To explore the association between demographic factors and functional performance measures of patients with acute stroke in an inpatient rehabilitation facility (IRF) and falls during the IRF stay and to quantify the diagnostic accuracy of functional outcome measures in identifying fallers.
Retrospective cohort study.
Inpatient rehabilitation facility.
Individuals with acute stroke admitted to hospital-based IRF (N=139).
Main Outcome Measures
Odds ratios were used to examine the relationship between fall frequency and functional outcome measures (National Institute of Stroke Scale, neglect [Item #11], Berg Balance Scale, Stroke Rehabilitation Assessment of Movement mobility and Stroke Rehabilitation Assessment of Movement lower extremity subscales [STREAM-LE], Montreal Cognitive Assessment, Dynamic Gait Index, and Stroke Impact Scale). Receiver operator characteristic analysis with area under the curve, sensitivity, specificity, and diagnostic odds ratio were used to assess the diagnostic accuracy of each functional outcome measure to distinguish patients who fell vs those who did not fall in the IRF.
A total of 23 patients (16.2%) fell during the IRF hospitalization. Patients who did and did not fall did not differ in terms of age, sex, stroke type, or stroke location. Only the STREAM-LE was associated with falls (odds ratio, 0.93; 95% CI, 0.86-0.99). Area under the curve was 0.67 (95% CI, 0.51-0.82). With a positivity cutoff point of 12, sensitivity and specificity were 73.3% (95% CI, 54.6%-92.2%) and 50.0% (95% CI, 39.9%-59.2%), respectively. The diagnostic odds ratio was 3.4.
The STREAM-LE score at admission to IRF may identify patients with acute stroke who are more likely to fall during their stay. However, the search for measures with greater diagnostic accuracy should continue.
List of abbreviations:AUC (area under the curve), BBS (Berg Balance Scale), DOR (diagnostic odds ratio), DGI (Dynamic Gait Index), EMR (electronic medical record), ICC (intraclass correlation coefficient), IRF (inpatient rehabilitation facility), MoCA (Montreal Cognitive Assessment), NIHSS (National Institute of Health Stroke Scale), NIHSS-11 (National Institute of Health Stroke Scale, item 11), NPV (negative predictive values), OT (occupational therapist), PPV (positive predictive value), PT (physical therapist), PTA (physical therapist assistant), REDCap (Research Electronic Data Capture), ROC (receiver operating characteristic), STREAM (Stroke Rehabilitation Assessment of Movement), STREAM-LE (Stroke Rehabilitation Assessment of Movement, lower extremity subscale), STREAM-M (Stroke Rehabilitation Assessment of Movement, mobility subscale)
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Published online: June 12, 2019
© 2019 by the American Congress of Rehabilitation Medicine