Abstract
PurposeTo use structural equation model (SEM) to explain falls at home in individuals with chronic stroke, based on the International Classification of Functioning, Disability and Health (ICF).Materials and methodsA cross sectional observation study was conducted in home-dwelling individuals with chronic stroke (N = 236; 148 non-fallers, 88 fallers). Participants were assessed; structural impairments using Modified Ashworth Scale, Fugl-Meyer Assessment upper (FMA-UE), lower (FMA-LE), and sensory function, ankle plantarflexor strength; activity limitations using Timed Up and Go Test, Step Test, Berg Balance Scale, Barthel Index (BI); participation restrictions using Stroke Impact Scale-participation (SIS-P); and contextual factors using home hazard environments, home safety surroundings, risk behaviors, and Fall-related Self Efficacy. The measurement model was analyzed by confirmatory factor analysis. The SEM was conducted to analyze a structural model of falls at home.ResultsFMA-UE was significantly (p<0.01) associated with FMA-LE, combining as one variable in the structural impairments. In the measurement model, variables were fit to their domains, except variables of contextual factors, but the ICF domains did not correspond to disability. A structural model of falls at home demonstrated a significant (p<0.01) direct path of contextual factors and activity limitations with falls at home. The structural impairments showed a significant (p<0.01) direct path with activity limitations. All variables, except BI, SIS-P and risk behaviors, related to their domains in the structural model.ConclusionsA structural model of falls at home proposes contextual factors being the strongest association with falls at home that home hazard environments seem the most influence in its domain. The activity limitations presented by balance ability are directed to falls at home. The structural impairments are associated with falls at home through activity limitations. Home assessment to decrease home hazard environments is suggested to prevent falls at home for individuals with chronic stroke.
Highlights
Individuals with stroke have long-term disability and are at high risk of falls
Variables were fit to their domains, except variables of contextual factors, but the ICF domains did not correspond to disability
A structural model of falls at home proposes contextual factors being the strongest association with falls at home that home hazard environments seem the most influence in its domain
Summary
Individuals with stroke have long-term disability and are at high risk of falls. A rate of falls was 8.7 [1] or 1.3–6.5 falls/person/year [2], otherwise, 3.57 [3], or about 1.77 times a year [4]. Individuals with stroke contain a number of fall risk factors that can reciprocally link, for instance, lower limb performance and mobility [12], motor function and balance [13], balance and walking and participation restrictions [14], self-efficacy and physical activity [15], or environment and frequency of walking [16]. A previous study demonstrated the use of the ICF for selecting assessment tools associating with falls in individuals with stroke, for example Fugl-Meyer Assessment lower extremity function (FMA-LE) for structural impairments, Berg Balance Scale (BBS) for activity limitations [20]. In addition to tone of ankle plantarflexor, the strength of the muscle is important for walking [27,28,29], a category of component activities and participation [24], and associates with fear of falling in individuals with stroke [30].
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