Abstract
Objective
To identify whether, and to what extent, treatment with cardiovascular drugs and neurotropic
drugs are associated with postural control and falls in patients with acute stroke.
Design
Observational cohort study.
Setting
A stroke unit at a university hospital.
Participants
A consecutive sample of patients (N=504) with acute stroke.
Interventions
Not applicable.
Main Outcome Measures
Postural control was assessed using the modified version of the Postural Assessment
Scale for Stroke Patients. Data including baseline characteristics, all drug treatments,
and falls were derived from medical records. Univariable and multivariable logistic
regression and Cox proportional hazards models were used to analyze the association
of drug treatment and baseline characteristics with postural control and with falls.
Results
In the multivariable logistic regression analysis, factors significantly associated
with impaired postural control were treatment with neurotropic drugs (eg, opioids,
sedatives, hypnotics, antidepressants) with an odds ratio (OR) of 1.73 (95% confidence
interval [CI], 1.01-2.97, P=.046); treatment with opioids (OR 9.23, 95% CI, 1.58-54.00, P=0.014); age (OR 1.09, 95% CI, 1.07-1.12, P<.0001), stroke severity, which had a high National Institutes of Health Stroke Scale-score
(OR 1.29, 95% CI, 1.15-1.45, P<.0001), and sedentary life style (OR 4.32, 95% CI, 1.32-14.17, P=.016). No association was found between neurotropic drugs or cardiovascular drugs
and falls.
Conclusions
Treatment with neurotropic drugs, particularly opioids, in the acute phase after stroke,
is associated with impaired postural control. Since impaired postural control is the
major cause of falls in patients with acute stroke, these results suggest opioids
should be used with caution in these patients.
Keywords
List of abbreviations:
ACE (angiotensin-converting enzyme), ARB (angiotensin receptor blockers), ATC (Anatomical Therapeutic Chemical), CI (confidence interval), FallsGOT (Fall Study of Gothenburg), ICD-10 (10th Revision of the International Classification of Diseases), NIHSS (National Institutes of Health Stroke Scale), OR (odds ratio), ROC (receiver operating characteristic), SGPALS (Saltin-Grimby Physical Activity Level Scale), SwePASS (Swedish modified version of the Postural Assessment Scale for Stroke Patients)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: January 02, 2019
Footnotes
Supported by the Swedish Stroke Association (2016-02-24, 2016-12-02), the Healthcare Board, Region Västra Götaland (VGFOUREG-479231 (2014-12-17), VGFOUREG-546871 (2015-12-17)), the Sahlgrenska University Hospital Foundation (2014-05-28, 2015-04-30), Felix Neubergh Foundation (2015-02-25, 2017-03-06), Greta and Einar Asker’s Foundation (2014-04-14) and Stroke Center West (2014-02-10).
Clinical Trial Registration No.: NCT02264470.
Disclosures: none.
Identification
Copyright
© 2019 by the American Congress of Rehabilitation Medicine
