title: Changes in balance and walking from stroke rehabilitation to the community: a follow-up observational study.
abstract: OBJECTIVE
  To investigate (1) whether clinical test scores at discharge predict falls or limited community mobility after discharge from inpatient stroke rehabilitation; and (2) how walking and dynamic standing balance change after discharge.
  
  
  METHODS
  Follow-up observational study between 6 and 36 months after discharge.
  
  
  METHODS
  Rehabilitation setting.
  
  
  METHODS
  Community-dwelling stroke survivors (N=30) who could walk unassisted when discharged from inpatient rehabilitation.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Six-minute walk test (6MWT), Four Square Step Test (FSST), Step Test (ST), Environmental Analysis of Mobility Questionnaire (EAMQ), Falls Efficacy Scale-International (FES-I), and self-reported falls.
  
  
  RESULTS
  Follow-up occurred at a median of 14.5 months postdischarge. Significant improvements occurred between discharge and follow-up for the 6MWT (mean difference [MD]=110.1m; 95% confidence interval [CI], 70.8-149.4; P<.001), ST (MD=1.8 steps; 95% CI, 0.3-3.4; P=.03), and FSST (MD=4.3s; 95% CI, -10.3 to 1.6; P=.05). Despite this, 40% of participants reported falling. The group who fell had lower clinical test scores at discharge and follow-up than nonfallers. Specific cutoff scores for the clinical tests accurately classified falls history in 70% to 78% of participants. The cutoff scores were <250m for the 6MWT, <10 steps on the ST, and a failure or ≥15 seconds to complete the FSST. Participants performing under the cutoff scores reported lower levels of community mobility (EAMQ, P<.04). Concern about falling was only higher for those classified at risk by the FSST (FES-I, P=.008).
  
  
  CONCLUSIONS
  The FSST, ST, and 6MWT scores at discharge had good falls prediction. People classified at risk of falls avoided more tasks in their home and community than those not classified at risk.
authors.affiliation: Physiotherapy Department, Austin Health: Royal Talbot Rehabilitation Centre, Kew, Victoria, Australia. Jannette.Blennerhassett@austin.org.au
authors.forename: Jannette M
authors.initials: JM
authors.lastname: Blennerhassett
authors.forename: Wayne
authors.initials: W
authors.lastname: Dite
authors.forename: Emily R
authors.initials: ER
authors.lastname: Ramage
authors.forename: Meagan E
authors.initials: ME
authors.lastname: Richmond
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000203:Activities of Daily Living; D000368:Aged; D016009:Chi-Square Distribution; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D004856:Postural Balance / Q000502:physiology*; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D000071939:Stroke Rehabilitation; D011795:Surveys and Questionnaires; D016138:Walking / Q000502:physiology*