Possibilities of stability evaluation in clinical practice in patients at risk of falls Falls are a serious global public
Authors:
I. Fiedorová 1,2; E. Mrázková 1
Authors‘ workplace:
Ostravská univerzita, Lékařská fakulta, Ústav epidemiologie a ochrany veřejného zdraví, Přednosta: doc. MUDr. Rastislav Maďar PhD., MBA, FRCPS
1; Fakultní nemocnice Ostrava, Klinika léčebné rehabilitace, Přednostka: MUDr. Irina Chmelová, PhD., MBA
2
Published in:
Prakt. Lék. 2020; 100(5): 225-232
Category:
Of different specialties
Overview
Falls are a serious global public health problem with significant socio-economic implications. Stability disorders resulting from disease or aging lead to an increased risk of falls. Risk factors increasing the incidence of falls include age over 65 and chronic illness. Fall monitoring, evidence, diagnosis, prevention and intervention should always be part of a comprehensive preventive and therapeutic approach, not only in hospitals but also in community facilities and other public places. A considerable lack of screening and standardization procedures can still be observed with most general practitioners. Accurate objectification of the risk of falling will make it possible to promptly start with preventive measures, monitoring the development of stability disorders over time, establishing the prognosis, evaluating intervention efficiency both in individuals and in groups, also for recording purposes. This article comes with an overview of the options available for stability evaluation in patients at risk of falling in clinical practice. Given the multi-factorial causes of stability disorders, it is a problem to find one single way to address all aspects of postural control and thus evaluate to what extent exactly the patient is threatened by falling. For this reason, it is optimal to use a combination of instrumental examination (posturography – a somato-sensory organization test), clinical testing (BEST test, Berg’s Balance Scale) and also a subjective stability assessment questionnaire regarding daily life activities (Falls Efficacy Scale International). Testing and examining stability is the responsibility of physicians, physiotherapists and occupational therapists; other related assessment can only detect the presence of risk factors associated with patient falls. Particular attention should be paid to the phenomenon of “fear of falls”, an often overlooked yet significant risk factor, especially in seniors
Keywords:
fall prediction – stability evaluation – fall risk factors – functional stability tests – posturography – fear of falls
Sources
1. Batchelor FA, Mackintosh SF, Said CM, Hill KD. Falls after stroke. Int J Stroke 2012; 7(6): 482–490.
2. Bloem BR, Marinus J, Almeida Q, et al. Measurement instruments to assess posture, gait, and balance in Parkinson’s disease: critique and recommendations. Mov Disord 2016; 31(9): 1342–1355.
3. Cleary KK, Skornyakov E. Reliability and internal consistency of the Activities-Specific Balance Confidence Scale. Phys Occup Ther Geriatr 2014; 32(1): 58–67.
4. Česká asociace sester. Sledování pádů u hospitalizovaných pacientů v roce 2015 [online]. Dostupné z: https://www.cnna.cz/docs/tiskoviny/zaverecna_zprava_pady_2015.pdf [cit. 2020-05-23].
5. De Oliveira DS, Gomes L, Vieira, et al. Identification of risk factors for falls in people with multiple sclerosis: a systematic review of prospective studies. Fisioter Pesqui 2019; 26(4): 439–449.
6. Fasano A, Canning CG, Hausdorff JM, et al. Falls in Parkinson’s disease: A complex and evolving picture. Mov Disord 2017; 32(11): 1524–1536.
7. Horak FB. Posturalorientation and equilibrium: what do we need to know about neural control of balance to prevent falls? Age ageing 2006; 35(Suppl 2): ii7–ii11.
8. Horak FB, Wrisley DM, Frank J. The Balance Evaluation Systems Test (BESTest) to differentiate balance deficits. Phys Ther 2009; 89(5): 484–498.
9. Jácome C, Cruz J, Oliveira A, Marques A. Validity, reliability, and ability to identify fall status of the Berg Balance Scale, BESTest, Mini-BESTest, and Brief-BESTest in patients with COPD. Physical Therapy 2016; 96(11): 1807–1815.
10. Joint Commission Resources. Prevence pádů ve zdravotnickém zařízení. Praha: Grada Publishing 2007.
11. Jurásková D. Pády a zranění pacientů v souvislosti s poskytováním zdravotní a sociální péče. Ošetřovatelství 2008; 10(3–4): 58–75.
12. Kalvach Z, a kol. Geriatrie a gerontologie. Praha: Grada Publishing 2004.
13. Khan S, Hadian MR, Olyaei G, et al. Comparing Falls Efficacy Scale-International and Berg Balance Scale in predicting recurrent risk of fall in stroke patients. JMR 2017; 11(2): 103–108.
14. Kolář P, a kol. Rehabilitace v klinické praxi. Praha: Galén 2009.
15. Krivošíková M. Úvod do ergoterapie. Praha: Grada Publishing 2011.
16. Leddy AL, Crowner BE, Earhart EGM. Functional gait assessment and balance evaluation system test: reliability, validity, sensitivity, and specificity for identifying individuals with parkinson disease who fall. Phys Ther 2011; 91(1): 102–113.
17. Lee C, Sun T. Evaluation of postural stability based on a force plate and inertial sensor during static balance measurements. J Physiol Anthropol 2018; 37(1): 27.
18. Lima CA, Ricci NA, Nogueira EC, Perracini MR. The Berg Balance Scale as a clinical screening tool to predict fall risk in older adults: a systematic review. Physiotherapy 2018; 104(4): 383–394.
19. Mancini M, Horak FB. The relevance of clinical balance assessment tools to differentiate balance deficits. Eur J Phys Rehabil Med 2010; 46(2): 239–248.
20. Národní portál pro Systém hlášení nežádoucích událostí. Pády [online]. Dostupné z: https://shnu.uzis.cz/cs/metodicke-materialy/pady/ [cit. 2020-05-23].
21. Ministerstvo zdravotnictví České republiky. Resortní bezpečnostní cíle [online]. Dostupné z: https://www.mzcr.cz/KvalitaABezpeci/obsah/resortni-bezpecnostni-cile-_2922_29.html [cit. 2020-05-23].
22. Phelan EA, Mahoney JE, Voit JC, Stevens JA. Assessment and management of fall risk in primary care settings. Med Clin North Am 2015; 99(2): 281–293.
23. Reguli Z, Svobodová L. Česká verze diagnostiky strachu z pádů u seniorů – FES-I (Falls Efficacy Scale International). Studia sportiva 2011; 5(2): 5–12.
24. Růžičková V, Zeleníková R. Strach z pádu u seniorů ve zdravotnických a sociálních zařízeních. Osetrovatel’stvo 2017; 7(1): 6–11.
25. Shumway-Cook A, Woollacott, HM. Motor control. 4th ed. Philadelphia: Lippincott Williams & Wilkins 2010.
26. van De Wyngaerde, Kelly M, Lee M, et al. The component structure of the dizziness handicap inventory (DHI): a reappraisal. Otology 2019; 40(9): 1217–1223.
27. Ministerstvo zdravotnictví ČR. Vyhláška č. 55/2011 Sb. Vyhláška o činnostech zdravotnických pracovníků a jiných odborných pracovníků [online]. Dostupné z: https://www.zakonyprolidi.cz/cs/2011-55 [cit. 2020-05-23].
28. Weerdesteyn V, De Niet M, Hanneke JR, et al. Falls in individuals with stroke. J Rehabil Res Dev 2008; 45(8): 1195–1213.
29. Zhao Y, Heejung K. Older adult inpatient falls in acute care hospitals intrinsic, extrinsic, and environmental factors. J Gerontol Nurs 2015; 41(7): 29–43.
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