Fall-related self-efficacy, not balance and mobility performance, is related to accidental falls in chronic stroke survivors with low bone mineral density
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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.
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.
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.
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).
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.
KeywordsBone density Cerebrovascular accident Falls Fractures Rehabilitation Self-efficacy
M.Y.C.P. was supported by a post-doctoral fellowship from Natural Sciences and Engineering Research Council of Canada. This study was supported by a grant-in-aid from the Heart Stroke Foundation of British Columbia and Yukon (J.J.E.) and from career scientist awards from Canadian Institute of Health Research (J.J.E) and the Michael Smith Foundation for Health Research (J.J.E.).
Conflicts of interest
- 16.Maki BE, Holliday PJ, Topper AK et al (1991) Fear of falling and postural performance in the elderly. J Gerontol Med Sci 46:M123–M131Google Scholar
- 17.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 8:832–838Google Scholar
- 18.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 35:2002–2007Google Scholar
- 23.Eng JJ, Pang MYC, Ashe MA. Role of exercise in reducing the risk of fracture after stroke. J Rehabil Res Dev. In press.Google Scholar
- 27.Berg KO, Wood-Dauphinee SL, Williams JI et al (1992) Measuring balance in the elderly: Validation of an instrument. Physiother Can 41:304–311Google Scholar
- 30.Bohannon RW (1997) Measurement and nature of muscle strength in patients with stroke. J Neuro Rehabil 11:115–125Google Scholar
- 33.Tabachnick B, Fidell L (eds) (2001) Using multivariate statistics. 4th edition. Allyn and Bacon, BostonGoogle Scholar
- 42.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:P384–392Google Scholar