A Comparison of the Falls Efficacy Scale-International with Berg Balance Scale to Evaluate the Risk of Falls in Post Stroke Patients (original) (raw)
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Introduction: Stroke patients often experience falls with potentially serious consequences. Associated factors with falling in stroke patients have already been identified. The present study was conducted to find a better assessment tool for measuring the risk of falling, Fear of Falling (FOF), and balance between Falls Efficacy Scale-International (FES-I) and Berg Balance Scale (BBS). Materials and Methods: One hundred stroke patients were recruited from the physiotherapy clinics affiliated to Tehran University of Medical Sciences (TUMS) based on inclusive criteria to administer two predictive scales; FES-I and BBS. In 16-item FES-I, face to face interview provide information on FOF in daily life activities. BBS is used to measure the FOF during sitting, standing, and postural changes (reaching, balancing on one limb and transferring). Data were analyzed on the basis of age, post stroke duration, history of falling since disease onset and in the last 6 months as well as risk of falling. Results: Based on FES-I scale, the majority (69.8%) of old patients (50-64 years) showed low risk of falls and according to BBS, the majority of the stroke patients older than 64 years had high concern for falling. Both genders showed low concern for falling on FES-I and BBS scales and the results were not significant. On BBS, the falling concern was more among those who had one falling during the last 6 months. Conclusion: BBS is more relevant to predict the risk of falls among Iranian stroke patients and is also easy to administer at the stroke centers with minimum equipment.
Journal of Neurologic Physical Therapy, 2009
Background and Purpose: To determine whether individual Berg Balance Scale (BBS) items or a group of items would have greater accuracy than the total BBS in classifying community-dwelling people with stroke with a history of multiple falls. Methods: The subjects were 44 community-dwelling individuals with chronic stroke; 34 had one or no falls in the past six months, and 10 had multiple falls. Each BBS item was dichotomized at three points along the scoring scale of 0-4: between scores of 1 and 2, 2 and 3, and 3 and 4. Sensitivity (Sn), specificity (Sp), and positive (ϩLR) and negative (ϪLR) likelihood ratios were calculated for all items for each scoring dichotomy based on their accuracy in classifying subjects with a history of multiple falls. These findings were compared with the total BBS score where the cutoff score was derived from receiver operating characteristic curve analysis. Results: Dichotomized point 3-4 for items B11 (turning 360 degrees), B12 (alternate foot on stool), B13 (tandem stance), and B14 (standing on one leg) all revealed Sn greater than 60%. B14 had the best Sn and Sp (0.90 and 0.50). Combining B11, B12, or B13 with B14 did not improve Sn. Total BBS receiver operating characteristic curve revealed a cutoff score of 52 (Sn ϭ 90% and Sp ϭ 41%). Conclusion: Using selected items from the BBS may be more time efficient and accurate than the total BBS score for classifying people with chronic stroke living in the community with a history of multiple falls. Prospective study is needed to validate these findings relative to fall prediction.
Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association, 2016
This study aimed to determine risk factors related to the occurrence of falls in stroke patients and to propose a new predictive scale for falls. Demographic and clinical data were collected and the following scales were applied: Barthel Index, Timed Up and Go Test (TUG), and National Institutes of Health Stroke Scale (NIHSS). Subjects were followed prospectively for 2 years for the occurrence of recurrent (≥2) falls. Kaplan-Meier curves were constructed and univariable associations were tested using log-rank test. Two separate multivariable models were then used: the first used Cox proportional hazards regression and the second used Poisson regression. In each model, significant associations were considered present with a P value less than .05. We evaluated 150 individuals and the final analysis included 131 patients; the average age of the patients was 55.8 ± 13 years, 52% were women, and the median NIHSS score was 2 (interquartile range = 1-5). Falls occurred in 17% of patients, ...
Physical therapy, 2009
Background. Falls in people with stroke are extremely common and present a significant health risk to this population. Development of fall screening tools is an essential component of a comprehensive fall reduction plan. Objective. The purpose of this study was to examine the accuracy of clinical measures representing various domains of the International Classification of Functioning, Disability and Health (ICF) relative to their ability to identify individuals with a history of multiple falls. Design. A case series study design was used. Setting. The study was conducted in a community setting. Participants. Twenty-seven people with stroke participated in the study. Measurements. Clinical assessment tools included the lower-extremity subscale of the Fugl-Meyer Assessment of Sensorimotor Impairment (FMLE) and Five-Times-Sit-to-Stand Test (STS) representing the body function domain, the Berg Balance Scale (BBS) representing the activity domain, the Activities-specific Balance Confidence (ABC) Scale as a measure of personal factors, and the physical function subscale of the Stroke Impact Scale (SIS-16) as a broad measure of physical function. We used receiver operating characteristic (ROC) curves to generate cutoff scores, sensitivities, specificities, and likelihood ratios (LRs) relative to a history of multiple falls. Results. The FMLE and the STS showed a weak association with fall history. The BBS demonstrated fair accuracy in identifying people with multiple falls, with a cutoff score of 49 and a positive LR of 2.80. The ABC Scale and the SIS-16 were most effective, with cutoff scores of 81.1 and 61.7, respectively, positive LRs of 3.60 and 7.00, respectively, and negative LRs of 0.00 and 0.25, respectively. Limitations. A limitation of the study was the small sample size. Conclusion. The findings suggest that the ICF is a useful framework for selecting clinical measures relative to fall history and support the need for prospective study of tools in more-complex domains of the ICF for their accuracy for fall prediction in people with stroke.
Occurrence and Predictors of Falls in People With Stroke
Stroke, 2015
Background and Purpose— The purpose was to investigate the occurrence of self-reported falls in people with stroke at 3, 6, and 12 months and 6 years post stroke and predictors for falls during 6 years. Methods— A prospective study involving 121 people with stroke. Data were obtained through structured interviews and assessments. Generalized estimating equation modeling using proportional odds was used to explore the predictive value of fall history, functioning/disability, and personal factors during 6 years. Results— The proportion of fallers constituted of 35%, 26%, 33%, and 35% of the sample at 3, 6, and 12 months and 6 years of follow-up, respectively. Higher perceived effect of stroke on activities of daily living (odds ratio, 1.37; 95% confidence interval, 1.04–1.80), falls at 3 months (odds ratio, 1.0; 95% confidence interval, 1.01–3.94), and no gait/balance disability at baseline (odds ratio, 7.29; 95% confidence interval, 1.99–26.73) were predictors for future falls. Durin...
Post-Stroke Patients with Moderate Function Have the Greatest Risk of Falls: A National Cohort Study
2019
Background Stroke patients have increased risks of falls. We examined national registry data to evaluate the association between post-stroke functional level and the risk of low falls among post-stroke patients. Methods This retrospective cohort study analyzed data from national registries to examine the risk factors for post-stroke falls. Data for patients who suffered ischemic strokes and survived the index hospital admission was obtained from the Singapore National Stroke Registry and matched to the National Trauma Registry, from 2011 to 2015. The primary outcome measure was a low fall (fall height ≤0.5m). Competing risk analysis was performed to examine the association between functional level (by modified Rankin score [mRS] at discharge) and the risk of subsequent low falls. Results In all, 2,255 patients who suffered ischemic strokes had recorded mRS. The mean age was 66.6 years and 58.5% were men. By the end of 2015, 54 (2.39%) had a low fall while 93 (4.12%) died. After adju...
Prediction of falling among stroke patients in rehabilitation
Journal of rehabilitation medicine, 2011
To identify risk factors and predict falling in stroke patients. To determine the strength of general vs mobility screening for this prediction. Prospective study. Patients in the first 6 months after stroke. The following assessments were carried out: an interview concerning civil state and fall history, Mini-Mental State Examination, Geriatric Depression Scale, Falls Efficacy Scale (FES), Star Cancellation Task (SCT), Stroop test, Berg Balance Scale, Functional Ambulation Categories (FAC), Motricity Index, grip and quadriceps strength, Modified Ashworth Scale, Katz scale, and a 6-month fall follow-up. Sixty-five patients were included for analysis. Thirty -eight (58.5%) reported falling. Risk factors were: being single (odds ratio (OR) 4.7; 95% confidence interval (95% CI) 1.2-18.3), SCT-time (OR 1.2; 95% CI 1.0-1.3), grip strength on unaffected side (US) (OR 0.1; 95% CI 0.0-0.8), FAC 3 vs FAC 4-5 (OR 8.1; 95% CI 1.5-43.2), and walking aid vs none (OR 5.1; 95% CI 1.4-17.8). These ...
Physiotherapy Canada, 2017
Purpose: The Berg Balance Scale (BBS) is a performance-based measure of standing balance commonly used by clinicians working with individuals post-stroke. Performance on the BBS can be influenced by compensatory strategies, but measures derived from two force plates can isolate compensatory strategies and thus better indicate balance impairment. This study examined BBS scores that reflect “normal” and disordered balance with respect to dual force-plate measures of standing balance in individuals post-stroke. Methods: BBS and force-plate measures were extracted from 75 patient charts. Individuals were classified by BBS score with respect to (1) age-matched normative values and (2) values that suggested increased risk of falls. Multiple analysis of variance was used to examine the effect of group assignment on force-plate measures of standing balance. Results: Individuals with BBS scores within and below normative values did not differ in force-plate measures. Individuals with BBS sco...
Frontiers in Bioengineering and Biotechnology
Background/Purpose: To prevent falling, a common incident with debilitating health consequences among stroke survivors, it is important to identify significant fall risk factors (FRFs) towards developing and implementing predictive and preventive strategies and guidelines. This review provides a systematic approach for identifying the relevant FRFs and shedding light on future directions of research.Methods: A systematic search was conducted in 5 popular research databases. Studies investigating the FRFs in the stroke community were evaluated to identify the commonality and trend of FRFs in the relevant literature.Results: twenty-seven relevant articles were reviewed and analyzed spanning the years 1995–2020. The results confirmed that the most common FRFs were age (21/27, i.e., considered in 21 out of 27 studies), gender (21/27), motion-related measures (19/27), motor function/impairment (17/27), balance-related measures (16/27), and cognitive impairment (11/27). Among these factor...