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Published in: Osteoporosis International 7/2008

01-07-2008 | Original Article

Fall-related self-efficacy, not balance and mobility performance, is related to accidental falls in chronic stroke survivors with low bone mineral density

Authors: M. Y. C. Pang, J. J. Eng

Published in: Osteoporosis International | Issue 7/2008

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Abstract

Summary

Chronic stroke survivors with low hip bone density are particularly prone to fractures. This study shows that fear of falling is independently associated with falls in this population. Thus, fear of falling should not be overlooked in the prevention of fragility fractures in these patients.

Introduction

Chronic stroke survivors with low bone mineral density (BMD) are particularly prone to fragility fractures. The purpose of this study was to identify the determinants of balance, mobility and falls in this sub-group of stroke patients.

Methods

Thirty-nine chronic stroke survivors with low hip BMD (T-score <−1.0) were studied. Each subject was evaluated for the following: balance, mobility, leg muscle strength, spasticity, and fall-related self-efficacy. Any falls in the past 12 months were also recorded. Multiple regression analysis was used to identify the determinants of balance and mobility performance, whereas logistic regression was used to identify the determinants of falls.

Results

Multiple regression analysis revealed that after adjusting for basic demographics, fall-related self-efficacy remained independently associated with balance/mobility performance (R2 = 0.494, P < 0.001). Logistic regression showed that fall-related self-efficacy, but not balance and mobility performance, was a significant determinant of falls (odds ratio: 0.18, P = 0.04).

Conclusions

Fall-related self-efficacy, but not mobility and balance performance, was the most important determinant of accidental falls. This psychological factor should not be overlooked in the prevention of fragility fractures among chronic stroke survivors with low hip BMD.
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Literature
1.
go back to reference Jorgensen L, Engstad T, Jacobsen BK (2002) Higher incidence of falls in long-term stroke survivors than in population controls. Depressive symptoms predict falls after stroke. Stroke 33:542–547PubMedCrossRef Jorgensen L, Engstad T, Jacobsen BK (2002) Higher incidence of falls in long-term stroke survivors than in population controls. Depressive symptoms predict falls after stroke. Stroke 33:542–547PubMedCrossRef
2.
go back to reference Tutuarima JA, van der Meulen JHP, de Haan RJ et al (1997) Risk factors for falls of hospitalized stroke patients. Stroke 28:297–301PubMed Tutuarima JA, van der Meulen JHP, de Haan RJ et al (1997) Risk factors for falls of hospitalized stroke patients. Stroke 28:297–301PubMed
3.
go back to reference Nyberg L, Gustafson Y (1995) Patient falls in stroke rehabilitation: a challenge to rehabilitation strategies. Stroke 26:838–842PubMed Nyberg L, Gustafson Y (1995) Patient falls in stroke rehabilitation: a challenge to rehabilitation strategies. Stroke 26:838–842PubMed
4.
go back to reference Lamb SE, Ferrucci L, Volapto S et al (2003) Risk factors for falling in home-dwelling older women with stroke. The women’s health and aging study. Stroke 34:494–501PubMedCrossRef Lamb SE, Ferrucci L, Volapto S et al (2003) Risk factors for falling in home-dwelling older women with stroke. The women’s health and aging study. Stroke 34:494–501PubMedCrossRef
5.
go back to reference Hyndman D, Ashburn A, Stack E et al (2002) Fall events among people with stroke living in the community: circumstances of falls and characteristics of fallers. Arch Phys Med Rehabil 83:165–170PubMedCrossRef Hyndman D, Ashburn A, Stack E et al (2002) Fall events among people with stroke living in the community: circumstances of falls and characteristics of fallers. Arch Phys Med Rehabil 83:165–170PubMedCrossRef
6.
go back to reference Hyndman D, Ashburn A (2003) People with stroke living in the community: attention deficits, balance, ADL ability, and falls. Disabil Rehabil 25:817–822PubMedCrossRef Hyndman D, Ashburn A (2003) People with stroke living in the community: attention deficits, balance, ADL ability, and falls. Disabil Rehabil 25:817–822PubMedCrossRef
7.
go back to reference Eng JJ, Chu KS, Dawson AS et al (2002) Functional walk tests in individuals with stroke. Relation to perceived exertion and myocardial exertion. Stroke 33:756–761PubMedCrossRef Eng JJ, Chu KS, Dawson AS et al (2002) Functional walk tests in individuals with stroke. Relation to perceived exertion and myocardial exertion. Stroke 33:756–761PubMedCrossRef
8.
go back to reference Ng SS, Hui Chan CW (2005) 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 86:1641–1647PubMedCrossRef Ng SS, Hui Chan CW (2005) 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 86:1641–1647PubMedCrossRef
9.
go back to reference Tinetti ME, Speechley M, Gineter SF et al (1988) Risk factors for falls among elderly persons living in the community. N Engl J Med 319:1701–1707PubMedCrossRef Tinetti ME, Speechley M, Gineter SF et al (1988) Risk factors for falls among elderly persons living in the community. N Engl J Med 319:1701–1707PubMedCrossRef
10.
go back to reference Belgen B, Beninato M, Sullivan PE et al (2006) The association of balance capacity and falls self-efficacy with history of falling in community-dwelling people with chronic stroke. Arch Phys Med Rehabil 87:554–561PubMedCrossRef Belgen B, Beninato M, Sullivan PE et al (2006) The association of balance capacity and falls self-efficacy with history of falling in community-dwelling people with chronic stroke. Arch Phys Med Rehabil 87:554–561PubMedCrossRef
11.
go back to reference Rosen E, Sunnerhagen KS, Kreuter M et al (2005) Fear of falling, balance, and gait velocity in patients with stroke. Physiother Theory Pract 21:113–120PubMedCrossRef Rosen E, Sunnerhagen KS, Kreuter M et al (2005) Fear of falling, balance, and gait velocity in patients with stroke. Physiother Theory Pract 21:113–120PubMedCrossRef
12.
go back to reference Powell LE, Myers AM (1995) The Activities-Specific Balance Confidence (ABC) Scale. J Gerontol A Biol Sci Med Sci 50A:M28–M34PubMed Powell LE, Myers AM (1995) The Activities-Specific Balance Confidence (ABC) Scale. J Gerontol A Biol Sci Med Sci 50A:M28–M34PubMed
13.
go back to reference Myers AM, Fletcher PC, Myers AH et al (1998) Discriminative and evaluative properties of the Activities-specific Balance Confidence (ABC) Scale. J Gerontol A Biol Sci Med Sci 53:M287–294PubMed Myers AM, Fletcher PC, Myers AH et al (1998) Discriminative and evaluative properties of the Activities-specific Balance Confidence (ABC) Scale. J Gerontol A Biol Sci Med Sci 53:M287–294PubMed
14.
go back to reference Fletcher PC, Hirdes JP (2004) Restriction in activity associated with fear of falling among community-based seniors using home care services. Age Ageing 33:273–279PubMedCrossRef Fletcher PC, Hirdes JP (2004) Restriction in activity associated with fear of falling among community-based seniors using home care services. Age Ageing 33:273–279PubMedCrossRef
15.
go back to reference Tinetti ME, Mendes de Leon CF, Doucette JT et al (1994) Fear of falling and fall-related efficacy in relationship to functioning among community-living elders. J Gerontol 49:M140–M147PubMed Tinetti ME, Mendes de Leon CF, Doucette JT et al (1994) Fear of falling and fall-related efficacy in relationship to functioning among community-living elders. J Gerontol 49:M140–M147PubMed
16.
go back to reference Maki BE, Holliday PJ, Topper AK et al (1991) Fear of falling and postural performance in the elderly. J Gerontol Med Sci 46:M123–M131 Maki BE, Holliday PJ, Topper AK et al (1991) Fear of falling and postural performance in the elderly. J Gerontol Med Sci 46:M123–M131
17.
go back to reference Liu-Ambrose T, Khan KM, Donaldson MG et al (2006) Fall-related self-efficacy is independently associated with balance and mobility in older women with low bone mass. J Gerontol Med Sci A 8:832–838 Liu-Ambrose T, Khan KM, Donaldson MG et al (2006) Fall-related self-efficacy is independently associated with balance and mobility in older women with low bone mass. J Gerontol Med Sci A 8:832–838
18.
go back to reference Hellstrom K, Lindmark B, Wahlberg B et al (2003) Self-efficacy in relation to impairments and activities of daily living disability in elderly patients with stroke: a prospective investigation. J Rehabil Med 35:2002–2007 Hellstrom K, Lindmark B, Wahlberg B et al (2003) Self-efficacy in relation to impairments and activities of daily living disability in elderly patients with stroke: a prospective investigation. J Rehabil Med 35:2002–2007
19.
20.
go back to reference Farahmand BY, Michaelsson K, Ahlbom A et al (2005) Swedish Hip Fracture Study Group. Survival after hip fracture. Osteoporos Int 16:1583–1590PubMedCrossRef Farahmand BY, Michaelsson K, Ahlbom A et al (2005) Swedish Hip Fracture Study Group. Survival after hip fracture. Osteoporos Int 16:1583–1590PubMedCrossRef
21.
go back to reference Ramnemark A, Nilsson M, Borssen B et al (2000) Stroke, a major and increasing risk factor for femoral neck fracture. Stroke 31:1572–1577PubMed Ramnemark A, Nilsson M, Borssen B et al (2000) Stroke, a major and increasing risk factor for femoral neck fracture. Stroke 31:1572–1577PubMed
22.
go back to reference Di Monaco M, Vallero F, Di Monaco R et al (2003) Functional recovery and length of stay after hip fracture in patients with neurologic impairment. Am J Phys Med Rehabil. 82:143–148PubMedCrossRef Di Monaco M, Vallero F, Di Monaco R et al (2003) Functional recovery and length of stay after hip fracture in patients with neurologic impairment. Am J Phys Med Rehabil. 82:143–148PubMedCrossRef
23.
go back to reference Eng JJ, Pang MYC, Ashe MA. Role of exercise in reducing the risk of fracture after stroke. J Rehabil Res Dev. In press. Eng JJ, Pang MYC, Ashe MA. Role of exercise in reducing the risk of fracture after stroke. J Rehabil Res Dev. In press.
24.
go back to reference Braithwaite RS, Col NF, Wong JB et al (2003) Estimating hip fracture morbidity, mortality and costs. J Am Geriatr Soc 51:364–370PubMedCrossRef Braithwaite RS, Col NF, Wong JB et al (2003) Estimating hip fracture morbidity, mortality and costs. J Am Geriatr Soc 51:364–370PubMedCrossRef
25.
go back to reference Folstein MF, Folstein, SE, McHugh PR et al (1975) Mini-Mental State: A practical method for grading the state of patients for the clinician. J Psychiatr Res 12:189–198PubMedCrossRef Folstein MF, Folstein, SE, McHugh PR et al (1975) Mini-Mental State: A practical method for grading the state of patients for the clinician. J Psychiatr Res 12:189–198PubMedCrossRef
26.
go back to reference Washburn RA, Zhu W, McAuley E et al (2002) The physical activity scale for individuals with physical disabilities: development and evaluation. Arch Phys Med Rehabil 83:193–200PubMedCrossRef Washburn RA, Zhu W, McAuley E et al (2002) The physical activity scale for individuals with physical disabilities: development and evaluation. Arch Phys Med Rehabil 83:193–200PubMedCrossRef
27.
go back to reference Berg KO, Wood-Dauphinee SL, Williams JI et al (1992) Measuring balance in the elderly: Validation of an instrument. Physiother Can 41:304–311 Berg KO, Wood-Dauphinee SL, Williams JI et al (1992) Measuring balance in the elderly: Validation of an instrument. Physiother Can 41:304–311
28.
go back to reference Podsiadlo D, Richardson S (1991) The timed “Up & Go”: a test of basic functional mobility for frail elderly. J Am Geriatr Soc 39:142–148PubMed Podsiadlo D, Richardson S (1991) The timed “Up & Go”: a test of basic functional mobility for frail elderly. J Am Geriatr Soc 39:142–148PubMed
29.
go back to reference Kim CM, Eng JJ (2003) The relationship of lower-extremity muscle torque to locomotor performance in people with stroke. Phys Ther 83:49–57PubMed Kim CM, Eng JJ (2003) The relationship of lower-extremity muscle torque to locomotor performance in people with stroke. Phys Ther 83:49–57PubMed
30.
go back to reference Bohannon RW (1997) Measurement and nature of muscle strength in patients with stroke. J Neuro Rehabil 11:115–125 Bohannon RW (1997) Measurement and nature of muscle strength in patients with stroke. J Neuro Rehabil 11:115–125
31.
go back to reference Bohannon RW, Smith MB (1987) Interrater reliability of a Modified Ashworth Scale of muscle spasticity. Phys Ther 67:206–207PubMed Bohannon RW, Smith MB (1987) Interrater reliability of a Modified Ashworth Scale of muscle spasticity. Phys Ther 67:206–207PubMed
32.
go back to reference Botner EM, Miller WC, Eng JJ (2005) Measurement properties of the Activities-specific Balance Confidence Scale among individuals with stroke. Disabil Rehabil 27:156–163PubMedCrossRef Botner EM, Miller WC, Eng JJ (2005) Measurement properties of the Activities-specific Balance Confidence Scale among individuals with stroke. Disabil Rehabil 27:156–163PubMedCrossRef
33.
go back to reference Tabachnick B, Fidell L (eds) (2001) Using multivariate statistics. 4th edition. Allyn and Bacon, Boston Tabachnick B, Fidell L (eds) (2001) Using multivariate statistics. 4th edition. Allyn and Bacon, Boston
34.
go back to reference Bogle Thorbahn LD, Newton RA (1996) Use of the Berg Balance Test to predict falls in elderly persons. Phys Ther 76:576–582PubMed Bogle Thorbahn LD, Newton RA (1996) Use of the Berg Balance Test to predict falls in elderly persons. Phys Ther 76:576–582PubMed
35.
go back to reference Shumway-Cook A, Baldwin M, Polissar NL et al (1997) Predicting the probability of falls in community-dwelling older adults. Phys Ther 77:812–819PubMed Shumway-Cook A, Baldwin M, Polissar NL et al (1997) Predicting the probability of falls in community-dwelling older adults. Phys Ther 77:812–819PubMed
36.
go back to reference Steffen TM, Hacker TA, Mollinger L (2002) Age- and gender-related test performance in community-dwelling elderly people: six-minute walk test, Berg balance sale, timed up & go test, and gait speeds. Phys Ther 82:128–137PubMed Steffen TM, Hacker TA, Mollinger L (2002) Age- and gender-related test performance in community-dwelling elderly people: six-minute walk test, Berg balance sale, timed up & go test, and gait speeds. Phys Ther 82:128–137PubMed
37.
go back to reference Friedman SM, Munox B, West SK et al (2002) Falls and fear of falling: which comes first? A longitudinal prediction model suggests strategies for primary and secondary prevention. J Am Geriatr Soc 50:1329–1335PubMedCrossRef Friedman SM, Munox B, West SK et al (2002) Falls and fear of falling: which comes first? A longitudinal prediction model suggests strategies for primary and secondary prevention. J Am Geriatr Soc 50:1329–1335PubMedCrossRef
38.
go back to reference Salbach NM, Mayo NE, Robichaud-Ekstrand S et al (2006) Balance self-efficacy and its relevance to physical function and perceived health status after stroke. Arch Phys Med Rehabil 87:364–370PubMedCrossRef Salbach NM, Mayo NE, Robichaud-Ekstrand S et al (2006) Balance self-efficacy and its relevance to physical function and perceived health status after stroke. Arch Phys Med Rehabil 87:364–370PubMedCrossRef
39.
go back to reference Harris JE, Eng JJ, Marigold DS et al (2005) Relationship of balance and mobility to fall incidence in people with chronic stroke. Phys Ther 85:150–158PubMed Harris JE, Eng JJ, Marigold DS et al (2005) Relationship of balance and mobility to fall incidence in people with chronic stroke. Phys Ther 85:150–158PubMed
40.
go back to reference Melton III LJ, Brown Sr RD, Achenbach SJ et al (2001) Long-term fracture risk following ischemic stroke: a population study. Osteoporos Int 12:980–986PubMedCrossRef Melton III LJ, Brown Sr RD, Achenbach SJ et al (2001) Long-term fracture risk following ischemic stroke: a population study. Osteoporos Int 12:980–986PubMedCrossRef
41.
go back to reference Bandura A (1977) Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev 84:240–245CrossRef Bandura A (1977) Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev 84:240–245CrossRef
42.
go back to reference Howland J, Tennstedt S, Lachman M et al (1998) A randomized, controlled trial of a group intervention to reduce fear of falling and associated activity restriction in older adults. J Gerontol Psychol Sci 53B:P384–392 Howland J, Tennstedt S, Lachman M et al (1998) A randomized, controlled trial of a group intervention to reduce fear of falling and associated activity restriction in older adults. J Gerontol Psychol Sci 53B:P384–392
43.
go back to reference Nevitt MC, Cummings SR, Kidd S et al (1989) Risk factors for recurrent nonsyncopal falls. JAMA 261:2663–2668PubMedCrossRef Nevitt MC, Cummings SR, Kidd S et al (1989) Risk factors for recurrent nonsyncopal falls. JAMA 261:2663–2668PubMedCrossRef
44.
go back to reference Salbach NM, Mayo NE, Robichaud-Ekstrand S et al (2005) The effect of a task-oriented walking intervention on improving balance self-efficacy poststroke: a randomized, controlled trial. J Am Geriatr Soc 53:576–582PubMedCrossRef Salbach NM, Mayo NE, Robichaud-Ekstrand S et al (2005) The effect of a task-oriented walking intervention on improving balance self-efficacy poststroke: a randomized, controlled trial. J Am Geriatr Soc 53:576–582PubMedCrossRef
45.
go back to reference Jorgensen HS, Nakayama H, Raaschou HO et al (1999) Stroke: Neurologic and functional recovery. The Copenhagen Study. Phys Med Rehabil Clin N Am 10:887–906PubMed Jorgensen HS, Nakayama H, Raaschou HO et al (1999) Stroke: Neurologic and functional recovery. The Copenhagen Study. Phys Med Rehabil Clin N Am 10:887–906PubMed
Metadata
Title
Fall-related self-efficacy, not balance and mobility performance, is related to accidental falls in chronic stroke survivors with low bone mineral density
Authors
M. Y. C. Pang
J. J. Eng
Publication date
01-07-2008
Publisher
Springer-Verlag
Published in
Osteoporosis International / Issue 7/2008
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-007-0519-5

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