Klinik Araştırma
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Evaluating Fall Risk in Hemiplegic Patients: A Cross-Sectional Study with FROP-Com Assessment

Yıl 2025, Cilt: 47 Sayı: 4, 614 - 622, 18.06.2025
https://doi.org/10.20515/otd.1646359

Öz

Falls are a major concern for hemiplegic stroke patients, often leading to serious injuries and reduced quality of life. Identifying at-risk individuals is crucial for effective prevention. This study assesses fall risk prevalence and associated factors in hemiplegic patients using the Falls Risk for Older People in the Community (FROP-Com) and determines stroke-specific cutoff values. Additionally, it examines its relationship with the Timed Up and Go (TUG) test and Tinetti Performance-Oriented Mobility Assessment (POMA). This cross-sectional study included hemiplegic stroke patients. Fall risk was assessed using the FROP-Com, while mobility was evaluated with the Tinetti POMA and TUG test. Clinical characteristics such as age, stroke duration, functional mobility, and fall history were recorded. Correlations between assessment tools were analyzed, and a cutoff value for high fall risk was established. Sixty patients were analyzed (mean age 59.28±7.02 years; 66.7% male; 72% ischemic stroke). Falls were reported in 41.7% of patients, with 48% sustaining injuries. Most falls occurred indoors (56%), with balance loss being the primary cause (52%). Patients with a history of falls had significantly lower POMA scores and higher FROP-Com and TUG scores (p<0.05). The FROP-Com fall risk cutoff was 21 (AUC=0.78, sensitivity=68%, specificity=85.7%). The FROP-Com is a valuable tool for assessing fall risk in hemiplegic stroke patients, aiding in the identification of high-risk individuals and supporting targeted prevention strategies.

Etik Beyan

The study was approved by Afyonkarahisar Health Sciences University Medical Ethics Committee Noninterventional Clinical Research Ethical Committee (Decision no:390, Date: 06.12.2019).

Destekleyen Kurum

The authors declared that this study received no financial support

Teşekkür

Acknowledgments: None.

Kaynakça

  • Donkor ES. Stroke in the 21st Century: A Snapshot of the Burden, Epidemiology, and Quality of Life. Stroke Res Treat. 2018;11:3238165.
  • 2. Li S, Francisco GE, Zhou P. Post-stroke Hemiplegic Gait: New Perspective and Insights. Front Physiol. 2018;9:1021.
  • 3. Huynh E, Wiley E, Park S, Sakakibara BM, Tang A. Examining the association between balance self-efficacy and virtual balance performance in individuals with stroke: a cross-sectional study. Top Stroke Rehabil. 2024;24:1-9.
  • 4. Chen Y, Du H, Song M, et al. Relationship between fear of falling and fall risk among older patients with stroke: a structural equation modeling. BMC Geriatr. 2023;23(1):647.
  • 5. Ng MM, Hill KD, Batchelor F, Burton E. Factors Predicting Falls and Mobility Outcomes in Patients With Stroke Returning Home After Rehabilitation Who Are at Risk of Falling. Arch Phys Med Rehabil. 2017;98(12):2433-41.
  • 6. Mascarenhas M, Hill KD, Barker A, Burton E. Validity of the Falls Risk for Older People in the Community (FROP-Com) tool to predict falls and fall injuries for older people presenting to the emergency department after falling. Eur J Ageing. 2019;16(3):377-86.
  • 7. Adebero T, Bobos P, Somerville L, Howard J, Vasarhelyi EM, Lanting B, Hunter SW. Implementation of falls risk evaluation at one-year after total hip arthroplasty: a cross-sectional study. Arch Physiother. 2022;12(1):16.
  • 8. Meyer C, Chapman A, Klattenhoff Reyes K, Joe A. Profiling the risk factors associated with falls in older people with diabetes receiving at-home nursing care: Retrospective analysis of an Australian aged care provider database. Health & social care in the community, 2022; 30(2): 762–75.
  • 9. Mascarenhas M, Hill KD, Barker A, Burton E. Validity of the Falls Risk for Older People in the Community (FROP-Com) tool to predict falls and fall injuries for older people presenting to the emergency department after falling. Eur J Ageing. 2019 Jan 21;16(3):377-86.
  • 10. Ng SSM, Liu TW, Kwong PWH, et al. Psychometric testing of the Fall Risks for Older People in the Community screening tool (FROP-Com screen) for community-dwelling people with stroke. PLoS One. 2020;15(5):e0233045.
  • 11. Campbell GB, Matthews JT. An integrative review of factors associated with falls during post-stroke rehabilitation. J Nurs Scholarsh. 2010;42(4):395-404.
  • 12. Önal B, Köse N, Önal ŞN, Zengin HY. Validity and intra- and inter-rater reliability of the Tinetti performance-oriented mobility assessment balance subscale using different tele-assessment methods in patients with chronic stroke. Top Stroke Rehabil. 2024;31(6):547-55.
  • 13. Tinetti ME. Performance-oriented assessment of mobility problems in elderly patients. J Am Geriatr Soc. 1986;34:119-26.
  • 14. Barry E, Galvin R, Keogh C, Horgan F, Fahey T. Is the Timed Up and Go test a useful predictor of risk of falls in community dwelling older adults: A systematic review and meta-analysis. BMC Geriatr. 2014;14:14.
  • 15. Ng SSM, Tse MMY, Chen P, et al. Reliability, Concurrent Validity, and Minimal Detectable Change of Timed Up and Go Obstacle Test in People With Stroke. Arch Phys Med Rehabil. 2023;104(9):1465-73.
  • 16. Russell MA, Hill KD, Blackberry I, Day LM, Dharmage SC. The reliability and predictive accuracy of the falls risk for older people in the community assessment (FROP-Com) tool. Age Ageing. 2008;37:634-9.
  • 17. Batchelor F, Hill K, Mackintosh S, Said C. What works in falls prevention after stroke? A systematic review and meta-analysis. Stroke. 2010;41(8):1715-22.
  • 18. Green J, Forster A, Bogle S, Young J. Physiotherapy for patients with mobility problems more than 1 year after stroke: a randomised controlled trial. Lancet. 2002;359(9302):199-203.
  • 19. Belgen B, Beninato M, Sullivan PE, Narielwalla K. The association of balance capacity and falls self-efficacy with history of falling in community-dwelling people with chronic stroke. Arch Phys Med Rehabil. 2006;87(4):554-61.
  • 20. Samuelsson CM, Hansson PO, Persson CU. Early prediction of falls after stroke: a 12-month follow-up of 490 patients in The Fall Study of Gothenburg (FallsGOT). Clin Rehabil. 2019;33(4):773-83.
  • 21. Saverino A, Benevolo E, Ottonello M, Zsirai E, Sessarego P. Falls in a rehabilitation setting: functional independence and fall risk. Eura Medicophys. 2006;42(3):179-84.
  • 22. Tsur A, Segal Z. Falls in stroke patients: risk factors and risk management. Isr Med Assoc J. 2010;12(4):216-9.
  • 23. Bugdayci D, Paker N, Dere D, Özdemir E, Ince N. Frequency, features, and factors for falls in a group of subacute stroke patients hospitalized for rehabilitation in Istanbul. Arch Gerontol Geriatr. 2011;52(3):e215-9.
  • 24. Xu T, Clemson L, O'Loughlin K, et al. Risk Factors for Falls in Community Stroke Survivors: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil. 2018;99(3):563-573.e5.
  • 25. 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(4):e19431.
  • 26. Wing JJ, Burke JF, Clarke PJ, Feng C, Skolarus LE. The role of the environment in falls among stroke survivors. Arch Gerontol Geriatr. 2017;72:1-5.
  • 27. Anderson C, Dolansky M, Damato EG, Jones KR. Predictors of serious fall injury in hospitalized patients. Clin Nurs Res. 2015;24(3):269-83.
  • 28. Mackintosh SF, Hill KD, Dodd KJ, Goldie PA, Culham EG. Balance score and a history of falls in hospital predict recurrent falls in the 6 months following stroke rehabilitation. Arch Phys Med Rehabil. 2006;87(12):1583-9.
  • 29. Sze KH, Wong E, Leung HY, Woo J. Falls among Chinese stroke patients during rehabilitation. Arch Phys Med Rehabil. 2001;82(9):1219-25.
  • 30. Tutuarima JA, van der Meulen JH, de Haan RJ, van Straten A, Limburg M. Risk factors for falls of hospitalized stroke patients. Stroke. 1997;28(2):297-301.
  • 31. Tack KA, Ulrich B, Kehr C. Patient falls: profile for prevention. J Neurosci Nurs. 1987;19(2):83-9.
  • 32. Hyndman D, Ashburn A, Stack E. Fall events among people with stroke living in the community: circumstances of falls and characteristics of fallers. Arch Phys Med Rehabil. 2002;83(2):165-70.
  • 33. Cho K, Lee G. Impaired dynamic balance is associated with falling in post-stroke patients. Tohoku J Exp Med. 2013;230(4):233-9.
  • 34. An S, Lee Y, Lee G. Validity of the performance-oriented mobility assessment in predicting fall of stroke survivors: a retrospective cohort study. Tohoku J Exp Med. 2014;233(2):79-87.

Hemiplejik Hastalarda Düşme Riskinin Değerlendirilmesi: FROP-Com Değerlendirmesi ile Yapılan Kesitsel Bir Çalışma

Yıl 2025, Cilt: 47 Sayı: 4, 614 - 622, 18.06.2025
https://doi.org/10.20515/otd.1646359

Öz

Düşmeler, hemiplejik inme hastalarında ciddi yaralanmalara ve yaşam kalitesinin azalmasına yol açmaktadır. Risk altındaki bireylerin belirlenmesi, önleyici tedbirler için kritik öneme sahiptir. Bu çalışma, hemiplejik hastalarda Düşme Riski için Yaşlı İnsanlarda Değerlendirme Anketi (FROP-Com) ile düşme riski prevalansını ve ilişkili faktörleri değerlendirmeyi amaçlamaktadır. Ayrıca, FROP-Com için inme spesifik eşik değerlerini belirleyerek Timed Up and Go (TUG) testi ve Tinetti Performans Odaklı Mobilite Değerlendirmesi (POMA) ile ilişkisini incelemektedir. Bu kesitsel çalışmada hemiplejik inme hastalarının düşme riski FROP-Com ile, mobiliteleri ise Tinetti POMA ve TUG testi ile değerlendirildi. Yaş, inme süresi, fonksiyonel mobilite ve düşme öyküsü gibi klinik veriler kaydedildi. Değerlendirme araçlarının skorları arasındaki korelasyonlar analiz edilerek FROP-Com için yüksek düşme riski eşik değeri belirlendi. Toplam 60 hasta incelendi (ortalama yaş 59.28±7.02 yıl; %66.7 erkek; %72 iskemik inme). Hastaların %41.7’si düşme öyküsü bildirdi, yaralanma oranı %48’di. Düşmelerin %56’sı iç mekânda, en yaygın yönü öne doğru (%40) ve nedeni denge kaybıydı (%52). Düşen hastalarda POMA skoru düşük, FROP-Com ve TUG skorları anlamlı derecede yüksekti (p<0.05). FROP-Com eşik değeri 21 olarak hesaplandı (AUC=0.78, duyarlılık=68%, özgüllük=85.7%). FROP-Com, hemiplejik inme hastalarında düşme riskini belirlemede etkili bir araçtır. Bu bulgular, yüksek riskli bireylerin tespitinde ve önleyici stratejilerin uygulanmasında klinik önemini vurgulamaktadır.

Kaynakça

  • Donkor ES. Stroke in the 21st Century: A Snapshot of the Burden, Epidemiology, and Quality of Life. Stroke Res Treat. 2018;11:3238165.
  • 2. Li S, Francisco GE, Zhou P. Post-stroke Hemiplegic Gait: New Perspective and Insights. Front Physiol. 2018;9:1021.
  • 3. Huynh E, Wiley E, Park S, Sakakibara BM, Tang A. Examining the association between balance self-efficacy and virtual balance performance in individuals with stroke: a cross-sectional study. Top Stroke Rehabil. 2024;24:1-9.
  • 4. Chen Y, Du H, Song M, et al. Relationship between fear of falling and fall risk among older patients with stroke: a structural equation modeling. BMC Geriatr. 2023;23(1):647.
  • 5. Ng MM, Hill KD, Batchelor F, Burton E. Factors Predicting Falls and Mobility Outcomes in Patients With Stroke Returning Home After Rehabilitation Who Are at Risk of Falling. Arch Phys Med Rehabil. 2017;98(12):2433-41.
  • 6. Mascarenhas M, Hill KD, Barker A, Burton E. Validity of the Falls Risk for Older People in the Community (FROP-Com) tool to predict falls and fall injuries for older people presenting to the emergency department after falling. Eur J Ageing. 2019;16(3):377-86.
  • 7. Adebero T, Bobos P, Somerville L, Howard J, Vasarhelyi EM, Lanting B, Hunter SW. Implementation of falls risk evaluation at one-year after total hip arthroplasty: a cross-sectional study. Arch Physiother. 2022;12(1):16.
  • 8. Meyer C, Chapman A, Klattenhoff Reyes K, Joe A. Profiling the risk factors associated with falls in older people with diabetes receiving at-home nursing care: Retrospective analysis of an Australian aged care provider database. Health & social care in the community, 2022; 30(2): 762–75.
  • 9. Mascarenhas M, Hill KD, Barker A, Burton E. Validity of the Falls Risk for Older People in the Community (FROP-Com) tool to predict falls and fall injuries for older people presenting to the emergency department after falling. Eur J Ageing. 2019 Jan 21;16(3):377-86.
  • 10. Ng SSM, Liu TW, Kwong PWH, et al. Psychometric testing of the Fall Risks for Older People in the Community screening tool (FROP-Com screen) for community-dwelling people with stroke. PLoS One. 2020;15(5):e0233045.
  • 11. Campbell GB, Matthews JT. An integrative review of factors associated with falls during post-stroke rehabilitation. J Nurs Scholarsh. 2010;42(4):395-404.
  • 12. Önal B, Köse N, Önal ŞN, Zengin HY. Validity and intra- and inter-rater reliability of the Tinetti performance-oriented mobility assessment balance subscale using different tele-assessment methods in patients with chronic stroke. Top Stroke Rehabil. 2024;31(6):547-55.
  • 13. Tinetti ME. Performance-oriented assessment of mobility problems in elderly patients. J Am Geriatr Soc. 1986;34:119-26.
  • 14. Barry E, Galvin R, Keogh C, Horgan F, Fahey T. Is the Timed Up and Go test a useful predictor of risk of falls in community dwelling older adults: A systematic review and meta-analysis. BMC Geriatr. 2014;14:14.
  • 15. Ng SSM, Tse MMY, Chen P, et al. Reliability, Concurrent Validity, and Minimal Detectable Change of Timed Up and Go Obstacle Test in People With Stroke. Arch Phys Med Rehabil. 2023;104(9):1465-73.
  • 16. Russell MA, Hill KD, Blackberry I, Day LM, Dharmage SC. The reliability and predictive accuracy of the falls risk for older people in the community assessment (FROP-Com) tool. Age Ageing. 2008;37:634-9.
  • 17. Batchelor F, Hill K, Mackintosh S, Said C. What works in falls prevention after stroke? A systematic review and meta-analysis. Stroke. 2010;41(8):1715-22.
  • 18. Green J, Forster A, Bogle S, Young J. Physiotherapy for patients with mobility problems more than 1 year after stroke: a randomised controlled trial. Lancet. 2002;359(9302):199-203.
  • 19. Belgen B, Beninato M, Sullivan PE, Narielwalla K. The association of balance capacity and falls self-efficacy with history of falling in community-dwelling people with chronic stroke. Arch Phys Med Rehabil. 2006;87(4):554-61.
  • 20. Samuelsson CM, Hansson PO, Persson CU. Early prediction of falls after stroke: a 12-month follow-up of 490 patients in The Fall Study of Gothenburg (FallsGOT). Clin Rehabil. 2019;33(4):773-83.
  • 21. Saverino A, Benevolo E, Ottonello M, Zsirai E, Sessarego P. Falls in a rehabilitation setting: functional independence and fall risk. Eura Medicophys. 2006;42(3):179-84.
  • 22. Tsur A, Segal Z. Falls in stroke patients: risk factors and risk management. Isr Med Assoc J. 2010;12(4):216-9.
  • 23. Bugdayci D, Paker N, Dere D, Özdemir E, Ince N. Frequency, features, and factors for falls in a group of subacute stroke patients hospitalized for rehabilitation in Istanbul. Arch Gerontol Geriatr. 2011;52(3):e215-9.
  • 24. Xu T, Clemson L, O'Loughlin K, et al. Risk Factors for Falls in Community Stroke Survivors: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil. 2018;99(3):563-573.e5.
  • 25. 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(4):e19431.
  • 26. Wing JJ, Burke JF, Clarke PJ, Feng C, Skolarus LE. The role of the environment in falls among stroke survivors. Arch Gerontol Geriatr. 2017;72:1-5.
  • 27. Anderson C, Dolansky M, Damato EG, Jones KR. Predictors of serious fall injury in hospitalized patients. Clin Nurs Res. 2015;24(3):269-83.
  • 28. Mackintosh SF, Hill KD, Dodd KJ, Goldie PA, Culham EG. Balance score and a history of falls in hospital predict recurrent falls in the 6 months following stroke rehabilitation. Arch Phys Med Rehabil. 2006;87(12):1583-9.
  • 29. Sze KH, Wong E, Leung HY, Woo J. Falls among Chinese stroke patients during rehabilitation. Arch Phys Med Rehabil. 2001;82(9):1219-25.
  • 30. Tutuarima JA, van der Meulen JH, de Haan RJ, van Straten A, Limburg M. Risk factors for falls of hospitalized stroke patients. Stroke. 1997;28(2):297-301.
  • 31. Tack KA, Ulrich B, Kehr C. Patient falls: profile for prevention. J Neurosci Nurs. 1987;19(2):83-9.
  • 32. Hyndman D, Ashburn A, Stack E. Fall events among people with stroke living in the community: circumstances of falls and characteristics of fallers. Arch Phys Med Rehabil. 2002;83(2):165-70.
  • 33. Cho K, Lee G. Impaired dynamic balance is associated with falling in post-stroke patients. Tohoku J Exp Med. 2013;230(4):233-9.
  • 34. An S, Lee Y, Lee G. Validity of the performance-oriented mobility assessment in predicting fall of stroke survivors: a retrospective cohort study. Tohoku J Exp Med. 2014;233(2):79-87.
Toplam 34 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Klinik Tıp Bilimleri (Diğer)
Bölüm ORİJİNAL MAKALELER / ORIGINAL ARTICLES
Yazarlar

Nuran Eyvaz 0000-0001-7810-9004

Ahsen Erkaraca 0009-0008-2655-5609

Burak Tozluk Bu kişi benim 0009-0003-5036-2253

Ebru Gürel Bu kişi benim 0009-0004-9557-6914

Esra Nur İzmir 0009-0002-4104-7078

Furkan Yanga Bu kişi benim 0009-0001-0249-8899

İlkay Yildirim Bu kişi benim 0009-0006-2986-3151

Ali İzzet Akçin 0000-0001-5751-0333

Yayımlanma Tarihi 18 Haziran 2025
Gönderilme Tarihi 25 Şubat 2025
Kabul Tarihi 26 Mayıs 2025
Yayımlandığı Sayı Yıl 2025 Cilt: 47 Sayı: 4

Kaynak Göster

Vancouver Eyvaz N, Erkaraca A, Tozluk B, Gürel E, İzmir EN, Yanga F, vd. Evaluating Fall Risk in Hemiplegic Patients: A Cross-Sectional Study with FROP-Com Assessment. Osmangazi Tıp Dergisi. 2025;47(4):614-22.


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