Screening cutoff values to identify the risk of falls after stroke: A scoping review

Authors

  • Daisuke Matsumoto Department of Occupational Therapy, School of Health Sciences, Fukushima Medical University, Fukushima, Japan
  • Takaaki Fujita Department of Occupational Therapy, School of Health Sciences, Fukushima Medical University, Fukushima, Japan
  • Ryuichi Kasahara Department of Rehabilitation, Kita-Fukushima Medical Center, Date, Japan
  • Kenji Tsuchiya Faculty of Health Science, Nagano University of Health and Medicine, Nagano, Japan
  • Kazuaki Iokawa Department of Occupational Therapy, School of Health Sciences, Fukushima Medical University, Fukushima, Japan

DOI:

https://doi.org/10.2340/jrm.v56.40560

Keywords:

Berg Balance Scale, Falls Efficacy Scale-International, fall risk, stroke, Timed Up and Go test

Abstract

Objective: The present scoping review aimed to summarize and determine the accuracy of the variables and cutoff values reported to date for identifying fall risk in patients with stroke and identify the commonalities, limitations, and clinical implications.

Methods: Articles published by the end of 2023 were searched using PubMed, Cumulative Index of Nursing and Allied Health Literature, and Scopus electronic databases. Two reviewers created a search formula, searched the databases, and conducted primary and secondary screenings.

Results: This review included 21 articles. The most commonly used individual indicator for identifying fall risk after stroke was the Berg Balance Scale; the cutoff values were relatively consistent, ranging between 46.5 and 50.5 points (area under the curve: 0.72–0.81). For the Timed Up and Go test and Falls Efficacy Scale-International, the cutoff values were in the range of 15–19 s and 27–29 points, respectively, and were relatively consistent across the articles. However, the area under the curve values were low (0.66–0.70 and 0.68–0.71, respectively).

Conclusion: Among various assessments, the Berg Balance Scale is the most extensively studied tool, with established cutoff values associated with falls risk. It serves as a reliable indicator for detecting fall risk, especially in community-dwelling individuals with chronic stroke.

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References

Saini V, Guada L, Yavagal DR. Global epidemiology of stroke and access to acute ischem-ic stroke interventions. Neurology 2021; 97: S6–S16.

https://doi.org/10.1212/wnl.0000000000012781 DOI: https://doi.org/10.1212/WNL.0000000000012781

Montero-Odasso M, van der Velde N, Martin FC, Petrovic M, Tan MP, Ryg J, et al. World guidelines for falls prevention and management for older adults: a global initiative. Age Ageing 2022; 51: afac205.

https://doi.org/10.1093/ageing/afac205 DOI: https://doi.org/10.1093/ageing/afac205

Campbell GB, Matthews JT. An integrative review of factors associated with falls during post-stroke rehabilitation. J Nurs Scholarsh 2010; 42: 395–404.

https://doi.org/10.1111/j.1547-5069.2010.01369.x DOI: https://doi.org/10.1111/j.1547-5069.2010.01369.x

Xie Q, Pei J, Gou L, Zhang Y, Zhong J, Su Y, et al. Risk factors for fear of falling in stroke pati-ents: a systematic review and meta-analysis. BMJ Open 2022; 12: e056340.

https://doi.org/10.1136/bmjopen-2021-056340 DOI: https://doi.org/10.1136/bmjopen-2021-056340

Abdollahi M, Whitton N, Zand R, Dombovy M, Parnianpour M, Khalaf K, et al. A systematic review of fall risk factors in stroke survivors: towards improved assessment platforms and protocols. Front Bioeng Biotechnol 2022; 10: 910698.

https://doi.org/10.3389/fbioe.2022.910698 DOI: https://doi.org/10.3389/fbioe.2022.910698

Zheng JQ, Lai HJ, Zheng CM, Yen YC, Lu KC, Hu CJ, et al. Association of stroke subtypes with risk of hip fracture: a population-based study in Taiwan. Arch Osteoporos 2017; 12: 104.

https://doi.org/10.1007/s11657-017-0390-8 DOI: https://doi.org/10.1007/s11657-017-0390-8

Kumagai M, Otaka Y, Yoshida T, Kitamura S, Ushizawa K, Mori N, et al. Cumulative risk and associated factors for fall-related fractures in stroke survivors after discharge from reha-bilitation wards: a retrospective study with a 6-year follow-up. J Rehabil Med 2022; 54: jrm00294.

https://doi.org/10.2340/jrm.v54.2314 DOI: https://doi.org/10.2340/jrm.v54.2314

Schmid AA, Rittman M. Consequences of poststroke falls: activity limitation, increased dependence, and the development of fear of falling. Am J Occup Ther 2009; 63: 310–316.

https://doi.org/10.5014/ajot.63.3.310 DOI: https://doi.org/10.5014/ajot.63.3.310

Kim EJ, Kim DY, Kim WH, Lee KL, Yoon YH, Park JM, et al. Fear of falling in subacute he-miplegic stroke patients: associating factors and correlations with quality of life. Ann Rehabil Med 2012; 36: 797–803.

https://doi.org/10.5535/arm.2012.36.6.797 DOI: https://doi.org/10.5535/arm.2012.36.6.797

GBD 2019 Stroke Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol 2021; 20: 795–820.

https://doi.org/10.1016/S1474-4422(21)00252-0 DOI: https://doi.org/10.1016/S1474-4422(21)00252-0

Walsh ME, Horgan NF, Walsh CD, Galvin R. Systematic review of risk prediction models for falls after stroke. J Epidemiol Community Health 2016; 70: 513–519.

https://doi.org/10.1136/jech-2015-206475 DOI: https://doi.org/10.1136/jech-2015-206475

Stinear CM, Smith MC, Byblow WD. Prediction tools for stroke rehabilitation. Stroke 2019; 50: 3314–3322.

https://doi.org/10.1161/strokeaha.119.025696 DOI: https://doi.org/10.1161/STROKEAHA.119.025696

Lee J, Geller AI, Strasser DC. Analytical review: focus on fall screening assessments. PM R 2013; 5: 609–621.

https://doi.org/10.1016/j.pmrj.2013.04.001 DOI: https://doi.org/10.1016/j.pmrj.2013.04.001

Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med 2018; 169: 467–473.

https://doi.org/10.7326/m18-0850 DOI: https://doi.org/10.7326/M18-0850

Alenazi AM, Alshehri MM, Alothman S, Rucker J, Dunning K, D’Silva LJ, et al. Functional reach, depression scores, and number of medications are associated with number of falls in people with chronic stroke. PM R 2018; 10: 806–816.

https://doi.org/10.1016/j.pmrj.2017.12.005 DOI: https://doi.org/10.1016/j.pmrj.2017.12.005

Alzayer L, Beninato M, Portney LG. The accuracy of individual Berg Balance Scale items compared with the total Berg score for classifying people with chronic stroke according to fall history. J Neurol Phys Ther 2009; 33: 136–143.

https://doi.org/10.1097/npt.0b013e3181b51307 DOI: https://doi.org/10.1097/NPT.0b013e3181b51307

An S, Lee Y, Lee G. Validity of the performance-oriented mobility assessment in predicting fall of stroke survivors: a retrospective cohort study. Tohoku J Exp Med 2014; 233: 79–87.

https://doi.org/10.1620/tjem.233.79 DOI: https://doi.org/10.1620/tjem.233.79

An SH, Jee YJ, Shin HH, Lee GC. Validity of the original and short versions of the Dynamic Gait Index in predicting falls in stroke survivors. Rehabil Nurs 2017; 42: 325–332.

https://doi.org/10.1002/rnj.280 DOI: https://doi.org/10.1002/rnj.280

Belgen B, Beninato M, Sullivan PE, Narielwalla K. The association of balance capacity and falls self-efficacy with history of falling in community-dwelling people with chronic stroke. Arch Phys Med Rehabil 2006; 87: 554–561.

https://doi.org/10.1016/j.apmr.2005.12.027 DOI: https://doi.org/10.1016/j.apmr.2005.12.027

Beninato M, Portney LG,. Sullivan PE. Using the International Classification of Functioning, Disability and Health as a framework to examine the association between falls and clinical assessment tools in people with stroke. Phys Ther 2009; 89: 816–825.

https://doi.org/10.2522/ptj.20080160 DOI: https://doi.org/10.2522/ptj.20080160

Faria-Fortini I, Polese JC, Faria CDCM, Scianni AA, Nascimento LR, Teixeira-Salmela LF. Fall Efficacy Scale-International cut-off score discriminates fallers and non-fallers individuals who have had stroke. J Bodyw Mov Ther 2021; 26: 167–173.

https://doi.org/10.1016/j.jbmt.2020.12.002 DOI: https://doi.org/10.1016/j.jbmt.2020.12.002

Fiedorová I, Mrázková E, Zádrapová M, Tomášková H. Receiver operating characteristic curve analysis of the Somatosensory Organization Test, Berg Balance Scale, and Fall Effi-cacy Scale-International for predicting falls in discharged stroke patients. Int J Environ Res Public Health 2022; 19: 9181.

https://doi.org/10.3390/ijerph19159181 DOI: https://doi.org/10.3390/ijerph19159181

Huo M, Maruyama H, Chen L. Relationship between probe reaction time during walking and falls for patients with post-stroke hemiplegia. J Phys Ther Sci 2009; 21: 349–354.

https://doi.org/10.1589/JPTS.21.349 DOI: https://doi.org/10.1589/jpts.21.349

Kızılkaya E, Köse N, Ünsal Delialioğlu S, Karakaya J, Fil Balkan A. Psychometric properties of Fullerton Advanced Balance Scale in patients with stroke. Top Stroke Rehabil 2024; 31: 145–156.

https://doi.org/10.1080/10749357.2023.2235800 DOI: https://doi.org/10.1080/10749357.2023.2235800

Lee KB, Lee JS, Jeon IP, Choo DY, Baik MJ, Kim EH, et al. An analysis of fall incidence rate and risk factors in an inpatient rehabilitation unit: a retrospective study. Top Stroke Re-habil 2021; 28: 81–87.

https://doi.org/10.1080/10749357.2020.1774723 DOI: https://doi.org/10.1080/10749357.2020.1774723

Maeda N, Kato J, Shimada T. Predicting the probability for fall incidence in stroke patients using the Berg Balance Scale. J Int Med Res 2009; 37: 697–704.

https://doi.org/10.1177/147323000903700313 DOI: https://doi.org/10.1177/147323000903700313

Park EY, Lee YJ, Choi YI. The sensitivity and specificity of the Falls Efficacy Scale and the Activities-specific Balance Confidence Scale for hemiplegic stroke patients. J Phys Ther Sci 2018; 30: 741–743.

https://doi.org/10.1589/jpts.28.741 DOI: https://doi.org/10.1589/jpts.28.741

Persson CU, Hansson PO, Sunnerhagen KS. Clinical tests performed in acute stroke identify the risk of falling during the first year: postural stroke study in Gothenburg (POSTGOT). J Rehabil Med 2011; 43: 348–353.

https://doi.org/10.2340/16501977-0677 DOI: https://doi.org/10.2340/16501977-0677

Pinto EB, Nascimento C, Marinho C, Oliveira I, Monteiro M, Castro M, Castro, et al. Risk factors associated with falls in adult patients after stroke living in the community: base-line data from a stroke cohort in Brazil. Top Stroke Rehabil 2014; 21: 220–227. DOI: https://doi.org/10.1310/tscir2101-220

https://doi.org/10.1310/tsr2103-220 DOI: https://doi.org/10.1310/tsr2103-220

Sahin IE, Guclu-Gunduz A, Yazici G, Ozkul C, Volkan-Yazici M, Nazliel B, et al. The sensiti-vity and specificity of the balance evaluation systems test-BESTest in determining risk of fall in stroke patients. NeuroRehabilitation 2019; 44: 67–77.

https://doi.org/10.3233/nre-182558 DOI: https://doi.org/10.3233/NRE-182558

Takatori K, Shomoto K, Shimada T. Relationship between self-perceived postural limits and falls among hospitalized stroke patients. J Phys Ther Sci 2009; 21: 29–35.

https://doi.org/10.1589/jpts.21.29 DOI: https://doi.org/10.1589/jpts.21.29

Takatori K, Okada Y, Shomoto K, Shimada T. Does assessing error in perceiving postural limits by testing functional reach predict likelihood of falls in hospitalized stroke pati-ents? Clin Rehabil 2009; 23: 568–575.

https://doi.org/10.1177/0269215509102957 DOI: https://doi.org/10.1177/0269215509102957

Tsang CS, Liao LR, Chung RC, Pang MY. Psychometric properties of the Mini-Balance Evaluation Systems Test (Mini-BESTest) in community-dwelling individuals with chronic stroke. Phys Ther 2013; 93: 1102–1115.

https://doi.org/10.2522/ptj.20120454 DOI: https://doi.org/10.2522/ptj.20120454

Yamasaki Y, Arai T, Takaishi S, Takamura H, Maruki H. Increased stride time variability is associated with a higher risk of falls in patients with ataxia after stroke. Physiother The-ory Pract 2023: 1–9.

https://doi.org/10.1080/09593985.2023.2286334 DOI: https://doi.org/10.1080/09593985.2023.2286334

Zou TE, Liang PJ, Lee SC. Turning duration and steps predict future falls in poststroke hemiplegic individuals: a preliminary cohort study. Top Stroke Rehabil 2021; 28: 33–41.

https://doi.org/10.1080/10749357.2020.1760644 DOI: https://doi.org/10.1080/10749357.2020.1760644

Mandrekar JN. Receiver operating characteristic curve in diagnostic test assessment. J Thorac Oncol 2010; 5: 1315–1316.

https://doi.org/10.1097/jto.0b013e3181ec173d DOI: https://doi.org/10.1097/JTO.0b013e3181ec173d

Lima CA, Ricci NA, Nogueira EC, Perracini MR. The Berg Balance Scale as a clinical scre-ening tool to predict fall risk in older adults: a systematic review. Physiotherapy 2018; 104: 383–394.

https://doi.org/10.1016/j.physio.2018.02.002 DOI: https://doi.org/10.1016/j.physio.2018.02.002

Neuls PD, Clark TL, Van Heuklon NC, Proctor JE, Kilker BJ, Bieber ME, et al. Usefulness of the Berg Balance Scale to predict falls in the elderly. J Geriatr Phys Ther 2011; 34: 3–10.

https://doi.org/10.1097/jpt.0b013e3181ff2b0e

Wrisley DM, Kumar NA. Functional gait assessment: concurrent, discriminative, and pre-dictive validity in community-dwelling older adults. Phys Ther 2010; 90: 761–73.

https://doi.org/10.2522/ptj.20090069 DOI: https://doi.org/10.2522/ptj.20090069

Ng SS, Hui-Chan CW. The timed up & go test: its reliability and association with lower-limb impairments and locomotor capacities in people with chronic stroke. Arch Phys Med Rehabil 2005; 86: 1641–7.

https://doi.org/10.1016/j.apmr.2005.01.011 DOI: https://doi.org/10.1016/j.apmr.2005.01.011

Barry E, Galvin R, Keogh C, Horgan F, Fahey T. Is the Timed Up and Go test a useful pre-dictor of risk of falls in community-dwelling older adults: a systematic review and meta-analysis. BMC Geriatr 2014; 14: 14.

https://doi.org/10.1186/1471-2318-14-14 DOI: https://doi.org/10.1186/1471-2318-14-14

Beauchet O, Fantino B, Allali G, Muir SW, Montero-Odasso M, Annweiler C. Timed Up and Go test and risk of falls in older adults: a systematic review. J Nutr Health Aging 2011; 15: 933–938.

https://doi.org/10.1007/s12603-011-0062-0 DOI: https://doi.org/10.1007/s12603-011-0062-0

Eikenberry M, Ganley KJ, Zhang N, Kinney CL. Association between performance on an interdisciplinary stroke assessment battery and falls in patients with acute stroke in an inpatient rehabilitation facility: a retrospective cohort study. Arch Phys Med Rehabil 2019; 100: 2089–2095.

https://doi.org/10.1016/j.apmr.2019.05.026 DOI: https://doi.org/10.1016/j.apmr.2019.05.026

Additional Files

Published

2024-10-24

How to Cite

Matsumoto, D., Fujita, T., Kasahara, R., Tsuchiya, K., & Iokawa, K. (2024). Screening cutoff values to identify the risk of falls after stroke: A scoping review. Journal of Rehabilitation Medicine, 56, jrm40560. https://doi.org/10.2340/jrm.v56.40560

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