Citation

Westerlind EK, Lernfelt B, Hansson PO, Persson CU. Arch. Phys. Med. Rehabil. 2019; 100(7): 1267-1273.

Affiliation

Institute of Medicine, Department of Molecular and Clinical Medicine (Westerlind, Hansson, Lernfelt) and the Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Rehabilitation Medicine (Persson), Sahlgrenska Academy at the University of Gothenburg, Sweden.

Copyright

(Copyright © 2019, Elsevier Publishing)

DOI

10.1016/j.apmr.2018.12.018

PMID

30610872

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.

Copyright © 2018. Published by Elsevier Inc.

Language: en

Keywords

Accidental Falls; Drug Therapy; Postural Balance; Stroke