Academic journal article Journal of Rehabilitation Research & Development

Circumstances and Consequences of Falls among People with Chronic Stroke

Academic journal article Journal of Rehabilitation Research & Development

Circumstances and Consequences of Falls among People with Chronic Stroke

Article excerpt


Falls are a common and serious complication after stroke, with up to 76 percent of people falling poststroke [1-2]. Both the fall risk and associated risk for fall-related injuries persist into the chronic phases of stroke recovery. Moreover, people with stroke who fall have continued increased incidence of serious adverse outcomes, including fractures, depression, and mortality, compared with adults without stroke [3]. People with stroke have a sevenfold increase in the risk of fracture than those without stroke [4]. Additionally, poststroke falls are associated with lowered rehabilitation potential and functional recovery [5] and contribute to poststroke dependence in activities of daily living (ADLs), instrumental ADLs (IADLs), and decreased participation in society [6]. Poststroke falls contribute to the development of fear of falling, ADL limitations, and increased dependence [7].

The circumstances and characteristics of fall events for older adults and nonstroke populations (e.g., people with multiple sclerosis) have been studied [8-10]. However, the literature is limited regarding differences between fallers and non-fallers in the poststroke population, as well as in the circumstances that surround poststroke falls. Hyndman and Ashburn, in a study of 48 poststroke individuals, found that 50 percent of their sample reported a history of a fall since the stroke and that falls were associated with decreased balance and divided attention [11]. In another study, Hyndman et al. found that people with chronic stroke who fell more than once (n = 10) had worse mobility, arm function, and ability to complete ADLs, as well as greater anxiety and depression, than those with one or no falls [5]. While it is known that falls are common poststroke [1-2] and fall risk factors are numerous [5,11] a key step in the development of effective interventions to reduce poststroke falls is to identify the circumstances under which people fall after stroke.

The objectives of the study were to (1) identify the differences between fallers and non-fallers among people with chronic stroke, (2) identify the circumstances of fall events, and (3) examine the consequences of the falls.



Data for the current study were collected as part of a prospective longitudinal randomized trial focused on sleep apnea identification and management among veterans with a history of cerebrovascular disease and hypertension [12]. The methods of the clinical trial have been described elsewhere [12]. As part of this trial, participants were contacted at least every other month for the 1 yr study period to inquire about adverse events. During these in-person or telephone contacts, participants were specifically asked about fall events.


Study participants were recruited from two Veterans Health Administration medical centers (West Haven, Connecticut, and Indianapolis, Indiana). Inclusion criteria for the randomized trial included history of stroke or transient ischemic attack and a diagnosis of hypertension or blood pressure > 140/90 mm Hg. Individuals were excluded if they had known sleep apnea, had a sleep disorder other than sleep apnea (e.g., narcolepsy), had a life expectancy less than 6 mo, were unable to wear a nasal or facial continuous positive airway pressure mask, did not speak English, or were unable to provide informed consent. Only individuals with a history of stroke were included in the current analyses.


Baseline assessments for all study participants included patient interviews and examinations and medical record reviews.


Demographics include age, sex, education, race, and marital/coupled status.

Stroke and Health Characteristics

The time since stroke event was collected on the basis of both chart review and patient interview. Stroke-related disability was assessed with the modified Rankin Scale (mRS) [13], a validated measure of the degree of poststroke disability and dependence [14]. …

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