Does assessing error in perceiving postural limits by testing functional reach predict likelihood of falls in hospitalized stroke patients?

Abstract

Objective: To investigate the relationship between errors in perceiving postural limits and falls in hospitalized hemiplegic patients and to determine whether this relationship is useful for identifying patients at high risk of falls.

Design: Observational study.

Subjects: Seventy-six hemiplegic patients who were admitted to a rehabilitation hospital.

Methods: Error in perceiving postural limits was defined as the difference between the estimated maximum reach and actual reach distances, and its relationship to falls during hospitalization was investigated. Other measurements included Functional Ambulation Category, Brunnstrom's recovery stage, sensory disturbance, fear of falling and the Japanese version of the Montgomery-Åsberg Depression Rating Scale (MADRS-J).

Results: For the multiple fall group, the error in estimated distance (EED) was significantly greater than that for the zero/single fall group (P<0.01). Stepwise logistic regression analysis showed that EED (odds ratio 1.2, 95% confidence interval (CI) 1.1—1.4, P<0.01) and MADRS-J scores (odds ratio 1.1, 95% CI 1.0—1.3, P<0.05) were correlated with multiple falls. According to the receiver operating characteristic curve for EED, the cut-off value for discriminating multiple fallers was 6.3cm (sensitivity 81.0%, specificity 78.2%, area under the curve 0.8).

Conclusions: The results suggest that assessing error in perceiving postural limits by measuring the maximum reach of the non-affected side of hemiplegic patients is one way to identify those who are at high risk for falling.

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