Ilana Spokoyny, MD

Minet LR, Peterson E, von Koch L, and Ytterberg C. Occurrence and Predictors of Falls in People With Stroke: Six-Year Prospective Study. Stroke. 2015
Falls post-stroke are common but not enough data exists on which stroke patients tend to have falls, and when. This information is obviously needed in order to design fall prevention strategies. Minet et al. carried out the first prospective long-term study on falls post-stroke which was comprised of 121 patients from the “Life After Stroke” cohort in Sweden. The cohort originally had 349 patients but the remainder were either deceased or declined to participate.

The variable studied was self-reported falls, at intervals of 3 months, 6 months, 12 months, and 6 years. Variables included in the univariate model were age, sex, SOC (sense of coherence, an assessment of attitude toward life post-stroke and ability to cope with stressful situations), stroke severity, cognitive function, perceived impact of stroke in eight domains, self-rated recovery, gait/balance disability, social/lifestyle activities, and occurrence of falls in the first 3 months post-stroke.

At each time point, about 1/3 of patients reported falling in the preceding time period (the time period was the last 3 months for the 3- and 6-month assessments and the last 6 months for 12 month and 6 year assessments). Predictors of future falls were:

– a clinically significant decrease in the Stoke Impact Scale score (more than 15 point drop)
– report of falls at 3 months, and
ABSENCE of gait/balance disability at baseline

Interestingly, the odds for falling decreased over time for those with gait/balance disability at baseline, but increased for those without disability.

Of the relatively large proportion of patients who were alive but did not follow up, the mean age was higher than those who followed up, and there was a lower proportion of mild strokes. This may represent healthy survivor bias, and should not be overlooked. There may also have been a component of recall bias, in that falls were self-reported. Another possible confounding factor is that if some patients with significant gait disability were no longer ambulatory (wheelchair-bound), they would be expected to have a lower fall risk.

Participants with gait/balance disability at baseline are routinely given access to rehabilitation services (with the level of intensity determined by physical and occupational therapists), which help not only with improvement of current functioning but also teach safety strategies to prevent falls in the future. This study highlights the importance of assessment of fall risk longitudinally, and may lend support to multi-disciplinary clinics for stroke patients (in which they have access to therapists as well as medical providers).