A Follow-up Study: Fear Of Falling Among Patients With First Ever Cerebral Infarction And Its Related Factors

ObjectiveTo introduce the Chinese version of Short Falls Efficacy Scale International and test its reliability and validity in patients with cerebral infarction;to investigate and do longitudinal comparison of the stroke patients' fear of falling in acute and recovery phase(the course of disease was six months) and analyze its main related factors; to explore the factors which can be controlled by the nurses and prevent the falls caused by psychological factors, promote the functional recovery of patients, eventually improve the quality of patients. MethodsThe study was a prospective investigation. A sample of 105 inpatients with cerebral infarction were recruited from two tertiary hospitals in Tianjin, according to the inclusion and exclusion criteria by convenience sampling method. The investigation was carried out at two time points: acute period(before discharge) and recovery phase(the course of disease was six months).By contacting with the Prevention of Falls Network Europe to get the English version and the traditional Chinese version of the short FES-I scale, the simplified Chinese version was developed after a further revision. We used the simplified Chinese version short FES-I scale, Modified Falls Efficacy Scale(MFES),Generalized Anxiety Disorder-7(GAD-7), Patient Health Questionnaire-9(PHQ-9), Bathel Index rating scale(BI),Functional Ambulation Category scale(FAC), Modified Rankin Scale(MRS)and Social Support Scale(SSS) to investigated the participations' fear of falling, falls efficacy, mental status, ability of daily living, walking ability, disease outcome and social support. Data were entered and analyzed using statistical software SPSS16.0. Result 1 The Chinese version of Short Falls Efficacy Scale International reliability and validity analysisThere were significant correlation between the score of each item and total scores of the scale, and the scale had good discrimination. The criterion validity was-0.41. The correlation coefficient was 0.52 with GAD-7 score, 0.46 with PHQ-9 score.And the Cronbach's ? coefficient of the short FES-I scale was 0.98. 2 The fear of falling of the cerebral infarction patients in the acute period and recovery phaseAt the acute period,the score of the short FES-I scale of the patients with cerebral infarction was 15.38±7.43, the highest average score of the items was“ Going out to a social event”,the lowest was“ Getting dressed/undressed”; At the recovery phase(the course of disease was six months), the score of the short FES-I scale of the patients with cerebral infarction was 13.88±7.36, the highest average score of the items was “Going out to a social event”,the lowest was“ Getting in or out of a chair”. Items showing statistically significant decrease at recovery period compared to acute period were “Getting dressed/undressed”, “Taking a bath or shower”, “Getting in or out of a chair”(p<0.05). 3 The influencing factors of FOF in patients with cerebral infarction during the acute periodAt the acute period, multiple stepwise regression analysis showed that age,marital status, fall history,Walking ability,disease outcome and Anxiety were important factors of FOF, which explained 81.4% variance of the fear of falling. 4 The influencing factors of FOF in patients with cerebral infarction during the recovery phaseAt the recovery phase(the course of disease was six months),multiple stepwise regression analysis showed that age, caregiver type, fall history, disease outcome, Walking ability and depression were important factors of FOF, which explained 77.1% variance of the fear of falling. 5 Predictors of falls in recovery period in patients with first-ever cerebral infarctionLogistic regression analysis showed that caregiver type and fear of falling were the independent predictors of falls in patients with cerebral infarction during recovery period. Conclusion 1 The short FES-I scale is highly reliable and valid, and is a more direct and simple clinical assessment tool which can be applied to the screening of fear of falling among patients with cerebral infarction. 2 FOF is common phenomenon among patients with cerebral infarction. The average score of “Going out to a social event” was the highest all the time, which indicated that clinical staff, family members of the patients should be concern with the patients' social participation requirements and safety, encourage and help them overcome difficulties, to improve their quality of life. 3 At the acute period and recovery phase, the common influential factors of FOF were: age, fall history, Walking ability, disease outcome. This indicate that clinical staff should guide the patients with first cerebral infarction especially who had a history of falling to take active and effective measures to deal with their FOF, and pay more attention on patient who was elderly, assisted walking and anxiety,poor outcome, to release their FOF, prevent the falling and promote the functional recovery of patients. 4 Anxiety and marital status were other influential factor of FOF in the acute period. So we should not neglect the psychological state of patients. Caregiver type and depression were other influential factors of FOF in recovery phase. This also suggests that the role of the family in the recovery of patients with cerebral infarction is essential, health care workers, patients and families should work together, eventually promote physical and mental health together of individuals. 5 Caregiver type and fear of falling were the independent predictors of falls in patients with cerebral infarction during recovery period.