Study On The Infulance And The Risk Facters In Chengdu Community Post-Stroke Patients

Objective: To investigate the occurrence of falls in patients with sequelae of stroke in the Chengdu community for more than 6 months,to explore the correlation of falling with the basic situation,disease-related conditions,use of assistive devices,balance,motor function,fear of falling and ability of daily life.To provide reference for the construction of hospital-community-family fall prevention system of stroke patients,to promote the establishment of hospital-based,community-hold,family-focused stroke rehabilitation and old-age care new system in China.Method:Using a cross-sectional survey method.The survey was conducted from June 2017 to June 2018 in a total of 30 community health service centers in Qingyang District,Wuhou District,Jinjiang District,Chenghua District and Jinniu District of Chengdu,with a history of stroke and living in community for more than 6 months.Use the general data questionnaire,the modified fall efficacy scale(MFES),the modified Barthel Index(Bathel Index,MBI),the Berg Balance Scale(BBS),the lower limb Fugel-meyer rating scale(FMA))to investigate and assessment.Using Epidata3.1 to enter data,SPSS 17.0 for statistical analysis,statistical methods including descriptive data using case and percentage analysis,counting data using mean ± standard deviation(`x ±D),The factors related to fall were analyzed by single factor analysis and binary multivariate logistic regression analysis.Result:1.The incidence of falls: 729 cases were included in the survey,459 males accounted for 63.0%,270 female accounted for 37.0%,234 cases fell,the fall rate was 32.1%,and one times falling was 84 cases,accounting for 35.9%;two times falling occurred in 37 cases,accounting for 15.8%;3 times falling occurred in 52 cases,accounting for 22.2%;and occurrences of 4 or more falls were 61 cases,accounting for26.1%;2.Falling place distribution : 75 cases occurred in the toilet,accounted for32.1%,12.8% in the kitchen,26.9% in the living room,and 14.8% in the bedroom,and 102 cases in the outdoor,accounted for 43.6%;3.Fall injury: 132 cases without any injury,accounted for 43.3%,84 cases with different degrees of soft tissue injury,accounted for27.5%,36 cases with brain trauma,accounted for 11.8%,and 53 cases with fractures accounted for 17.4%.4.Influencing factors of falls: Through statistical analysis,the resultsof the analysis indicate that the factors that cause the fall of stroke patients are diverse,and the independent influencing factors of stroke patients and their OR and 95% confidence intervals(95% CI)are sleep disorders 9.723(1.881-50.261),combined with hypertension0.162(0.039-0.672),combined hearing impairment 9.963(25.009-75.445),combined visual impairment 17.788(5.789-54.660),combined with bone and joint disease 7.525(14.877-28.427),residual after stroke Limb dysfunction 0.003(0.000-0.030),residual cognitive dysfunction 10.798(0.919-6.857),residual sensory dysfunction 3.240(4.413-7.165),balance dysfunction 0.962(0.335-2.768),ADL dependence 7.769(2.674-22.574),fear of falling 8.795(4.111-7.568),falling performance score 0.166(0.049-0.555);protective factors for stroke patients with fall and their OR and 95% confidence interval(95% CI)were using crutches 0.040(0.008-0.195),home installation armrest 0.000(0.000-0.007),home installation toilet 0.000(0.000-0.005),accept fall knowledge training0.12 3(0.011-1.318).Conclusion:1.The factors influencing the fall of post-stroke patients are diversified.The main factors are balance dysfunction,motor dysfunction,cognitive dysfunction,daily living ability dependence,fear of falling,sleep disorders,hypertension,visual impairment and combined with bone and joint systems,etc.2.Reasonable assessment and intervention for stroke patients can help reduce falls.Choosing the right crutches,using appropriate assistive devices such as installing appropriate armrests and toilets,and training on falls are protective factors for falls,which can help reduce fall.3.The incidence of falls in community stroke patients is higher than other old people.The recurrent injuries caused by falls such as fractures and brain trauma are more serious than those of the general elderly.It is worthy to concern of medical staff,patients and their families.4.The fall of community post-stroke patients mainly occurs in indoors such as toilets,bedrooms,living rooms,etc.,where there are many obstacles.The probability of patients falling once will fall again in life,and we should prevent the occurrence and recurrence of falls.