Estimated Risk for Falls Among Community-Dwelling Stroke Survivors Referred to Outpatient Physiotherapy

Title: Estimated risk for falls among community-dwelling stroke survivors referred to outpatient physiotherapy Authors: Carla Pimenta1,2, Anabela Correia1,2, Marta Alves3, Daniel Virella3 1. Physiotherapy Department, Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central, Portugal. 2. Department of Rehabilitation Science and Technology, Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, Portugal. 3. Epidemiology and Statistics Office of the Research Unit, Centro Hospitalar Universitário Lisboa Central, Portugal. Background: In the sub-acute phase of stroke, most of the patients with moderate or severe impairments typically attend in-patient rehabilitation. Functional recovery continues after discharge and patients can benefit of outpatient physiotherapy. Homecoming may lead to an increased risk for falls, as the patient is no longer in a protected environment. The physiotherapy assessment should identify the risk of falling, in order to minimize it. Purpose: To estimate the risk for falls among community-dwelling stroke survivors referred to the outpatient physiotherapy in a tertiary care hospital and to explore factors associated with increased risk for falls. Methods: Observational, cross-sectional study with nested case-control study, of individuals referred to the physiotherapy department less than 12 months after stroke and able to walk independently. A referral period of 4 years was considered. Three functional tools were applied: Berg Balance Scale (BBS), Timed Up and Go Test (TUG) and the Motor Assessment Scale (MAS); demographic and clinical data were collected. Risk for falls was defined as BBS≤45 or TUG³14. Independent variables to include in the multivariable logistic regression model were identified by Chi- Square test and Mann-Whitney test. Results: Of 217 individuals referred for ambulatory treatment, 140 fulfilled the inclusion criteria. Patients were 21 to 87 years old (median 66), 80 males, in 109 the stroke occurred in the lasts 6 months, 117 had ischemic stroke and in 29 it was a recurrent stroke. Risk for falls was identified in 117 individuals (83.6% [95%CI 76.6 - 88.8]); 95 cases were identified by both BBS and TUG, 12 only by BBS and 10 by TUG alone. The model for risk for falls included age, gender and MAS shows that for each increase in one year of age, the odds for falls increased 10% (adjusted OR 1.10; 95%CI 1.04 – 1.17; p=0.002), odds for falls was 14 fold higher in females (adjusted OR 14.43; 95%CI 1.89 – 110.12; p=0.010) and for each increase in MAS units, the odds for falls decreased 23% (adjusted OR 0.77; 95%CI 0.66 – 0.88; p