Drug Treatment, Postural Control and Falls: An Observational Cohort Study of 504 Patients with Acute Stroke, The Fall Study of Gothenburg (FallsGOT)

Publication date: Available online 3 January 2019

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Ellen K. Westerlind, Bodil Lernfelt, Per-Olof Hansson, Carina U. Persson

Abstract

Objective

To identify whether, and to what extent, treatment with cardiovascular drugs and neurotropic drugs are associated with postural control and falls in patients with acute stroke.

Design

Observational cohort study

Setting

A stroke unit at a University hospital

Participants

A consecutive sample of 504 patients with acute stroke.

Interventions

Not applicable.

Main outcome measures

Postural control was assessed using the modified version of the Postural Assessment Scale for Stroke Patients (SwePASS). Data including baseline characteristics, all drug treatments, and falls were derived from medical records. Univariable and multivariable logistic regression and Cox proportional hazards models were used to analyze the association of drug treatment and baseline characteristics with postural control and with falls.

Results

In the multivariable logistic regression analysis, factors significantly associated with impaired postural control were treatment with neurotropic drugs (e.g.: opioids/sedatives/

hypnotics/antidepressants) (Odds ratio (OR): 1.73, 95% confidence interval (Cl): 1.01-2.97, P=0.046), treatment with opioids (OR: 9.23, 95% Cl: 1.58-54.00, P=0.014), age (OR: 1.09, 95% Cl: 1.07-1.12, P<0.0001), stroke severity (high NIHSS-score) (OR: 1.29, 95% Cl: 1.15-1.45, P<0.0001) and sedentary life style (OR: 4.32, 95% Cl: 1.32-14.17, P=0.016). No association was found between neurotropic drugs or cardiovascular drugs and falls.

Conclusions

Treatment with neurotropic drugs, particularly opioids, in the acute phase after stroke is associated with impaired postural control. Since impaired postural control is the major cause of falls in patients with acute stroke, these results suggest opioids should be used with caution in these patients.

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