Factors predicting falls and mobility outcomes in patients with stroke returning home after rehabilitation who are at risk of falling

Abstract

Objective: To identify factors predicting falls and limited mobility in people with stroke at 12 months after returning home from rehabilitation. Design: Observational cohort study with 12-month follow-up. Setting: Community. Participants: People with stroke (N=144) and increased falls risk discharged home from rehabilitation. Interventions: Not applicable. Main Outcome Measures: Falls were measured using monthly calendars completed by participants, and mobility was assessed using gait speed over 5m (high mobility: >0.8m/s vs low mobility: ≤0.8m/s). Both measures were assessed at 12 months postdischarge. Demographics and functional measures, including balance, strength, visual or spatial deficits, disability, physical activity level, executive function, functional independence, and falls risk, were analyzed to determine factors significantly predicting falls and mobility levels after 12 months. Results: Those assessed as being at high falls risk (Falls Risk for Older People in the Community [FROP-Com] score≥19) were 4.5 times more likely to fall by 12 months (odds ratio [OR], 4.506; 95% confidence interval [CI], 1.71–11.86; P=.002). Factors significantly associated with lower usual gait speed (≤0.8m/s) at 12 months in the multivariable analysis were age (OR, 1.07; 95% CI, 1.01–1.14; P=.033), physical activity (OR, 1.09; 95% CI, 1.03–1.17, P=.007), and functional mobility (OR, .83; 95% CI, .75–.93; P=.001). Conclusions: Several factors predicted falls and limited mobility for patients with stroke 12 months after rehabilitation discharge. These results suggest that clinicians should include assessment of falls risk (FROP-Com), physical activity, and dual-task Timed Up and Go test during rehabilitation to identify those most at risk of falling and experiencing limited mobility outcomes at 12 months, and target these areas during inpatient and outpatient rehabilitation to optimize long-term outcomes.