Falls and Fear of Falling After Stroke: A Case-Control Study.
Falls are common after stroke, with potentially serious consequences. Few investigations have included age-matched control participants to directly compare fall characteristics between older adults with and without stroke. Further, fear of falling, a significant psychological consequence of falls, has only been examined to a limited degree as a risk factor for future falls in a stroke population.



To compare the fall history between older adults with and without a previous stroke and to identify the determinants of falls and fear of falling in older stroke survivors.



Case-control observational study.



Primary teaching hospital.



Seventy-five patients with stroke (mean age ± standard deviation, 66 ± 7 years) and 50 age-matched control participants with no previous stroke were tested.



Fall history, fear of falling, and physical, cognitive, and psychological function were assessed. A χ2test was performed to compare characteristics between groups, and logistic regression was performed to determine the risk factors for falls and fear of falling.



Fall events in the past 12 months, Fall Efficacy Scale-International, Berg Balance Scale, Functional Ambulation Category, Fatigue Severity Scale, Montreal Cognitive Assessment, and Patient Healthy Questionnaire-9 were measured for all participants. Fugl-Meyer Motor Assessment was used to quantify severity of stroke motor impairments.



Twenty-three patients and 13 control participants reported at least one fall in the past 12 months (P = .58). Nine participants with stroke had recurrent falls (≥2 falls) compared with none of the control participants (P < .01). Participants with stroke reported greater concern for falling than did nonstroke control participants (P < .01). Female gender was associated with falls in the nonstroke group, whereas falls in the stroke group were not significantly associated with any measured outcomes. Fear of falling in the stroke group was associated with functional ambulation level and balance. Functional ambulation level alone explained 22% of variance in fear of falling in the stroke group.



Compared with persons without a stroke, patients with stroke were significantly more likely to experience recurrent falls and fear of falling. Falls in patients with stroke were not explained by any of the outcome measures used, whereas fear of falling was predicted by functional ambulation level. This study has identified potentially modifiable risk factors with which to devise future prevention strategies for falls in patients with stroke.



III.
School of Physical Therapy, Texas Woman's University, Dallas, TX 75235(∗). Electronic address: huitinggoh76@gmail.com.
Hui-Ting
HT
Goh
Department of Rehabilitation Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia(†).
Mohanasuntharaam
M
Nadarajah
Department of Rehabilitation Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia(†).
Norhamizan Binti
NB
Hamzah
Division of Physiotherapy, Department of Rehabilitation Medicine, University of Malaya Medical Centre, Malaysia(‡).
Parimalaganthi
P
Varadan
Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia(¶); Ageing and Age Associated Disorders Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia(§).
Maw Pin
MP
Tan
D000058:Accidental Falls; D000368:Aged; D016022:Case-Control Studies; D005239:Fear; D005260:Female; D006801:Humans; D016015:Logistic Models; D012307:Risk Factors; D020521:Stroke