BACKGROUND Stroke patients have increased risks of falls. We examined national registry data to evaluate the association between post-stroke functional level and the risk of low falls among post-stroke patients. METHODS This retrospective cohort study analyzed data from national registries to examine the risk factors for post-stroke falls. Data for patients who suffered ischemic strokes and survived the index hospital admission was obtained from the Singapore National Stroke Registry and matched to the National Trauma Registry, from 2011 to 2015. The primary outcome measure was a low fall (fall height ≤ 0.5 m). Competing risk analysis was performed to examine the association between functional level (by modified Rankin score [mRS] at discharge) and the risk of subsequent low falls. RESULTS In all, 2255 patients who suffered ischemic strokes had recorded mRS. The mean age was 66.6 years and 58.5% were men. By the end of 2015, 54 (2.39%) had a low fall while 93 (4.12%) died. After adjusting for potential confounders, mRS was associated with fall risk with an inverted U-shaped relationship. Compared to patients with a score of zero, the sub-distribution hazard ratio (SHR) increased to a maximum of 3.42 (95%CI:1.21-9.65, p = 0.020) for patients with a score of 2. The SHR then declined to 2.45 (95%CI:0.85-7.12, p = 0.098), 2.86 (95%CI:0.95-8.61, p = 0.062) and 1.93 (95%CI:0.44-8.52, p = 0.38) for patients with scores of 3, 4 and 5 respectively. CONCLUSIONS An inverted U-shaped relationship between functional status and fall risk was observed. This is consistent with the complex interplay between decreasing mobility (hence decreased opportunity to fall) and increasing susceptibility to falls. Fall prevention intervention could be targeted accordingly. (263 words).

中文翻译：

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中度功能的中风后患者跌倒的风险最大：美国国家队列研究。

背景技术中风患者跌倒的风险增加。我们检查了国家注册表数据，以评估中风后功能水平与中风后患者跌倒风险之间的关联。方法这项回顾性队列研究分析了来自国家注册机构的数据，以检查中风后跌倒的危险因素。2011年至2015年，从新加坡国家中风登记处获得了缺血性中风并在指数医院入院后幸存的患者的数据，并与国家创伤登记处进行了匹配。主要的结局指标是低落（跌倒高度≤0.5 m）。进行竞争风险分析以检查功能水平（通过出院时改良的Rankin评分[mRS]）与随后发生低落的风险之间的关联。结果总的来说，2255名患有缺血性中风的患者记录了mRS。平均年龄为66.6岁，男性为58.5％。到2015年底，有54位（2.39％）的跌幅较低，而有93位（4.12％）死亡。在对潜在的混杂因素进行调整之后，mRS与倒U型关系相关的跌倒风险相关。与得分为零的患者相比，对于得分为2的患者，子分布风险比（SHR）最高增加到3.42（95％CI：1.21-9.65，p = 0.020）。得分为3的患者为2.45（95％CI：0.85-7.12，p = 0.098），2.86（95％CI：0.95-8.61，p = 0.062）和1.93（95％CI：0.44-8.52，p = 0.38） ，分别为4和5。结论观察到功能状态和跌倒风险之间呈倒U型关系。这与活动性下降（因此跌倒的机会减少）和跌倒的敏感性增加之间的复杂相互作用是一致的。预防跌倒的干预措施可以相应地作为目标。（263个字）。