Assosiations Between Fear of Fall, Functional Ambulation Category and Quality of Life in Stroke Survivors
Condition: Fall
Study type: Observational [Patient Registry]

Summary: 
      Stroke is one of the most common causes of acquired adult disability. The stroke survivors
      have lots of mobility difficulties such as poor standing, decreased walking speed, balance
      disturbances, and increased risk of falls (1).

      Falling is a major threat to stroke patients for physical injury. Fracture resulting from
      falling, could affect the rehabilitation potential and functional recovery (2,3).

      After a stroke, falls are one of the most common medical complications with a 73% incidence
      within the six months (4). In addition to physical components, psychological factors related
      falling include fear of falling(5). Fear of falling is defined as persisting concern
      regarding falling and associated with many negative physical and psychological factors (6,7).
      It not only affects a simple health concern, but also avoidance of activities and a loss of
      confidence (8).

      To determine the associating factors of fear of falling (FOF) and the correlations between
      FOF, functional ambulation category (FAC) and quality of life (QOL) on stroke patients.
    

Detailed description: 
      This study was a cross-sectional observational study. Each participant was assessed with
      standardized questionnaires and examined. Eighty six hemiplegic cronic stroke patients were
      recruited from our clinic from March 2018 to December 2020 with informed consent. We divided
      the participants into two groups; with fallers and non-fallers.

      The inclusion criteria were stroke duration of 6 months or more follow 3-step commands, were
      able to walk 10m with no physical assistance with or without any assistive device, and
      scoring ≥3 on Functional Ambulation Category, and physically able to complete the testing
      procedure.

      Exclusion criteria were other neurologic diagnosesor were medically unstable, lower-extremity
      fracture, or other surgical procedures during the last 6 months and were unable to provide
      consent.

      All participants signed a written consent prior to participation in the study. The study was
      approved by the local institutional review board. The study was conducted in accordance with
      the Declaration of Helsinki ethical principles for human experimentation.

      Demographic characteristics and medical history recorded by questionnaire included age,
      height, weight, comorbidities, number of medications, use of assistive device, date of stroke
      onset, and side of stroke, hemorrhagic or ischemic.

      Falls history included number of falls during last 6 months or number of falls since the
      stroke onset, if stroke was less than 6 months prior. Fear of falling was assessed by asking
      subjects if they were afraid of falling (yes, no) and also ranking Falls Efficacy
      Scale-International (FES-I)(1).

      Also functional ambulation levels, motor functions, spasticity and quality of life were
      assessed using Functional Ambulation Category (FAC), Brunnstrom staging, Modified Ashworth
      scale (MAS), Stroke Impact Scale 3.0 (SIS) (2-5).

        1. Delbaere K, Close JC, Mikolaizak AS, Sachdev PS, Brodaty H, Lord SR. The Falls Efficacy
           Scale International (FES-I). A compre- hensive longitudinal validation study. Age Ageing
           2010;39:210-216

        2. Mehrholz J, Wagner K, Rutte K, Meissner D, Pohl M. Predictive validity and
           responsiveness of the functional ambulation category in hemiparetic patients after
           stroke. Arch Phys Med Rehabil 2007; 88:1314-1319

        3. Hantal AÖ, Doğu B, Büyükavcı R, Kuran B. İnme etki ölçeği 3, 0: Türk toplumundaki inmeli
           hastalarda güvenilirlik ve geçerlilik çalışması. Türk Fiz Tıp Rehab Derg.
           2014;60:106-16.

        4. Ansari NN, Naghdi S, Younesian P, Shayeghan M, practice. Inter-and intrarater
           reliability of the Modified Modified Ashworth Scale in patients with knee extensor
           poststroke spasticity. Physiotherapy theory. 2008;24(3):205-13.

        5. Brunnstrom S. Motor testing procedures in hemiplegia: based on sequential recovery
           stages. Physical therapy. 1966;46(4):357-75.
    

Intervention name(s): Falls Efficacy Scale-International (FES-I)
Intervention type(s): Diagnostic Test
Intervention description(s): The FES-1 was used to assess the fear of falling level of participants about falling during indoor or outdoor activities. It has 16 items scored on a four-point Likert scale. The Turkish validated version of the FES-I was used in this study. The total score (sum of the 16 responses) ranging from 16 to 64 points was used for data analysis. A higher score indicates better mobility performance. A cut-off score of 27 points on the 16- item FES-I was used to differentiate high concern for falling from low concern
Other intervention name(s): Functional Ambulation Category (FAC); Stroke Impact Scale 3.0 (SIS)
Observational model: Case-Control
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        stroke duration of 6 months or more follow 3-step commands 18-65 years were able to walk
        10m with no physical assistance with or without any assistive device
      
Keywords: fear of fall; quality of life; ambulation