본문 바로가기
KERD
논문KCI 등재

뇌졸중 환자의 낙상 예측을 위한 평가도구 비교

A Comparison of Assessment Tools for Prediction of Falls in Patients With Stroke

1

조회

0

다운로드

1

인용

0

참고문헌

키워드

주제분류물리치료학

초록

Falls are common after stroke and most frequently related to loss of balance while walking. Consequently, preventing falls is one of the goals of acute, rehabilitative, and chronic stroke care. The purpose of this study was to investigate the incidence and risk factors of falls and to determine how well the Falls Efficacy Scale (FES), Timed Up and Go test (TUG), and Berg Balance Scale (BBS) could distinguish between fallers and non-fallers among stroke patients during inpatient rehabilitation. One hundred and fifteen participants with at least 3 months post-stroke and able to walk at least 3 m with or without a mono cane participated in this study. Fifty-four (47%) participants reported falling, and 15 (27.8%) had a recurrent fall. Logistic regression analysis for predicting falls showed that left hemiplegia [odds ratio (OR)=4.68] and fear of falling (OR=5.99) were strong risk factors for falls. Fallers performed worse than non-fallers on the FES, TUG, and BBS (p<.05, p<.01, respectively). In the receiver operator characteristic curve analysis, the TUG demonstrated the best discriminating ability among the three assessment tools. The cut-off score was 22 seconds on the TUG for discriminating fallers from non-fallers (sensitivity=88.9%, specificity=45.9%) and 27 seconds for discriminating recurrent fallers from single fallers and non-fallers (sensitivity=71.4%, specificity=40.2%). Results suggest that there is a need for providing fall prevention and injury minimization programs for stroke patients who record over 22 seconds on the TUG.

Abstract

Falls are common after stroke and most frequently related to loss of balance while walking. Consequently, preventing falls is one of the goals of acute, rehabilitative, and chronic stroke care. The purpose of this study was to investigate the incidence and risk factors of falls and to determine how well the Falls Efficacy Scale (FES), Timed Up and Go test (TUG), and Berg Balance Scale (BBS) could distinguish between fallers and non-fallers among stroke patients during inpatient rehabilitation. One hundred and fifteen participants with at least 3 months post-stroke and able to walk at least 3 m with or without a mono cane participated in this study. Fifty-four (47%) participants reported falling, and 15 (27.8%) had a recurrent fall. Logistic regression analysis for predicting falls showed that left hemiplegia [odds ratio (OR)=4.68] and fear of falling (OR=5.99) were strong risk factors for falls. Fallers performed worse than non-fallers on the FES, TUG, and BBS (p<.05, p<.01, respectively). In the receiver operator characteristic curve analysis, the TUG demonstrated the best discriminating ability among the three assessment tools. The cut-off score was 22 seconds on the TUG for discriminating fallers from non-fallers (sensitivity=88.9%, specificity=45.9%) and 27 seconds for discriminating recurrent fallers from single fallers and non-fallers (sensitivity=71.4%, specificity=40.2%). Results suggest that there is a need for providing fall prevention and injury minimization programs for stroke patients who record over 22 seconds on the TUG.

참고문헌 (47)

  1. Akobeng AK, "Understanding diagnostic test 3 : Receiver operating characteristic curves", Acta Paediatr, 96(5), pp.644~647 (2007)
  2. Andersson AG, "Fear of falling in stroke patients: Relationship with previous falls and functional characteristics", Int J Rehabil Res, 31(3), pp.261~264 (2008)[DOI]
  3. Belgen B, "The association of balance capacity and falls self-efficacy with history of falling in community-dwelling people with chronic stroke", Arch Phys Med Rehabil, 87(4), pp.554~561 (2006)
  4. Berg KO, "Clinical and laboratory measures of postural balance in an elderly population", Arch Phys Med Rehabil, 73(11), pp.1073~1080 (1992)
  5. Berg K, "Measuring balance in the elderly: Preliminary development of an instrument", Physiother Can, 41(6), pp.304~311 (1989)[DOI]
  6. Bogle Thorbahn LD, "Use of the Berg Balance Test to predict falls in elderly persons", Phys Ther, 76(6), pp.576~583 (1996)
  7. Chandler JM, "Geriatric Physical Therapy", pp.280~292 (2000), Mosby
  8. Chiu AY, "A comparison of four functional tests in discriminating fallers from non-fallers in older people", Disabil Rehabil, 25(1), pp.45~50 (2003)
  9. 조광연, "노인에서 한국어판 낙상효능척도(국제형)와 낙상의 빈도와의 연관성", Annals of Rehabilitation Medicine, 34(3), pp.342~346 (2010), 대한재활의학회
  10. Chun CS, "Patient falls in stroke rehabilitation", J Korean Acad Rehabil Med, 23(5), pp.905~912 (1999)
  11. Divani AA, "Risk factors associated with injury attributable to falling among elderly population with history of stroke", Stroke, 40(10), pp.3286~3292 (2009)[DOI]
  12. Duncan PW, "The stroke impact scale version 2.0. Evaluation of reliability, validity, and sensitivity to change", Stroke, 30(10), pp.2131~2140 (1999)
  13. Engberg W, "Balance-related efficacy compared with balance function in patients with acute stroke", Physiother Theory Pract, 24(2), pp.105~111 (2008)[DOI]
  14. Fletcher PC, "Restriction in activity associated with fear of falling among community-based seniors using home care services", Age Ageing, 33(3), pp.273~279 (2004)
  15. Forster A, "Incidence and consequences of falls due to stroke : A systematic inquiry", BMJ, 311(6997), pp.83~86 (1995)
  16. Friedman SM, "Falls and fear of falling : Which comes first? A longitudinal prediction model suggests strategies for primary and secondary prevention", J Am Geriatr Soc, 50(8), pp.1329~1335 (2002)
  17. Gresham GE, "Survival and functional status 20 or more years after first stroke : The framingham study", Stroke, 29(4), pp.793~797 (1998)
  18. Hong CM, "Development of perception measurement of fall risk for the community-dwelling elderly", 박사, pp.2011
  19. Hyndman D, "People with stroke living in the community : Attention deficits, balance, ADL ability and falls", Disabil Rehabil, 25(15), pp.817~822 (2003)
  20. Jang SN, "The validity and reliability of Korean Fall Efficacy Scale(FES)and Activities-specific Balance Confidence Scale(ABC)", J Korean Geriatr Soc, 7(4), pp.255~268 (2003)
  21. Jørgensen L, "Higher incidence of falls in long-term stroke survivors than in population controls : Depressive symptoms predict falls after stroke", Stroke, 33(2), pp.542~547 (2002)
  22. 정한영, "한글화된 Berg 균형검사법의 신뢰도 분석", Annals of Rehabilitation Medicine, 30(6), pp.611~618 (2006), 대한재활의학회
  23. Kwon OY, "Introduction to Physical Therapy", pp.143~147 (2005), Topmed Co.
  24. Liston RA, "Reliability and validity of measures obtained from stroke patients using the Balance Master", Arch Phys Med Rehabil, 77(5), pp.425~430 (1996)
  25. Mackintosh SF, "Falls and injury prevention should be part of every stroke rehabilitation plan", Clin Rehabil, 19(4), pp.441~451 (2005)
  26. Mackintosh SF, "Balance score and a history of falls in hospital predict recurrent falls in the 6 months following stroke rehabilitation", Arch Phys Med Rehabil, 87(12), pp.1583~1589 (2006)
  27. Maeda N, "Predicting the probability for fall incidence in stroke patients using the Berg Balance Scale", J Int Med Res, 37(3), pp.697~704 (2009)
  28. Ng SS, "The Timed-Up & Go test : Its reliability and association with lower-limb impairments and locomotor capacities in people with chronic stroke", Arch Phys Med Rehabil, 86(8), pp.1641~1647 (2005)
  29. Pang MY, "Fall-related self-efficacy, not balance and mobility performance, is related to accidental falls in chronic stroke survivors with low bone mineral density", Osteoporos Int, 19(7), pp.919~927 (2008)
  30. Podsiadlo D, "The timed"Up & Go" : A test of basic functional mobility for frail elderly persons", J Am Geriatr Soc, 39(2), pp.142~148 (1991)
  31. Poole KE, "Falls, fractures, and osteoporosis after stroke: Time to think about protection?", Stroke, 33(5), pp.1432~1436 (2002)
  32. Rabadi MH, "An analysis of falls occuring in patients with stroke on an acute rehabilitation unit", Rehabil Nurs, 33(3), pp.104~109 (2008)
  33. Ramnemark A, "Stroke, a major and increasing risk factor for femoral neck fracture", Stroke, 31(7), pp.1572~1577 (2000)
  34. Rapport LJ, "Predictors of falls among right-hemisphere stroke patients in the rehabilitation setting", Arch Phys Med Rehabil, 74(6), pp.621~626 (1993)
  35. Rizzo JA, "Health care utilization and costs in a Medicare population by fall status", Med Care, 36(8), pp.1174~1188 (1998)
  36. Shumway-Cook A, "Predicting the probability of falls in community-dwelling older adults", Phys Ther, 77(8), pp.812~819 (1997)
  37. Shumway-Cook A, "Predicting the probability for falls in community-dwelling older adults using the Timed Up &Go Test", Phys Ther, 80(9), pp.896~903 (2000)
  38. Stevenson TJ, "Detecting change in patients with stroke using the Berg Balance Scale", Aust J Physiother, 47(1), pp.29~38 (2001)
  39. Sze KH, "Falls among chinese stroke patients during rehabilitation", Arch Phys Med Rehabil, 82(9), pp.1219~1225 (2001)
  40. Teasell R, "The incidence and consequences of falls in stroke patients during inpatient rehabilitation : Factors associated with high risk", Arch Phys Med Rehabil, 83(3), pp.329~333 (2002)
  41. Tinetti ME, "Falls efficacy as a measure of fear of falling", J Gerontol, 45(6), pp.P239~P243 (1990)
  42. Tutuarima JA, "Risk factors for falls of hospitalized stroke patients", Stroke, 28(2), pp.297~301 (1997)
  43. Ugur C, "Characteristics of falling in patients with stroke", J Neurol Neurosurg Psychiatry, 69(5), pp.649~651 (2000)
  44. Vlahov D, "Epidemiology of falls among patients in a rehabilitation hospital", Arch Phys Med Rehabil, 71(1), pp.8~12 (1990)
  45. Weerdesteyn V, "Falls in individuals with stroke", J Rehabil Res Dev, 45(8), pp.1195~1213 (2008)
  46. 원종임, "지역사회 뇌졸중 환자를 위한 근력강화 운동과 보행훈련의 효과", 한국전문물리치료학회지, 13(3), pp.18~23 (2006), 한국전문물리치료학회
  47. Yates JS, "Falls in community-dwelling stroke survivors : An accumulated impairments model", J Rehabil Res Dev, 39(3), pp.385~394 (2002)

관련 논문AI추천

이 간행물의 다른 논문 (8건)