Development and validation of a risk assessment model for fear of falling in elderly stroke patients

Table 1 Comparison of baseline characteristics between the training and internal test cohorts, n (%)

Characteristic	Training cohort (n = 197)	Validation cohort (n = 101)	Statistic	P value
Age (years, mean ± SD)	74.67 ± 4.49	74.30 ± 4.24	0.6861	0.494
Sex			0.9732	0.324
Male	119 (60.41)	55 (54.46)
Female	78 (39.59)	46 (45.54)
BMI (kg/m2, mean ± SD)	24.54 ± 3.39	25.32 ± 2.97	1.9431	0.053
Educational level			1.6042	0.448
Primary school and below	20 (10.15)	7 (6.93)
Middle school	117 (59.39)	67 (66.34)
College and above	60 (30.46)	27 (26.73)
Marital status			0.9442	0.624
Married	163 (82.74)	87 (86.14)
Divorced	13 (6.60)	4 (3.96)
Widowed	21 (10.66)	10 (9.90)
Living situation			0.0832	0.774
Live alone	42 (21.32)	23 (22.77)
Live with family	155 (78.68)	78 (77.23)
Stroke type			0.1012	0.750
Ischemic	169 (85.79)	88 (87.13)
Hemorrhagic	28 (14.21)	13 (12.87)
Motor deficit side			1.6802	0.432
Left	46 (23.35)	22 (21.78)
Right	45 (22.84)	30 (29.70)
Bilateral	106 (53.81)	49 (48.51)
Disease duration			0.3412	0.559
< 3	142 (72.08)	76 (75.25)
≥ 3	55 (27.92)	25 (24.75)
Smoking history			0.0032	0.955
Yes	65 (32.99)	33 (32.67)
No	132 (67.01)	68 (67.33)
Drinking history			2.3222	0.128
Yes	57 (28.93)	38 (37.62)
No	140 (71.07)	63 (62.38)
Combined hypertension			0.5782	0.447
Yes	93 (47.21)	43 (42.57)
No	104 (52.79)	58 (57.43)
Combined diabetes			0.1002	0.752
Yes	66 (33.50)	32 (31.68)
No	131 (66.50)	69 (68.32)
Combined hyperlipidemia			0.1182	0.732
Yes	77 (36.84)	37 (41.57)
No	132 (63.16)	52 (58.43)
History of falls in the past 1 year			0.1602	0.689
Yes	61 (29.19)	26 (29.21)
No	148 (70.81)	63 (70.79)
Walking aid			0.0002	0.988
Yes	74 (37.56)	40 (39.60)
No	123 (62.44)	61 (60.40)
Number of medications during hospitalization [n, M (Q25, Q75)]	5.00 (4.00, 6.00)	5.00 (4.00, 7.00)	-1.1863	0.236
Nocturia frequency			1.3192	0.251
> 3	35 (17.77)	13 (12.87)
≤ 3	162 (82.23)	88 (87.13)
FRQ [points, M (Q25, Q75)]	5.00 (4.00, 6.00)	5.00 (4.00, 6.00)	-0.1053	0.916
NIHSS [points, M (Q25, Q75)]	9.00 (8.00, 11.00)	9.00 (7.00, 12.00)	-0.9473	0.344
BI (points, mean ± SD)	65.53 ± 13.07	65.98 ± 10.98	-0.2981	0.766
FTSST (seconds, mean ± SD)	17.93 ± 3.36	18.51 ± 3.77	-1.3551	0.177
TUGT (seconds, mean ± SD)	18.79 ± 3.83	19.23 ± 3.73	-0.9491	0.343
FSBT [levels, M (Q25, Q75)]	3.00 (2.00, 3.00)	3.00 (2.00, 3.00)	-0.0313	0.975

¹Independent samples t-test.

²χ² test.

³Mann-Whitney U test.

BMI: Body mass index; FRQ: Fall risk questionnaire; NIHSS: National Institute of Health Stroke Scale; BI: Barthel Index; FTSST: Five-Times Sit-to-Stand Test; TUGT: Timed Up & Go Test; FSBT: Four-Stage Balance Test.

Table 2 Univariate analysis of factors associated with high fear of falling in elderly stroke patients, n (%)

Characteristic	High FOF group (n = 124)	Low FOF group (n = 73)	Statistic	P value
Age (years, mean ± SD)	75.25 ± 4.37	73.68 ± 4.54	2.3971	0.017
Sex			2.3632	0.124
Male	80 (64.52)	39 (53.42)
Female	44 (35.48)	34 (46.58)
BMI (kg/m2, mean ± SD)	24.68 ± 3.53	24.31 ± 3.14	0.7491	0.455
Educational level			3.0732	0.215
Primary school and below	15 (12.10)	5 (6.85)
Middle school	76 (61.29)	41 (56.16)
College and above	33 (26.61)	27 (36.99)
Marital status			3.6962	0.158
Married	98 (79.03)	65 (89.04)
Divorced	9 (7.26)	4 (5.48)
Widowed	17 (13.71)	4 (5.48)
Living situation			0.8532	0.356
Live alone	29 (23.39)	13 (17.81)
Live with family	95 (76.61)	60 (82.19)
Stroke type			1.0072	0.316
Ischemic	104 (83.87)	65 (89.04)
Hemorrhagic	20 (16.13)	8 (10.96)
Motor deficit side			3.0722	0.215
Left	24 (19.35)	22 (30.14)
Right	29 (23.39)	16 (21.92)
Bilateral	71 (57.26)	35 (47.95)
Disease duration			2.0752	0.150
< 3	85 (68.55)	57 (78.08)
≥ 3	39 (31.45)	16 (21.92)
Smoking history			1.6442	0.200
Yes	45 (36.29)	20 (27.40)
No	79 (63.71)	53 (72.60)
Drinking history			1.3012	0.310
Yes	39 (31.45)	18 (24.66)
No	85 (68.55)	55 (75.34)
Combined hypertension			2.6052	0.107
Yes	64 (51.61)	29 (39.73)
No	60 (48.39)	44 (60.27)
Combined diabetes			5.4322	0.020
Yes	49 (39.52)	17 (23.29)
No	75 (60.48)	56 (76.71)
Combined hyperlipidemia			2.7272	0.099
Yes	52 (41.94)	22 (30.14)
No	72 (58.06)	51 (69.86)
History of falls in the past 1 year			10.0912	0.001
Yes	47 (37.90)	12 (16.44)
No	77 (62.10)	61 (83.56)
Walking aid			10.7052	0.001
Yes	56 (45.16)	16 (21.92)
No	68 (54.84)	57 (78.08)
Number of medications during hospitalization [n, M (Q25, Q75)]	5.00 (4.00, 7.00)	5.0 (4.00, 6.00)	-1.7643	0.078
Nocturia frequency			2.3472	0.126
> 3	26 (20.97)	9 (12.33)
≤ 3	98 (79.03)	64 (87.67)
FRQ [points, M (Q25, Q75)]	5.00 (4.00, 6.00)	4.0 (3.00, 5.00)	-3.6653	< 0.001
NIHSS [points, M (Q25, Q75)]	10.00 (8.00, 12.00)	9.0 (8.00, 10.00)	-4.0193	< 0.001
BI (points, mean ± SD)	62.98 ± 11.56	69.86 ± 14.35	-3.4871	< 0.001
FTSST (seconds, mean ± SD)	18.39 ± 3.48	17.14 ± 3.02	2.5671	0.011
TUGT (seconds, mean ± SD)	19.17 ± 3.96	18.16 ± 3.54	1.7891	0.075
FSBT [levels, M (Q25, Q75)]	2.00 (2.00, 3.00)	3.0 (2.00, 4.00)	-3.8983	< 0.001

¹Independent samples t-test.

²χ² test.

³Mann-Whitney U test.

BMI: Body mass index; FRQ: Fall risk questionnaire; NIHSS: National Institute of Health Stroke Scale; BI: Barthel Index; FTSST: Five-Times Sit-to-Stand Test; TUGT: Timed Up & Go Test; FSBT: Four-Stage Balance Test.

Table 3 Multivariable logistic regression analysis of factors associated with high fear of falling in elderly stroke patients

Characteristic	β	SE	Wald χ2	P value	OR	95%CI
History of falls in the past 1 year	1.817	0.508	12.802	< 0.001	6.156	2.275-16.659
Walking aid	1.679	0.455	13.621	< 0.001	5.361	2.198-13.076
FRQ	0.303	0.131	5.304	0.021	1.353	1.046-1.751
NIHSS score	0.392	0.101	14.985	< 0.001	1.480	1.214-1.805
BI	-0.049	0.016	9.134	0.003	0.953	0.923-0.983
FTSST	0.190	0.067	8.124	0.004	1.210	1.061-1.379
FSBT	-0.857	0.211	16.451	< 0.001	0.424	0.280-0.642

For categorical variables, the reference categories were no history of falls (fall history = 0) and no use of walking aid (walker = 0). OR: Odds ratio; CI: Confidence interval; FRQ: Fall risk questionnaire; NIHSS: National Institute of Health Stroke Scale; BI: Barthel Index; FTSST: Five-Times Sit-to-Stand Test; FSBT: Four-Stage Balance Test.

Table 4 Receiver operating characteristic analysis results for risk factors of fear of falling in elderly stroke patients

Characteristic	AUC	Sensitivity	Specificity	Youden index	Cut-off value	95%CI
History of falls in the past 1 year	0.607	0.836	0.379	0.215	0.500	0.547-0.668
Walking aid	0.616	0.781	0.452	0.232	0.500	0.551-0.681
FRQ	0.654	0.534	0.686	0.220	4.500	0.575-0.734
NIHSS	0.670	0.959	0.363	0.322	11.500	0.597-0.743
BI	0.646	0.452	0.807	0.259	73.500	0.563-0.729
FTSST	0.604	0.562	0.637	0.199	17.550	0.523-0.684
FSBT	0.660	0.740	0.548	0.288	2.500	0.583-0.736
Total	0.880	0.849	0.750	0.599	0.678	0.834-0.927

FRQ: Fall risk questionnaire; AUC: Area under the curve; CI: Confidence interval; NIHSS: National Institute of Health Stroke Scale; BI: Barthel Index; FTSST: Five-Times Sit-to-Stand Test; FSBT: Four-Stage Balance Test.