Background: Falling and fall-related injuries are common among community-dwelling individuals with chronic stroke. Falls often occur during dual-task walking scenarios. Accurate fall prediction is critical for formulating effective fall prevention strategies.
Research questions: Can dual-task walking tests and corresponding single-task tests predict falls among individuals with chronic stroke? Are dual-task walking tests involving visuospatial cognition more effective in predicting falls than those involving other cognitive domains?
Methods: Ninety-three individuals with stroke (age: 62.4 ± 6.7 years; stroke duration: 5.6 ± 4.5 years) participated in this prospective cohort study. Two mobility tasks (level-ground walking and obstacle-crossing) were performed with and without two cognitive tasks (auditory clock test and auditory Stroop test). Demographic information and clinical measures of depression, motor function, walking speed and balance were collected. Monthly telephone interviews were conducted to collect data on fall incidence, related circumstances and injuries incurred during a 12-month follow-up period. Multivariate logistic regression analysis was performed to identify predictive factors associated with future risk of falls.
Results: Thirty-six participants (39%) reported one or more falls during the follow-up period. The regression model including reaction time during the auditory clock task performance while negotiating obstacles correctly classified the fall status of 80% of the participants (72% future fallers and 84% non-fallers). Performance did not differ between fallers and non-fallers on any other measures tested.
Significance: Dual-task assessment combining an auditory clock task with an obstacle-crossing task has potential clinical utility for identifying future fall risk among people with chronic stroke.
Keywords: Cognitive-motor; Dual-task; Fall; Interference; Stroke; Walking.
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