Factors predicting falls and mobility outcomes in patients with stroke returning home after rehabilitation who are at risk of falling

Publication date: Available online 21 June 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Mandy Man-Di Ng, Keith D. Hill, Frances Batchelor, Elissa Burton
ObjectiveTo identify factors predicting falls and limited mobility in people with stroke at 12 months after returning home from rehabilitation.DesignObservational cohort study with 12 month follow-up.SettingCommunity.ParticipantsPeople with stroke (n=144) and increased falls risk discharged home from rehabilitation.InterventionsNot applicable.Main Outcome MeasuresFalls 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.ResultsThose 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).ConclusionSeveral 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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