Citation

Mansfield A, Wong JS, McIlroy WE, Biasin L, Brunton K, Bayley M, Inness EL. Physiotherapy 2015; 101(4): 373-380.

Affiliation

Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada.

Copyright

(Copyright © 2015, Chartered Society of Physiotherapy London)

DOI

10.1016/j.physio.2015.01.009

PMID

26050134

Abstract

OBJECTIVE: To determine if reactive balance control measures predict falls after discharge from stroke rehabilitation.

DESIGN: Prospective cohort study. SETTING: Rehabilitation hospital and community. PARTICIPANTS: Independently ambulatory individuals with stroke who were discharged home after inpatient rehabilitation (n=95). MAIN OUTCOME MEASURES: Balance and gait measures were obtained from a clinical assessment at discharge from inpatient stroke rehabilitation. Measures of reactive balance control were obtained: (1) during quiet standing; (2) when walking; and (3) in response to large postural perturbations. Participants reported falls and activity levels up to 6 months post-discharge. Logistic and Poisson regressions were used to identify measures of reactive balance control that were related to falls post-discharge.

RESULTS: Decreased paretic limb contribution to standing balance control [rate ratio 0.8, 95% confidence interval (CI) 0.7 to 1.0; P=0.011], reduced between-limb synchronisation of quiet standing balance control (rate ratio 0.9, 95% CI 0.8 to 0.9; P<0.0001), increased step length variability (rate ratio 1.4, 95% CI 1.2 to 1.7; P=0.0011) and inability to step with the blocked limb (rate ratio 1.2, 95% CI 1.0 to 1.3; P=0.013) were significantly associated with increased fall rates when controlling for age, stroke severity, functional balance and daily walking activity.

CONCLUSIONS: Impaired reactive balance control in standing and walking predicted increased risk of falls post-discharge from stroke rehabilitation. Specifically, measures that revealed the capacity of both limbs to respond to instability were related to increased risk of falls. These results suggest that post-stroke rehabilitation strategies for falls prevention should train responses to instability, and focus on remediating dyscontrol in the more-affected limb.

Language: en