Utility of an Obstacle-crossing Test to Classify Future Fallers and Non-fallers at Hospital Discharge After Stroke: A Pilot Study

Overview

Journal Gait Posture

Specialty Orthopedics

Date 2022 Jun 6

PMID 35667230

Authors

Jody A Feld

Adam P Goode

Vicki S Mercer

Prudence Plummer

Affiliations

Soon will be listed here.

Abstract

Background: Existing clinical assessments of balance and functional mobility have poor predictive accuracy for prospectively identifying post-stroke fallers, which may be due to a lack of ecological complexity that is typical of community-based fall incidents.

Research Question: Does an obstacle-crossing test at hospital discharge predict fall status of ambulatory stroke survivors 3 months after discharge?

Methods: Ambulatory stroke survivors being discharged home completed an obstacle-crossing test at hospital discharge. Falls were tracked prospectively for 3 months after discharge. Logistic regression examined the relationship between obstacle-crossing at discharge (pass/fail) and fall status (faller/non-faller) at 3 months post discharge.

Results: 45 participants had discharge obstacle test and 3-month fall data. 21 (47 %) participants experienced at least one fall during follow-up, with 52 % of the falls occurring within the first month after discharge. Of the 21 fallers, 14 failed the obstacle-crossing test (67 % sensitivity). Among the 24 non-fallers, 20 passed the obstacle-crossing test (83 % specificity). The area under the receiver operating characteristic curve was 0.75 (95 % CI 0.60-0.90). Individuals who failed the obstacle-crossing test were 10.00 (95 % CI: 2.45-40.78) times more likely to fall in the first 3 months after discharge. The unadjusted logistic regression model correctly classified 76 % of the subjects. After adjusting for age, sex, days post stroke, and post-stroke disability, the odds ratio remained significant at 6.93 (95 % CI: 1.01-47.52) and correctly classified 79.5% of the participants.

Significance: The obstacle-crossing test may be a useful discharge assessment to identify ambulatory stroke survivors being discharged home who are likely to fall in the first 3 months post discharge. Modifications to improve the obstacle-crossing test sensitivity should be explored further.

Citing Articles

Brief composite mobility index predicts post-stroke fallers after hospital discharge.

Plummer P, Feld J, Mercer V, Ni P Front Rehabil Sci. 2022; 3:979824.

PMID: 36275923 PMC: 9583924. DOI: 10.3389/fresc.2022.979824.

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