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- Better balance: a randomised controlled trial of oculomotor and gaze stability exercises to reduce risk of falling after strokePublication . Correia, Anabela; Pimenta, Carla; Alves, Marta; Virella, DanielObjective: To assess the effect of a domiciliary program of oculomotor and gaze stability exercises on the incidence of falls and the risk of fall in stroke survivors. Design: Two-arm, non-blinded parallel randomized controlled trial. Subjects: Stroke survivors older than 60 years, with positive Romberg test and autonomous gait after the stroke. Setting: Physiotherapy outpatient clinic of a tertiary care hospital. Interventions: Every participant accomplished the current rehabilitation program; the intervention group was randomly allocated into an additional three weeks intervention with a domiciliary program of oculomotor and gaze stability exercises. Main measures: Primary outcome was the incidence of falls through the three weeks after the intervention started; in addition, the variation of the estimated risk for falling assessed by both the Berg Balance Scale (four points) and Timed Up and Go Test (four seconds) was the secondary outcome. Results: 79 patients were recruited and 68 completed the protocol (control group 35; intervention group 33). During the follow-up, falls were registered in 4/35 participants in the control group and no event occurred in the intervention group (P = 0.064). The estimated risk for falling decreased in 11/35 control group participants and in 28/33 intervention group participants (RR 0.37; 95%CI 0.22–0.62; P < 0.001). Conclusion: After three weeks of a domiciliary program of oculomotor and gaze stability exercises, the estimated risk of falling significantly diminished, and no falls occurred among the intervention group. These findings encourage further exploration of this promising intervention.
- Assessing the risk for falls among Portuguese community-dwelling stroke survivors: are we using the better tools? Observational studyPublication . Pimenta, Carla; Correia, Anabela; Alves, Marta; Virella, DanielPurpose: This study assesses the estimation of the risk for falls among community-dwelling stroke survivors referred for ambulatory physiotherapy and explores factors that affect the risk. Methods: Observational, cross-sectional with nested case-control study, of individuals, referred to physiotherapy less than 12 months after stroke and able to walk independently. Berg Balance Scale, Timed Up and Go Test, and the Motor Assessment Scale were applied. Berg Balance Scale ≤45 or Timed Up and Go Test > 14 were used to estimate the risk for falls. The discrimination ability of the estimation was assessed. Alternative models were explored by logistic regression analysis. Results: One hundred sixty-seven patients fulfilled the inclusion criteria. Patients were 21 to 87years old (median 66), 98 men (58.7%), and 133 (79.6%) the stroke occurred in the last 6 months. Falls were reported by 78 (46.7%) of the patients but 139 (83.2% [95%CI 76.84–88.14]) were estimated as having risk for falls. The discrimination ability of the estimation of the actual occurrence of falls by Berg Balance Scale ≤45 or Timed Up and Go Test >14 was 55% (95%CI 47.5–62.4). The actual occurrence of falls was associated only with Motor Assessment Scale, as a protective factor. The discrimination ability of the estimation of the actual occurrence of falls by the Motor Assessment Scale alone was the area under the curve 0.69 (95%CI 0.60–0.77). Conclusions: Different tools with better performance are needed to identify the risk for falls after stroke.