Abstract
Blennerhassett JM, Dite W, Ramage ER, Richmond ME. Changes in balance and walking
from stroke rehabilitation to the community: a follow-up observational study.
Objectives
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.
Design
Follow-up observational study between 6 and 36 months after discharge.
Setting
Rehabilitation setting.
Participants
Community-dwelling stroke survivors (N=30) who could walk unassisted when discharged
from inpatient rehabilitation.
Interventions
Not applicable.
Main Outcome Measures
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.
Key Words
List of Abbreviations:
CI (confidence interval), EAMQ (Environmental Analysis of Mobility Questionnaire), FES-I (Falls Efficacy Scale–International), FSST (Four Square Step Test), MD (mean difference), 6MWT (6-minute walk test), ST (Step Test)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: April 19, 2012
Footnotes
Supported by the Royal Talbot Rehabilitation Centre, Research and Quality Assurance Grant.
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.
Reprints are not available from the author.
In-press corrected proof published online on May 30, 2012, at www.archives-pmr.org.
Identification
Copyright
© 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
