Discrepancies in perception of fall risk between patients with subacute stroke and physical therapists in a rehabilitation hospital: a retrospective cohort study.

Objective: Falls are one of the most common complications of a stroke. This study aimed to clarify the discrepancy between the perceived fall risk of hospitalized patients with stroke and the clinical judgment of physical therapists and to examine the changes in discrepancy during hospitalization. Design: Retrospective cohort study. Patients: This study included 426 patients with stroke admitted to a Japanese convalescent rehabilitation hospital between January 2019 and December 2020. Methods: The Falls Efficacy Scale-International was used to assess both patients' and physical therapists' perception of fall risk. The difference in Falls Efficacy Scale-International scores assessed by patients and physical therapists was defined as the discrepancy in fall risk, and its association with the incidence of falls during hospitalization was investigated. Results: Patients had a lower perception of fall risk than physical therapists at admission (p < 0.001), and this trend continued at discharge (p < 0.001). The discrepancy in fall risk perception was reduced at discharge for non-fallers and single fallers (p < 0.001), whereas the difference remained in multiple fallers. Conclusion: Unlike physical therapists, patients underestimated their fall risk, especially patients who experienced multiple falls. These results may be useful for planning measures to prevent falls during hospitalization.

Effects of Balance Exercise Assist Robot training for patients with hemiparetic stroke: a randomized controlled trial.

BACKGROUND: Robot-assisted rehabilitation for patients with stroke is promising. However, it is unclear whether additional balance training using a balance-focused robot combined with conventional rehabilitation programs supplements the balance function in patients with stroke. The purpose of this study was to compare the effects of Balance Exercise Assist Robot (BEAR) training combined with conventional inpatient rehabilitation training to those of conventional inpatient rehabilitation only in patients with hemiparetic stroke. We also aimed to determine whether BEAR training was superior to intensive balance training. METHODS: This assessor-blinded randomized controlled trial included 60 patients with first-ever hemiparetic stroke, admitted to rehabilitation wards between December 2016 and February 2019. Patients were randomly assigned to one of three groups, robotic balance training and conventional inpatient rehabilitation (BEAR group), intensive balance training and conventional inpatient rehabilitation (IBT group), or conventional inpatient rehabilitation-only (CR group). The intervention duration was 2 weeks, with assessments conducted pre- and post-intervention, and at 2 weeks follow-up. The primary outcome measure was a change in the Mini-Balance Evaluation Systems Test (Mini-BESTest) score from baseline. RESULTS: In total, 57 patients completed the intervention, and 48 patients were evaluated at the follow-up. Significant improvements in Mini-BESTest score were observed in the BEAR and IBT groups compared with in the CR group post-intervention and after the 2-week follow-up period (P < 0.05). CONCLUSIONS: The addition of balance exercises using the BEAR alongside conventional inpatient rehabilitation improved balance in patients with subacute stroke. TRIAL REGISTRATION: https://www.umin.ac.jp/ctr ; Unique Identifier: UMIN000025129. Registered on 2 December 2016.

Validity of gait asymmetry estimation by using an accelerometer in individuals with hemiparetic stroke.

[Purpose] The purpose of this study was to evaluate the validity of estimating step time and length asymmetries, using an accelerometer against force plate measurements in individuals with hemiparetic stroke. [Subjects and Methods] Twenty-four individuals who previously had experienced a stroke were asked to walk without using a cane or manual assistance on a 16-m walkway. Step time and length were measured using force plates, which is the gold standard for assessing gait asymmetry. In addition to ground reaction forces, trunk acceleration was simultaneously measured using an accelerometer. To estimate step time asymmetry using accelerometer data, the time intervals between forward acceleration peaks for each leg were calculated. To estimate step length asymmetry using accelerometer data, the integration of the positive vertical accelerations following initial contact of each leg was calculated. Asymmetry was considered the affected side value divided by the unaffected side value. [Results] Significant correlations were found between the accelerometer and the force plates for step time and length asymmetries (rho=0.83 and rho=0.64, respectively). [Conclusion] An accelerometer might be useful for assessing step time and length asymmetries in individuals with hemiparetic stroke, although improvements are needed for estimating the accuracy of step length asymmetry.