title: To what extent can multimorbidity be viewed as a determinant of postural control in stroke patients?
abstract: OBJECTIVE
  To investigate the determinants of postural imbalance after stroke in geriatric patients admitted for low-intensity rehabilitation in skilled nursing facilities (SNFs), particularly the role of multimorbidity.
  
  
  METHODS
  Cross-sectional study design.
  
  
  METHODS
  Fifteen SNFs.
  
  
  METHODS
  All patients who were admitted for rehabilitation after stroke in one of the participating SNFs (N=378) were eligible.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  The Berg Balance Scale (BBS) was selected as a measure of standing balance and the Functional Ambulation Categories (FAC) as a measure of walking balance.
  
  
  RESULTS
  Multimorbidity was present in 34% of the patients. The patients with multimorbidity differed from the patients without multimorbidity with respect to age, proprioception, and vibration sense, but not for any of the cognitive tests, muscle strength, or sitting balance. Patients with multimorbidity had, on average, lower scores on both outcome measures. In linear regression analyses, both the BBS and FAC were best explained by multimorbidity, muscle strength, and the interaction between muscle strength and static sitting balance (overall explained variance 66% and 67%, respectively), while proprioception added only to the variance of the FAC.
  
  
  CONCLUSIONS
  Multimorbidity was independently related to postural imbalance after stroke in patients admitted for rehabilitation in SNFs. Muscle strength and the interaction of muscle strength with static sitting balance were important determinants of both standing and walking balance, indicating these factors as essential targets for rehabilitation.
authors.affiliation: Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. M.Spruit-vanEijk@elg.umcn.nl
authors.forename: Monica
authors.initials: M
authors.lastname: Spruit-van Eijk
authors.forename: Sytse U
authors.initials: SU
authors.lastname: Zuidema
authors.forename: Bianca I
authors.initials: BI
authors.lastname: Buijck
authors.forename: Raymond T
authors.initials: RT
authors.lastname: Koopmans
authors.forename: Alexander C
authors.initials: AC
authors.lastname: Geurts
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005081:Exercise Therapy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D053580:Muscle Strength / Q000502:physiology*; D009426:Netherlands; D004856:Postural Balance; D020127:Recovery of Function / Q000502:physiology; D012044:Regression Analysis; D012307:Risk Factors; D012678:Sensation Disorders / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D012720:Severity of Illness Index; D012866:Skilled Nursing Facilities; D020521:Stroke / Q000150:complications / Q000175:diagnosis; D000071939:Stroke Rehabilitation; D013647:Task Performance and Analysis; D013997:Time Factors; D016896:Treatment Outcome