The Fall and Fracture in Early Stroke Patients and The Evaluation of Influencing Factors 1-Year Follow-Up

Abstract

Objective: This study aims to examine the factors that may affect the falls and fractures which was in stroke patients during the rehabilitation phase and follow-up phase in the first year after discharge. It was aimed to assess the frequency of falls and fractures in early period after stroke. Materials and Methods: This study which was conducted between 2011-2013, included 50 patients who were admitted to and hospitalized at the rehabilitation clinic between the first two weeks and six months since the date of the stroke, who had sitting balance or were suitable to undergo ambulation. The demographic and clinical characteristics, complications and previous histories of the patients were recorded and physical examinations were performed. The patients were called for follow-up at the sixth month and first year after discharge; the number of falls and presence, number and location of fractures associated with falls were queried.Results: 76% of the patients returned for follow-up at the sixth month;70% for follow-up at the first year. Fall rates were 2% during the clinical follow-up; 26.3% during the first sixth months; 25.7% between the 6th and 12 months. 1 of 35 patients had wrist fracture on the hemiplegic side during the first six months. The patients were divided into two groups as fallen and not fallen. Conclusion: Fall after stroke is common during acute period, rehabilitation phase and chronic period. Early rehabilitation after stroke may increase balance and upper limb motor functions leading to lower rates of falls and fractures. Progressed osteoporosis and weakened bones leading to increased risk of fractures may be observed with longer follow-up periods

Keywords

• Stroke,fall,fracture

References

1. Dalyan Aras M, Çakçı A. İnme rehabilitasyonu. İçinde: Oğuz H, Dursun E, Dursun N, editörler. Tıbbi Rehabilitasyon. İstanbul: Nobel Tıp Kitabevi; 2004. ss.589–617.
2. Batchelor FA, Mackintosh SF, Said CM, Hill KD. Falls after stroke. Int J Stroke 2012;7:482–490. [CrossRef]
3. Simpson LA, Miller WC, Eng JJ. Effect of stroke on fall rate, location and predictors: a prospective comparison of older adults with and without stroke. PLoS One 2011;6:e19431. [CrossRef]
4. Langhorne P, Stott DJ, Robertson L, et al. Medical complications after stroke: a multicenter study. Stroke 2000;31:1223–1229. [CrossRef]
5. Mackintosh SFH, Hill K, Dodd KJ, Goldie P, Culham E. Falls and injury prevention should be part of every stroke rehabilitation plan. Clin Rehabil 2005;19:441–451. [CrossRef]
6. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry 1961;4:561–571. [CrossRef]
7. Thaxton LL, Patel AR. Sleep Disturbances: epidemiology, assesment and treatment. In: Zasler ND, Katz DL, Zafonte RD. editors. Brain Injury Medicine. New York: Demos Medical Publishing; 2007. pp.557–575.
8. Ganesan K, Shalini D. Design of Customizable Automated Low Cost Eye Testing System. J Clin Diagn Res 2014;8:85–87. [CrossRef]

9. Wilson B, Cockburn J, Halligan P. Development of a behavioural test of visuo-spatial neglect. Arch Phys Med Rehabil 1987;68:98–102.
10. Holden MK, Gill KM, Magliozzi MR. Gait assessment for neurologically impaired patients, standards for outcome assessement. Phys Ther 1986;66:1530–1539. [CrossRef]
11. Kidd D, Stewart G, Baldry J, et al. The Functional Independence Measure: A comparative validity and reliability study. Disabil Rehabil 1995;17:10–14. [CrossRef]
12. Fugl-Meyer AR, Jaaskö L, Olsson S, Steglind S. The post stroke hemiplejik patient: A method for evaluation of physical performance. Scand J Rehab Med 1975;7:13–31.
13. Wade DT. Measurement in Neurological Rehabilitation. Oxford University Press; 1992.
14. Hill KD, Bernhardt J, Mc Gann AM, Maltese D. A new test of dynamic standing balance for stroke patients: reliability, validity and comparison with healthy elderly. Physiother Can 1996;(fall):257–262. [CrossRef]
15. Siggeirsdottir K, Jonsson BY, Jonsson H, Iwarsson S. The Timed ‘Up&Go’ is dependent on Chair Type. Clin Rehabil 2002;16:609–616. [CrossRef]
16. Langhorne P, Stott DJ, Robertson L, et al. Medical complications after stroke: A multicenter study. Stroke 2000;31:1223–1229. [CrossRef]
17. Hyndman D, Asburn A, Stack E. Fall event among people with stroke living in the community: Circumstances of falls and Characteristics of fallers. Arch Phys Med Rehabil 2002;83:165–170. [CrossRef]
18. Leipzing RM, Cumming RG, Tinetti ME. Drugs and falls in older people: a systematic review and meta-analysis: I. Psychotropic drugs. J Am Geriatr Soc 1999;47:30–39. [CrossRef]
19. Machintosh SF, Hill KD, Dodd KJ, Goldie PA, Culham EG. Balance skore and history of falls in hospital predict recurrent falls in the 6 months following stroke rehabilitation. Arch Phys Med Rehabil 2006;87:1583–1589. [CrossRef]
20. Kerse N, Parag V, Feigin VL, et al. Falls after stroke: results from the Auckland Regional Community Stroke (ARCOS) study 2002–2003. Stroke 2008;39:1890–1893. [CrossRef]
21. Harris JE, Eng JJ, Marigold DS, Tokuno CD, Louis CL. Relationship of balance and mobility to fall incidence in people with chronic stroke. Phys Ther 2005;85:150–158. [CrossRef]
22. Teasell R, McRae M, Foley N, Bhardwaj A. The Incidence and Consequences of Falls in Stroke Patients During Inpatient Rehabilitation: Factors Associated With High Risk. Arch Phys Med Rehabil 2002;83:329–333. [CrossRef]
23. Asburn A, Hyndman D, Pickering R, Yardley L, Harris S. Predicting people with stroke at risk of falls. Age Ageing 2008;37:270–276. [CrossRef]
24. Baetens T, de Kegel A, Calders P, Vanderstraeten G, Cambier D. Prediction of Falling Among Stroke Patients in Rehabilitation. J Rehabil Med 2011;43:876–883. [CrossRef]
25. Campbell GB, Matthews JT. An integrative review of factors associated with falls during post-stroke rehabilitation. J Nurs Scholarsh 2010;42:395–404. [CrossRef]
26. Liu-Ambrose T, Pang MYC, Eng JJ. Executive functioning is independently associated with performances of balance and mobility in community dwelling older adults after mild stroke: implications for falls prevention. Cerebrovasc Dis 2007;23:203–210. [CrossRef]
27. Jorgensen L, Jacobsen BK. Functional status of the paretic arm affects the loss of bone mineral in the proximal humerus after stroke: a one- year prospective study. Calcif Tissue Int 2001;68:11–15. [CrossRef]