National Institutes of Health Stroke Scale [NIHSS] Š8, adjusted odds ratio [OR] = 3.63, 95% confidence interval [CI]: 1.46-9.00) and history of anxiety (adjusted OR = 4.90, 95% CI: 1.70-13.90). Falls were independently associated with a loss of function (adjusted OR = 9.85, 95% CI: 1.22-79.75) even after adjusting for age, stroke severity, gait abnormalities, and past stroke. Stroke severity (NIHSS >8) may be clinically useful during the acute inpatient setting in identifying those at greatest risk of falling. Given the association between falls and poor patient outcomes, rehabilitation interventions should be implemented to prevent falls poststroke.

Key words: activities of daily living, falls, function, functional status, outcomes, predictors, prevalence, stroke, stroke recovery, stroke severity.

This article and any supplementary material should be cited as follows:
Schmid AA, Wells CK, Concato J, Dallas MI, Lo AC, Nadeau SE, Williams LS, Peixoto AJ, Gorman M, Boice JL, Struve F, McClain V, Bravata DM. Prevalence, preditors, and outcomes of postroke falls in acute hospital setting. J Rehabil Res Dev. 2009;47(6):553-62.
DOI:10.1682/JRRD.2009.08.0133

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