Association Between Performance on an Interdisciplinary Stroke Assessment Battery and Falls in Patients With Acute Stroke in an Inpatient Rehabilitation Facility: A Retrospective Cohort Study

M. Eikenberry, Kathleen Ganley, Nan Zhang, Carolyn L. Kinney

Research output: Contribution to journalArticle

Abstract

Objective: To explore the association between demographic factors and functional performance measures of patients with acute stroke in an inpatient rehabilitation facility (IRF) and falls during the IRF stay and to quantify the diagnostic accuracy of functional outcome measures in identifying fallers. Design: Retrospective cohort study. Setting: Inpatient rehabilitation facility. Participants: Individuals with acute stroke admitted to hospital-based IRF (N=139). Interventions: Not applicable. Main Outcome Measures: Odds ratios were used to examine the relationship between fall frequency and functional outcome measures (National Institute of Stroke Scale, neglect [Item #11], Berg Balance Scale, Stroke Rehabilitation Assessment of Movement mobility and Stroke Rehabilitation Assessment of Movement lower extremity subscales [STREAM-LE], Montreal Cognitive Assessment, Dynamic Gait Index, and Stroke Impact Scale). Receiver operator characteristic analysis with area under the curve, sensitivity, specificity, and diagnostic odds ratio were used to assess the diagnostic accuracy of each functional outcome measure to distinguish patients who fell vs those who did not fall in the IRF. Results: A total of 23 patients (16.2%) fell during the IRF hospitalization. Patients who did and did not fall did not differ in terms of age, sex, stroke type, or stroke location. Only the STREAM-LE was associated with falls (odds ratio, 0.93; 95% CI, 0.86-0.99). Area under the curve was 0.67 (95% CI, 0.51-0.82). With a positivity cutoff point of 12, sensitivity and specificity were 73.3% (95% CI, 54.6%-92.2%) and 50.0% (95% CI, 39.9%-59.2%), respectively. The diagnostic odds ratio was 3.4. Conclusions: The STREAM-LE score at admission to IRF may identify patients with acute stroke who are more likely to fall during their stay. However, the search for measures with greater diagnostic accuracy should continue.

Original languageEnglish (US)
JournalArchives of Physical Medicine and Rehabilitation
DOIs
StatePublished - Jan 1 2019

Fingerprint

Inpatients
Cohort Studies
Rehabilitation
Retrospective Studies
Stroke
Odds Ratio
Outcome Assessment (Health Care)
Lower Extremity
Area Under Curve
Sensitivity and Specificity
Gait
Hospitalization
Demography
Stroke Rehabilitation

Keywords

  • Accidental falls
  • Rehabilitation
  • Stroke

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation

Cite this

@article{9af71a6a1d3e4bdeba1c233b5fa69038,
title = "Association Between Performance on an Interdisciplinary Stroke Assessment Battery and Falls in Patients With Acute Stroke in an Inpatient Rehabilitation Facility: A Retrospective Cohort Study",
abstract = "Objective: To explore the association between demographic factors and functional performance measures of patients with acute stroke in an inpatient rehabilitation facility (IRF) and falls during the IRF stay and to quantify the diagnostic accuracy of functional outcome measures in identifying fallers. Design: Retrospective cohort study. Setting: Inpatient rehabilitation facility. Participants: Individuals with acute stroke admitted to hospital-based IRF (N=139). Interventions: Not applicable. Main Outcome Measures: Odds ratios were used to examine the relationship between fall frequency and functional outcome measures (National Institute of Stroke Scale, neglect [Item #11], Berg Balance Scale, Stroke Rehabilitation Assessment of Movement mobility and Stroke Rehabilitation Assessment of Movement lower extremity subscales [STREAM-LE], Montreal Cognitive Assessment, Dynamic Gait Index, and Stroke Impact Scale). Receiver operator characteristic analysis with area under the curve, sensitivity, specificity, and diagnostic odds ratio were used to assess the diagnostic accuracy of each functional outcome measure to distinguish patients who fell vs those who did not fall in the IRF. Results: A total of 23 patients (16.2{\%}) fell during the IRF hospitalization. Patients who did and did not fall did not differ in terms of age, sex, stroke type, or stroke location. Only the STREAM-LE was associated with falls (odds ratio, 0.93; 95{\%} CI, 0.86-0.99). Area under the curve was 0.67 (95{\%} CI, 0.51-0.82). With a positivity cutoff point of 12, sensitivity and specificity were 73.3{\%} (95{\%} CI, 54.6{\%}-92.2{\%}) and 50.0{\%} (95{\%} CI, 39.9{\%}-59.2{\%}), respectively. The diagnostic odds ratio was 3.4. Conclusions: The STREAM-LE score at admission to IRF may identify patients with acute stroke who are more likely to fall during their stay. However, the search for measures with greater diagnostic accuracy should continue.",
keywords = "Accidental falls, Rehabilitation, Stroke",
author = "M. Eikenberry and Kathleen Ganley and Nan Zhang and Kinney, {Carolyn L.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.apmr.2019.05.026",
language = "English (US)",
journal = "Archives of Physical Medicine and Rehabilitation",
issn = "0003-9993",
publisher = "W.B. Saunders Ltd",

}

TY - JOUR

T1 - Association Between Performance on an Interdisciplinary Stroke Assessment Battery and Falls in Patients With Acute Stroke in an Inpatient Rehabilitation Facility

T2 - A Retrospective Cohort Study

AU - Eikenberry, M.

AU - Ganley, Kathleen

AU - Zhang, Nan

AU - Kinney, Carolyn L.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objective: To explore the association between demographic factors and functional performance measures of patients with acute stroke in an inpatient rehabilitation facility (IRF) and falls during the IRF stay and to quantify the diagnostic accuracy of functional outcome measures in identifying fallers. Design: Retrospective cohort study. Setting: Inpatient rehabilitation facility. Participants: Individuals with acute stroke admitted to hospital-based IRF (N=139). Interventions: Not applicable. Main Outcome Measures: Odds ratios were used to examine the relationship between fall frequency and functional outcome measures (National Institute of Stroke Scale, neglect [Item #11], Berg Balance Scale, Stroke Rehabilitation Assessment of Movement mobility and Stroke Rehabilitation Assessment of Movement lower extremity subscales [STREAM-LE], Montreal Cognitive Assessment, Dynamic Gait Index, and Stroke Impact Scale). Receiver operator characteristic analysis with area under the curve, sensitivity, specificity, and diagnostic odds ratio were used to assess the diagnostic accuracy of each functional outcome measure to distinguish patients who fell vs those who did not fall in the IRF. Results: A total of 23 patients (16.2%) fell during the IRF hospitalization. Patients who did and did not fall did not differ in terms of age, sex, stroke type, or stroke location. Only the STREAM-LE was associated with falls (odds ratio, 0.93; 95% CI, 0.86-0.99). Area under the curve was 0.67 (95% CI, 0.51-0.82). With a positivity cutoff point of 12, sensitivity and specificity were 73.3% (95% CI, 54.6%-92.2%) and 50.0% (95% CI, 39.9%-59.2%), respectively. The diagnostic odds ratio was 3.4. Conclusions: The STREAM-LE score at admission to IRF may identify patients with acute stroke who are more likely to fall during their stay. However, the search for measures with greater diagnostic accuracy should continue.

AB - Objective: To explore the association between demographic factors and functional performance measures of patients with acute stroke in an inpatient rehabilitation facility (IRF) and falls during the IRF stay and to quantify the diagnostic accuracy of functional outcome measures in identifying fallers. Design: Retrospective cohort study. Setting: Inpatient rehabilitation facility. Participants: Individuals with acute stroke admitted to hospital-based IRF (N=139). Interventions: Not applicable. Main Outcome Measures: Odds ratios were used to examine the relationship between fall frequency and functional outcome measures (National Institute of Stroke Scale, neglect [Item #11], Berg Balance Scale, Stroke Rehabilitation Assessment of Movement mobility and Stroke Rehabilitation Assessment of Movement lower extremity subscales [STREAM-LE], Montreal Cognitive Assessment, Dynamic Gait Index, and Stroke Impact Scale). Receiver operator characteristic analysis with area under the curve, sensitivity, specificity, and diagnostic odds ratio were used to assess the diagnostic accuracy of each functional outcome measure to distinguish patients who fell vs those who did not fall in the IRF. Results: A total of 23 patients (16.2%) fell during the IRF hospitalization. Patients who did and did not fall did not differ in terms of age, sex, stroke type, or stroke location. Only the STREAM-LE was associated with falls (odds ratio, 0.93; 95% CI, 0.86-0.99). Area under the curve was 0.67 (95% CI, 0.51-0.82). With a positivity cutoff point of 12, sensitivity and specificity were 73.3% (95% CI, 54.6%-92.2%) and 50.0% (95% CI, 39.9%-59.2%), respectively. The diagnostic odds ratio was 3.4. Conclusions: The STREAM-LE score at admission to IRF may identify patients with acute stroke who are more likely to fall during their stay. However, the search for measures with greater diagnostic accuracy should continue.

KW - Accidental falls

KW - Rehabilitation

KW - Stroke

UR - http://www.scopus.com/inward/record.url?scp=85068761023&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85068761023&partnerID=8YFLogxK

U2 - 10.1016/j.apmr.2019.05.026

DO - 10.1016/j.apmr.2019.05.026

M3 - Article

C2 - 31201780

AN - SCOPUS:85068761023

JO - Archives of Physical Medicine and Rehabilitation

JF - Archives of Physical Medicine and Rehabilitation

SN - 0003-9993

ER -