Advertisement

External validation of the recurrent falls risk scale in community-dwelling stroke individuals

      Abstract

      Objective

      To externally validate the Recurrent Fall Risk Scale (ReFR) in community-dwelling stroke survivors.

      Methods

      Cohort of stroke survivors with independent gait ability recruited from a reference outpatient stroke clinic. Besides sociodemographic and clinical data, the following scales were used: Modified Barthel Index (mBI), ReFR scale and National Institutes of Health Stroke Scale (NIHSS). Participants were followed up for 12 months to record the incidence of falls. Accuracy of the ReFR scale was measured by the area under the ROC curve.

      Results

      One hundred and thirteen individuals were recruited between April 2016 and November 2016: mean age 54 years (± 14), 55% women, median time since the last stroke 24 months (range 12 –48 months), posterior vascular territory affected in 35% of the sample. Median NIHSS was 3 (range 1 to 6), median mBI 49 (range 46–50), median ReFR 3 (range 2 to 5). During the follow-up period, 32 (33%) subjects had at least one fall and 18 (19%) were recurrent fallers (two or more falls). The accuracy of ReFR scale was 0.67 (95% CI = 0.54–0.79), p = 0.026.

      Conclusion

      This study externally validated the ReFR as a tool to predict recurrent falls in individuals after stroke.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Stroke and Cerebrovascular Diseases
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Tsur A.
        • Segal Z.
        Falls in stroke patients: risk factors and risk management.
        IMAJ. 2010; 12 (PMID:20803880): 216-219
        • Jalayondeja C.
        • Sullivan P.E.
        • Pichaiyongwongdee S.
        Six-month prospective study of fall risk factors identification in patients post-stroke.
        Geriatr Gerontol Int. 2014; 14: 778-785https://doi.org/10.1111/ggi.12164
        • Geng Y.
        • Lo J.C.
        • Brickner L.
        • Gordon N.P.
        Racial-ethnic diferences in fall prevalence among older women: a cross sectional survey study.
        BMC Geriatrics. 2017; 17: 65https://doi.org/10.1186/s12877-017-0447-y
      1. Berry Sarah D, Kiel Douglas P. Falls. American Geriatrics (AGS) review syllabus. UpdatedJuly 2018. https://geriatricscareonline.org/FullText/B023/B023_VOL001_PART001_SEC004_CH032.

        • Smith J.
        • Forster A.
        • Young J.
        Use of the “STRATIFY” falls risk assessment in patients recovering from acute stroke.
        Age Ageing. 2006; 35: 138-143https://doi.org/10.1093/ageing/afj027
        • Andersson A.G.
        • Kamwendo K.
        • Seiger A.
        • Appelros P.
        How to identify potential fallers in a stroke unit: validity indexes of four test methods.
        J Rehabil Med. 2006; 38: 186-191https://doi.org/10.1080/16501970500478023
        • Khan S.
        • Hadian M.R.
        • Olyaei G.
        • Arslan S.A.
        • Yekaninejad S.
        • Tafakhori A.
        Comparing falls efficacy scale-international and berg balance scale in predicting recurrent risk of fall in stroke patients.
        J Mod Rehab. 2017; 11: 103-108https://doi.org/10.15406/jnsk.2015.03.00089
        • Walsh M.
        • Galvin R.
        • Boland F.
        • et al.
        Validation of two risk-prediction models for recurrent falls in the first year after stroke: a prospective cohort study.
        Age Ageing. 2017; 0: 1-6https://doi.org/10.1093/ageing/afw255
        • Sherrington C.
        • Lord S.R.
        • Close J.C.T.
        • Barraclough E.
        • Taylor M.
        • O'Rourke S.
        • et al.
        Development of a tool for prediction of falls in rehabilitation settings (predict_first): a prospective cohort study.
        J Rehabil Med. 2010; 42: 482-488https://doi.org/10.2340/16501977-0550
        • Mackintosh S.F.
        • Hill K.D.
        • Dodd K.J.
        • Goldie P.A.
        • Culham E.G.
        Balance score and a history of falls in hospital predict recurrent falls in the 6 months following stroke rehabilitation.
        Arch Phys Med Rehabil. 2006; 87: 1583-1587https://doi.org/10.1016/j.apmr.2006.09.004
        • Pinto E.B.
        • Nascimento C.
        • Monteiro M.
        • Castro M.
        • Maso I.
        • Campos A.
        • et al.
        Proposal for a new predictive scale for recurrent fall risk in a cohort of community-dwelling patients with stroke.
        J Stroke Cerebrovasc Dis. 2016; 25: 2619-2626
        • Moons K.G.M.
        • Altman D.G.
        • Reitsma J.B.
        • et al.
        Transparent Reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): explanation and elaboration.
        Ann Intern Med. 2015; 162: W1-W73https://doi.org/10.7326/M14-0698
        • Cincura C.
        • Pontes-Neto O.M.
        • Neville I.S.
        • Mendes H.F.
        • Menezes D.F.
        • Mariano D.C.
        • et al.
        Validation of the National Institutes of Health Stroke Scale, Modified Rankin Scale and Barthel Index in Brazil: The role of cultural adaptation and structured interviewing.
        Cerebrovasc Disease. 2009; 27: 119-122https://doi.org/10.1159/000177918
        • Carot-Artal J.
        • Egido J.A.
        • Gonzáles J.L.
        • Seijas V.
        Quality of life among Stroke survivors evaluated 1 Year after Stroke experience of a Stroke unit.
        Stroke. 2000; 31: 2995-3000https://doi.org/10.1161/01.STR.31.12.2995
        • Persson C.U.
        • Hansson P.
        • Sunnerhagen K.S.
        Clinical tests performed in acute stroke identify the risk of falling during the first year: postural stoke study in Gothenburg (POSTGOT).
        J Rehabil Med. 2011; 43 (11): 348-353https://doi.org/10.2340/16501977-0677
        • Nystrom A.
        • Hellstrom K.
        Fall risk six weeks from onset of stroke and the ability of the Prediction of Falls in Rehabilitation Settings Tool and motor function to predict falls.
        Clin Rehabil. 2012; 27: 473-479https://doi.org/10.1177/0269215512464703
        • Breisinger T.P.
        • Skidmore E.R.
        • Niyonkuru C.
        • Terhorst L.
        • Campbell G.B.
        The stroke assessment of fall risk (SAFR): predictive validity in inpatient stroke rehabilitation.
        Clin Rehabil. 2014; 28: 1218-1224https://doi.org/10.1177/0269215514534276
        • Ma C.
        • Evans K.
        • Bertmar C.
        • Krause M.
        Predicitive value of the Royal Melbourne Hospital Falls Risk Assessment Tool (RMH FRAT) for post-stroke patients.
        J Clin Neurosci. 2014; 21: 607-611
        • Doroszkiewicz H.
        • Sierakowska M.
        • Muszalik M.
        Utility of the Care Dependency Scale in predicting care needs and health risks of elderly patients admitted to a geriatric unit: a cross-sectional study of 200 consecutive patients.
        Clin Interv Aging. 2018; 13: 887-894https://doi.org/10.2147/CIA.S159511
        • Ungar A.
        • Rafanelli M.
        • Iacomelli I.
        • Brunetti M.A.
        • Ceccofiglio A.
        • Tesi F.
        • et al.
        Fall prevention in the elderly.
        Clin Cases Min Bone Metab. 2013; 10 (PMID:24133524): 91-95
        • Oliver D.
        • Britton M.
        • Seed P.
        • Martin F.C.
        • Hopper A.H.
        Development and evaluation of evidence based risk assessment tool (STRATIFY) to predict which elderly inpatients will fall: case-control and cohort studies.
        BMJ. 1997; : 315https://doi.org/10.1136/bmj.315.7115.1049
        • Pollock C.L.
        Clinical measurement of walking balance in people post stroke: a systematic review.
        Clin Rehabil. 2011; 25: 693-708https://doi.org/10.1177/0269215510397394
        • Walsh M.E.
        • Horgan N.F.
        • Walsh C.D.
        • Galvin R.
        Systematic review of risk prediction models for falls after stroke.
        J Epidemiol Community Health. 2016; 0: 1-7https://doi.org/10.1136/jech-2015-206475
        • Batchelor F.A.
        • Mackintosh S.F.
        • Said C.M.
        • Hill K.D.
        Falls after stroke.
        Int J Stroke. 2012; 7: 482-490https://doi.org/10.1111/j.1747-4949.2012.00796.x
        • Papaioannou A.
        • Parkinson W.
        • Cook R.
        • Ferko N.
        • Coker E.
        • Adachi J.D.
        Prediction of falls using a risk assessment tool in the acute care setting.
        BMC Med. 2004; 2: 1https://doi.org/10.1186/1741-7015-2-1
        • Xu T.
        • Clemson L.
        • O'Loughlin
        • Lannin N.A.
        • Dean C.
        • Koh G.
        Risk factors for falls in community stroke survivors: A systematic review and metaanalysis.
        Arch Phys Med Rehabil. 2018; 99 (.e5): 563-573https://doi.org/10.1016/j.apmr.2017.06.032
        • Divani A.A.
        • Vazquez G.
        • Barrett A.M.
        • Asadollahi M.
        • Luft A.R.
        Risk factors associated with injury attributable to falling among elderly population with history of stroke.
        Stroke. 2009; 40: 3286-3292https://doi.org/10.1161/STROKEAHA.109.559195
        • Alenazi A.M.
        • Alshehri M.M.
        • Alothman S.
        • Rucker J.
        • Dunning K.
        • D'Silva L.
        • Kluding P.M.
        Functional Reach, Depression Scores and Number of Medications are Associated with Number of Falls in People with Chronic Stroke.
        PM&R. 2018; 10: 806-816https://doi.org/10.1016/j.pmrj.2017.12.005
        • Tsai S.F.
        • Yin J.H.
        • Tung T.H.
        • et al.
        Falls efficacy among stroke survivors living in the community.
        Disabil Rehabil. 2011; 33: 1785-1790https://doi.org/10.3109/09638288.2010.546938
        • Hwanga S.
        • Woob Y.
        • Kimc K.-H.
        • Kic K.-I.
        Effects of falls experience on cognitive functions and physical activities in community-dwelling individuals with chronic stroke.
        Int J Rehabil Res. 2013; 36: 134-139https://doi.org/10.1097/MRR.0b013e32835b667e
        • Samuelsson Carina M.
        • Hansson Per-Olof
        • Persson Perssons Carina U.
        Early prediction of falls after stroke: a 12-month follow-up of 490 patients in The Fall Study of Gothenburg (FallsGOT).
        Clin Rehabil I–II. 2018; (Article reuse guidelines: sagepub.com/journals-permissionsjournals.sagepub.com/home/cre)https://doi.org/10.1177/0269215518819701
      2. Ng MM, Hill KD, Batchelor F, Burton E. Factors predicting falls and mobility outcomes in patients with stroke returning home after rehabilitation who are at risk of falling. Arch Phys Med Rehabil DOI 10.1016/j.apmr.2017.05.018.

        • Sherrington C.
        • Michaleff Z.A.
        • Fairhall N.
        • et al.
        Exercise to prevent falls in older adults: an updated systematic review and meta-analysis.
        Br J Sports Med. 2017; 51: 1749-1757https://doi.org/10.1136/bjsports-2016-096547
        • Gerards M.
        • McCrum C.
        • Mansfield A.
        • Meijer K.
        Perturbation-based balance training for falls reduction among older adults: current evidence and implications for clinical practice.
        Geriatr Gerontol Int. 2017; 17: 2294-2303https://doi.org/10.1111/ggi.13082
        • Batchelor F.
        • Hill K.
        • Mackintosh S.
        • Said C.
        What Works in Falls Prevention After Stroke? a systematic review and meta-analysis.
        Stroke. 2010; 41: 1715-1722https://doi.org/10.1161/STROKEAHA.109.570390
        • Verheyden G.S.A.F.
        • Weerdesteyn V.
        • Pickering R.M.
        • Kunkel D.
        • Lennon S.
        • Geurts A.C.H.
        • Ashburn A.
        Interventions for preventing falls in people after stroke (Review).
        Cochrane Database of Syst Rev. 2013; (Art. No.: CD008728)https://doi.org/10.1002/14651858.CD008728.pub2
        • Mansfield A.
        • Aqui A.
        • Danells C.J.
        • et al.
        Does perturbation-based balance training prevent falls among individuals with chronic stroke? A randomised controlled trial.
        BMJ Open. 2018; 8e021510https://doi.org/10.1136/bmjopen-2018-021510
        • Shumway-Cook A.
        • Brauer S.
        • Woollacott M.
        Predicting the probability for falls in community-dwelling older adults using the timed up & go test.
        Phys Ther. 2000; 80 (PMID:10960937): 896-902
        • Bamford J.
        • Sandercock P.
        • Dennis M.
        • Burn J.
        • Warlow C.
        Classification and natural history of clinically identifiable subtypes of cerebral infarction.
        Lancet. 1991; 337: 1521-1526https://doi.org/10.1016/0140-6736(91)93206-o
        • Dewey H.
        • Macdonell R.
        • Donnan G.
        • McNeil J.
        • Freeman E.
        • Thrift A.
        • Sharples C.
        Inter-rater reliability of stroke sub-type classification by neurologists and nurses within a community-based stroke incidence study.
        J Clin Neurosci. 2001; 8: 14-17https://doi.org/10.1054/jocn.2000.0786