Risk of Falls and Walking

Tilson, J.K., Wu, S.S., Cen, S.Y., Feng, Q., Rose, D.R., Behrman, A.L., Azen, S. & Duncan, P.W. (2012) Characterizing and identifying risk for falls in the LEAPS study: A randomized clinical trial of interventions to improve walking post-stroke. Stroke 43(2), 446-452

Background and Purpose: Better understanding of fall risk post-stroke is required for developing screening and prevention programs. This study characterizes falls in the Locomotor Experience Applied Post Stroke (LEAPS) randomized clinical trial, describes the impact of two walking recovery interventions on falls, and examines the value of clinical assessments for predicting falls.

Methods: Community-dwelling ambulatory stroke survivors enrolled in LEAPS were assessed 2-months post-stroke. Falls were monitored until 12-months post-stroke and participants were characterized as multiple or injurious (M/I); single, non-injurious (S/NI); or non-fallers. Incidence and time to M/I falls was compared across interventions [home exercise (HEP) and locomotor training initiated 2-months (early-LTP) or 6-months (late-LTP) post-stroke]. Predictive value of 2-month clinical assessments for falls outcome was assessed.

Results: Among the 408 participants, 36.0% were M/I, 21.6% S/NI, and 42.4% non-fallers. Most falls occurred at home in the first three months after assessment. Falls incidence was highest for those with severe walking impairment who received early-LTP.(p=0.025). Berg Balance Scale (BBS) score ≤42/56 was the single best predictor of M/I falls.

Conclusions: As individuals with stroke improve walking capacity, risk for M/I falls remains high. Individuals walking <0.4 m/s are at higher risk for M/I falls if they receive early-LTP training. BBS, at 2-months post-stroke, is useful for informing falls risk but cannot account for the multifactorial nature of the problem. Falls prevention in stroke will require multifactorial risk assessment and management provided concomitantly with exercise interventions to improve mobility.