Content » Vol 49, Issue 5

Original report

Do clinical assessments, steady-state or daily-life gait characteristics predict falls in ambulatory chronic stroke survivors?

Michiel Punt, Sjoerd M. Bruijn, Harriet Wittink, Ingrid G. van de Port, Jaap H. van Dieën
Institute of movement studies,, Hogeschool Utrecht, 3584 JW Utrecht, The Netherlands. E-mail: michiel.punt@hu.nl
DOI: 10.2340/16501977-2234

Abstract

Objective: This exploratory study investigated to what extent gait characteristics and clinical physical therapy assessments predict falls in chronic stroke survivors.
Design: Prospective study.
Subjects: Chronic fall-prone and non-fall-prone stroke survivors.
Methods: Steady-state gait characteristics were collected from 40 participants while walking on a treadmill with motion capture of spatio-temporal, variability, and stability measures. An accelerometer was used to collect daily-life gait characteristics during 7 days. Six physical and psychological assessments were administered. Fall events were determined using a “fall calendar” and monthly phone calls over a 6-month period. After data reduction through principal component analysis, the predictive capacity of each method was determined by logistic regression.
Results: Thirty-eight percent of the participants were classified as fallers. Laboratory-based and daily-life gait characteristics predicted falls acceptably well, with an area under the curve of, 0.73 and 0.72, respectively, while fall predictions from clinical assessments were limited (0.64).
Conclusion: Independent of the type of gait assessment, qualitative gait characteristics are better fall predictors than clinical assessments. Clinicians should therefore consider gait analyses as an alternative for identifying fall-prone stroke survivors.

Lay Abstract

Can we identify stroke survivors with increased fall risk based on how they walk?
A large group of stroke survivors fall frequently. These falls can have devastating consequences like broken hips or even death. Identifying stroke survivors with increased fall risk is an important first step in preventing falls. Therefore we investigated if we can improve current used fall risk assessments by examining how stable stroke survivors walk. Our results show that assessing how stable a stroke survivor walks improves current used fall risk assessment.

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