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- Estimated Risk for Falls Among Community-Dwelling Stroke Survivors Referred to Outpatient PhysiotherapyPublication . Pimenta, C; Correia, A; Alves, M; Virella, DTitle: Estimated risk for falls among community-dwelling stroke survivors referred to outpatient physiotherapy Authors: Carla Pimenta1,2, Anabela Correia1,2, Marta Alves3, Daniel Virella3 1. Physiotherapy Department, Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central, Portugal. 2. Department of Rehabilitation Science and Technology, Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, Portugal. 3. Epidemiology and Statistics Office of the Research Unit, Centro Hospitalar Universitário Lisboa Central, Portugal. Background: In the sub-acute phase of stroke, most of the patients with moderate or severe impairments typically attend in-patient rehabilitation. Functional recovery continues after discharge and patients can benefit of outpatient physiotherapy. Homecoming may lead to an increased risk for falls, as the patient is no longer in a protected environment. The physiotherapy assessment should identify the risk of falling, in order to minimize it. Purpose: To estimate the risk for falls among community-dwelling stroke survivors referred to the outpatient physiotherapy in a tertiary care hospital and to explore factors associated with increased risk for falls. Methods: Observational, cross-sectional study with nested case-control study, of individuals referred to the physiotherapy department less than 12 months after stroke and able to walk independently. A referral period of 4 years was considered. Three functional tools were applied: Berg Balance Scale (BBS), Timed Up and Go Test (TUG) and the Motor Assessment Scale (MAS); demographic and clinical data were collected. Risk for falls was defined as BBS≤45 or TUG³14. Independent variables to include in the multivariable logistic regression model were identified by Chi- Square test and Mann-Whitney test. Results: Of 217 individuals referred for ambulatory treatment, 140 fulfilled the inclusion criteria. Patients were 21 to 87 years old (median 66), 80 males, in 109 the stroke occurred in the lasts 6 months, 117 had ischemic stroke and in 29 it was a recurrent stroke. Risk for falls was identified in 117 individuals (83.6% [95%CI 76.6 - 88.8]); 95 cases were identified by both BBS and TUG, 12 only by BBS and 10 by TUG alone. The model for risk for falls included age, gender and MAS shows that for each increase in one year of age, the odds for falls increased 10% (adjusted OR 1.10; 95%CI 1.04 – 1.17; p=0.002), odds for falls was 14 fold higher in females (adjusted OR 14.43; 95%CI 1.89 – 110.12; p=0.010) and for each increase in MAS units, the odds for falls decreased 23% (adjusted OR 0.77; 95%CI 0.66 – 0.88; p<0.001). Conclusions: Estimated risk for falls is very frequent after stroke (75-90%), especially in the elder and in females; it is associated with lower autonomous functionality. Evidence is needed for the adequate physiotherapy interventions to prevent falls after stroke, customized by standardized risk assessment. Implications: The identification of the risk for falls and its causes, such as the balance disorders should be translated into physical therapy practice. Keywords: Fall, stroke, balance disorder, functionality, risk assessment. Funding acknowledgements: No external funding was granted to this study. Brief biography of presenting author: Carla Pimenta (presenting author) is a Physiotherapist with a graduation from the Escola Superior de Tecnologia da Saúde de Lisboa (ESTESL) and a MSc degree in Social and Organizational Intervention in Health from the Universidade de Évora / ESTESL. Presently, works as a physiotherapist, in a multidisciplinary team at the Rehabilitation Department in a tertiary hospital in Lisbon (Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central) and as an invited assistant, teaching at ESTESL. In more than 20 years of hospital practice has already worked in several departments that request physiotherapy interventions, with in and outpatients. Since 2001, is mainly dedicated to the area of neuromuscular therapy, with patients with neurological disorders in sub-acute phase, admitted to the rehabilitation department and follow up immediately after hospital discharge (essentially strokes, traumatic head injuries and neurosurgery patients). Information concerning any presentations or publications of the work made prior to congress: No presentation or publication of this work was done before the congress; however, the authors are writing a manuscript and intend to publish. Pimenta C, Correia A, Alves M, Virella D. (2009) Estimated risk for falls among community-dwelling stroke survivors referred to outpatient physiotherapy (Postrer). Geneve: World Conference for Physical Therapy
- Domiciliary Gaze Stability and Oculomotor Exercises Improves Balance After Stroke. Better Balance, a Randomized Controlled TrialPublication . Correia, A; Pimenta, C; Alves, M; Virella, DAbstract Title: Domiciliary gaze stability and oculomotor exercises improves balance after stroke. BetterBalance, a randomized controlled trial Authors: Anabela Correia1,2, Carla Pimenta1,2, Marta Alves3, Daniel Virella3 1. Physiotherapy Department, Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central, Portugal. 2. Department of Rehabilitation Science and Technology, Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, 3. Epidemiology and Statistics Office of the Research Unit, Centro Hospitalar Universitário Lisboa Central, Portugal. Background: Visual stabilization and the vestibulo-ocular reflex as mechanisms of gaze stability are needed to coordinate the movements of the head, trunk and pelvis during walking. Balance impairment after stroke is strongly associated with more severely impaired motor function, a decrease in recovery potential and an increase of the number of falls. Purpose: To verify the efficacy of a domiciliary training program for balance impairment after stroke in senior patients. Methods: Patients older than 60 years, discharged after stroke to the physiotherapy department, were recruited to a randomized controlled trial for improving orthostatic balance (ClinicalTrials.gov: NCT02280980). Eligible patients had stroke 3-15 months earlier, positive Romberg test and autonomous walk for ³3m. Participants were allocated (block randomization by age, balance and functionality) into the current rehabilitation program (observational group - OG) or into a supplemental intervention focused on a domiciliary program of oculomotor and gaze stability exercises (intervention group - IG) for three weeks. Primary outcome was the incidence of falls; the variation of the estimated risk for falls by Berg Balance Scale (BBS) and Timed Up and Go Test (TUG) were surrogate outcomes: minimum difference of 4 seconds in TUG and 4 points in BBS. Data were analyzed by per protocol. Relative Risk (RR) for the outcome was estimated with 95% confidence interval (95%CI). Multivariable logistic regression was applied to model for the decrease of the risk for falls. Results: From the 217 referred patients, 71 were recruited and completed the protocol 61 patients (OG 32; IG 29), aged 60-87 years old (median OG 73; IG 74), similarly distributed by gender, type of stroke and reported falls before recruitment (OG 21/32; IG 15/29). No falls were registered in the IG and 4 patients fell in the OG. The surrogate outcome occurred in 11/32 OG patients and in 26/29 IG patients (RR 2.61; 95%CI 1.59 - 4.28; p<0.001); all the IG females reached the surrogate outcome. The increase of BBS was larger (p<0.001) in the IG (median difference 7 vs. 2); a weak evidence of difference on TUG was observed (median difference OG=-0.72 sec. and IG=-1.28 sec.; p=0.059). The model for decrease of the estimated risk for falls revealed that the intervention lead to a 21.4 fold increase on the odds (aOR 21.43; 95%CI 4.75 – 96.66; p<0.001) and that females had 4.75 fold higher odds for decrease than males (aOR 4.75; 95%CI 1.11 – 20.25; p=0.035). Conclusions: The trial did not reach power to assess the efficacy of the intervention as actually preventing falls, although evidence was obtained that complementary oculomotor and gaze stability exercises decrease the estimated risk for falls and that this decrease is larger in females. Implications: Domiciliary oculomotor and gaze stability exercises are a promising approach as a complement in the physiotherapy intervention after stroke, whenever balance impairment is present. Given the high incidence of falls in these patients and their social and economic impact, this can be an efficient strategy to improve balance and reduce the risk for falls. Keywords: risk for falls, stroke, clinical trial Funding acknowledgements: No external funding was granted to this study. Brief biography of presenting author: Anabela Correia (presenting author) is a Portuguese Physiotherapist, with a graduation from the Escola Superior de Tecnologia da Saúde de Lisboa (ESTESL) and a MSc degree Physiotherapy from ESTESL. Works as a physiotherapist as part of a multidisciplinary team in a Rehabilitation Department in a central hospital in Lisbon (Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central) for more than 20 years and as an invited assistant, teaching at ESTESL since 2012. The mainly interest and current work is focus in vestibular and balance disorders in patients with vestibular, neurologic pathology and in patients with a high risk of falls. Information concerning any presentations or publications of the work made prior to congress This trial is registered (ClinicalTrials.gov NCT02280980) and the study protocol was published [Pimenta C, Correia A, Alves M, Virella D (2017) Effects of oculomotor and gaze stability exercises on balance after stroke: Clinical trial protocol. Porto Biomedical Journal. 2(3):76–80]. In this presentation will be released the preliminary results.
- O Repositório e o Anuário do Centro Hospitalar de Lisboa Central: Contributos Para a Ciência AbertaPublication . Quininha, A; Barreto, D; Pereira-da-Silva, L; Almeida, SNuma unidade de saúde, a atividade científica tem reconhecidas vantagens para a assistência clínica, investigação e ensino/formação. Têm sido adoptadas diversas estratégias para obter um registo completo da produção científica do CHLC, mas também para permitir o acesso aberto da ciência aos seus colaboradores. Assim, o Centro Hospitalar de Lisboa Central (CHLC) aderiu à rede de Repositórios Científicos de Acesso Aberto de Portugal (RCAAP) em 2011 e tem envidado esforços para registar a investigação desenvolvida na instituição na base nacional oficial, respondendo de forma rigorosa ao Inquérito ao Potencial Científico e Tecnológico Nacional (IPCTN).