Risk factors for falls in stroke patients during inpatient rehabilitation
Risk factors for falls in stroke patients during inpatient rehabilitation
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DOI：
10.1177/0269215508098894
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发表时间：
2009-02-01
影响因子：
3
通讯作者：
Czlonkowska, Anna
中科院分区：
文献类型：
--
作者：
Czernuszenko, Anna;Czlonkowska, Anna
目的：评估康复病房卒中患者福尔斯的发生率和情况、跌倒相关骨折的频率、福尔斯与康复结局之间的关系以及福尔斯的危险因素。设计：前瞻性观察研究。患者：共有1155例患者（56%为男性;平均年龄61.5 ± 14.3岁）在卒中后入住神经康复病房。中值卒中发生时间（四分位距）为36.5（68）天。主要测量指标：住院期间记录患者的福尔斯（1-74天）以及与卒中类型和症状、当前药物治疗、神经功能缺损相关的变量（斯堪的纳维亚卒中量表）和残疾结果：189例（16.3%）患者共发生252次福尔斯，其中45例患者发生108次反复福尔斯。福尔斯的发生率为7.6/1000患者-天（95%置信区间（CI）6.6-8.5）。大多数患者在转移（33.9%）和坐位（21.5%）时跌倒，1.2%的福尔斯跌倒导致骨折（n=3）。首次和多次福尔斯的风险增加与初始Barthel评分低于15分（风险比（HR）分别为5.2和4.5）和卒中发作时间≥ 12周（HR分别为2.3和2.3）密切相关。首次福尔斯跌倒与视觉空间忽视显著相关（HR 1.5）。反复福尔斯与年龄大于65岁有关（HR 1.4）。结论：脑卒中后早期重度残疾患者在康复过程中易发生福尔斯。多发性福尔斯跌倒最常见于65岁以上的患者。
Objectives: To assess the incidence and circumstances of falls among stroke patients in a rehabilitation ward, the frequency of fall-related fractures, the relationship between falls and rehabilitation outcomes, and risk factors for falls.Design: Prospective observational study.Setting: Neurological rehabilitation ward. Patients: In total 1155 patients (56% men; mean age 61.5 +/- 14.3 years) admitted to the neurological rehabilitation ward after a stroke. Median (interquartile range) time since stroke onset was 36.5 (68) days.Main measures: Patients' falls were registered during hospitalization (1-74 days) and variables relating to the type and symptoms of stroke, current medications, neurological deficit (Scandinavian Stroke Scale) and disability (Barthel Index) were collected from medical records.Results: A total of 252 falls were recorded for 189 (16.3%) patients and 45 patients experienced 108 repeated falls. The incidence rate for falls was 7.6/1000 patient-days (95% confidence interval (CI) 6.6-8.5). Most patients fell while being transferred (33.9%) and while seated (21.5%), and 1.2% of falls resulted in fractures (n=3). Increased risk of both first and multiple falls was strongly associated with initial Barthel score below 15 (hazard ratio (H R) 5.2 and 4.5, respectively) and time since stroke onset >= 12 weeks (HR 2.3 and 2.3, respectively). First falls were significantly associated with visuo-spatial neglect (HR 1.5). Repeated falls were related to age greater than 65 years (HR 1.4).Conclusions: Patients with severe stroke-related disability in the early period after stroke are prone to falls during rehabilitation. Multiple falls are most frequent in patients over 65 years of age.