Cumulative Risk And Associated Factors For Fall-Related Fractures In Stroke Survivors After Discharge From Rehabilitation Wards: A Retrospective Study With A 6-Year Follow-Up

Abstract

Objective: To investigate the long-term cumulative risk and factors associated with fall-related fractures in stroke survivors discharged from convalescent rehabilitation wards. Design: Retrospective cohort study. Participants: A total of 786 stroke survivors discharged from a rehabilitation hospital. Methods: Data regarding fall-related fractures posthospital discharge were collected using self-reported questionnaires. The Kaplan–Meier method was used to calculate the cumulative incidence of fall-related fractures, and risk factors were analysed using Cox proportional hazard regression analysis. Results: Of 1,861 consecutive stroke survivors who had been discharged from hospital, 786 (42.2%) provided information concerning fall-related fractures. Duration from time of discharge to time of collection of questionnaires ranged from 1 to 6 years (mean 38.0 months). The cumulative incidence of fall-related fractures at 1-, 2-, 3-, 4-, and 5-years post-discharge was 4.2%, 7.9%, 10.8%, 12.5% and 13.7%, respectively. Cox proportional hazard regression analysis indicated that female sex (hazard ratio (HR) 1.69) and moderate lower limb paresis (HR 3.08) were significant risk factors. Conclusion: The cumulative risk of fall-related fractures in stroke survivors post-discharge from a rehabilitation hospital was notably high. Intensive preventive intervention should be considered for female stroke survivors with moderate lower limb paresis. LAY ABSTRACT This study aimed to investigate the risk of fall-related fractures and associated factors in stroke survivors who had been discharged from rehabilitation wards. A questionnaire was sent by post to 1,861 post-discharge stroke survivors to investigate their experiences of fall-related fractures, to which 786 stroke survivors responded. The incidence of fall-related fractures at 1, 2, 3, 4, and 5 years post-discharge was 4.2%, 7.9%, 10.8%, 12.5% and 13.7%, respectively. The presence of moderate lower limb paresis and female sex were associated with 3.08- and 1.69-times higher risk of developing a fall-related fracture, respectively. Intensive preventive intervention should be considered for female stroke survivors with moderate lower limb paresis following discharge from rehabilitation wards.

Keywords

• accidental fall
• bone fracture
• cerebrovascular disorder
• rehabilitation
• risk factor