Poster The Joint Annual Meeting of the Stroke Society of Australasia (SSA) and Smartstrokes 2023

Serious Falls Over One-Year After Stroke: Insights from a Large International Rehabilitation Trial (#170)

Kelly J Bower 1 , Julian Wang 1 , Hannah Johns 1 , Natalie A Fini 1 , Catherine Said 1 2 , Frances Batchelor 1 3 , Leonid Churilov 1 4 , Janice Collier 4 , Fiona Ellery 4 , AVERT Trialist Collaboration 4 , Julie Bernhardt 4
  1. The University of Melbourne, Melbourne, VIC, Australia
  2. Western Health, Melbourne, VIC, Australia
  3. National Ageing Research Institute, Melbourne, VIC, Australia
  4. The Florey, Melbourne, VIC, Australia

Background: Falls following stroke are prevalent and debilitating. Around half of individuals will fall within the first year post-stroke and these falls are more likely to cause serious injury compared to people without stroke

Aims: Using data from A Very Early Rehabilitation Trial (AVERT) [1], this study aimed to investigate the frequency, context and consequences of serious falls (i.e., those classified as serious adverse events) over 12 months post-stroke. Additionally, we explored potential risk factors associated with these falls.

Methods: Serious falls were those resulting in death, life threatening conditions, hospitalisation or prolonged hospital stay. Demographic details, pre-existing function, stroke severity, hemi-neglect, functional independence and mobility were collected within 24hrs post-stroke. The associations between serious falls and these baseline variables were assessed using Fisher's tests or Firth's logistic regressions, with adjustments for age, stroke severity (NIHSS) and AVERT intervention.

Results: Among the 2104 participants (mean age 70.6±12.8, 61% male), 85 individuals (4%) experienced at least one serious fall (mean age 78.1±9.7, 53% male). There were 91 individual serious falls incidents. While precise context was not consistently recorded, falls most often occurred while walking, at home and during the day. Fifty-five (60%) serious falls resulted in fracture. Our analysis showed that advanced age (OR 1.06, 95%CI 1.04-1.09), lower Mobility Scale for Acute Stroke scores (OR 1.06, 95%CI 1.03-1.11 per one-unit decrease), and inability to walk independently for 10m within 24hrs of stroke (OR 6.25, 95%CI 1.59-50) were associated with a greater risk of serious falls.

Conclusion: This large study found that 4% of individuals experienced at least one serious fall in the first year after stroke and 60% of these involved a fracture. Our findings highlight the importance of considering factors such as age and early post-stroke mobility to identify at-risk individuals and facilitate targeted falls and injury prevention strategies.

  1. Bernhardt, J., Langhorne, P., Lindley, R. I., Thrift, A. G., Ellery, F., Collier, J., ... & Donnan, G. (2015). Efficacy and safety of very early mobilisation within 24 h of stroke onset (AVERT): a randomised controlled trial. Lancet, 386(9988), 46-55.