Objective To explore the threshold of 4 m-walking speed for predicting falls in patients with stroke and to evaluate its clinical significance. Methods A total of 1 079 cases of stroke patients in Neurology Surgery Department and Neurology Medicine Department of the Second Affiliated Hospital of Wenzhou Medical University from July 2015 to May 2017 were selected as the research subjects by convenience sampling method. Data of physical examination, body composition measurement, blood biochemistry, muscle strength and 4 m-walking speed were collected by questionnaire. According to the results of 4 m-walking speed test, the receiver operating characteristic curve (ROC) of subjects was drawn to determine the critical value of 4 m-walking speed for stroke patients, and the predictive value of the critical value of 4 m-walking speed for the risk of falling was analyzed by logistic regression. Results The incidence of falls was 37.5% in stroke patients. The 4 m-walking speed for male and female with stroke was (0.75±0.02) m/s and (0.82±0.06) m/s respectively. ROC curve showed that, in male patients, the critical value of 4 m-walking speed was 0.84 m/s, the area under curve (AUC) was 0.71 (0.65, 0.75), the sensitivity was 87.5%, and the specificity was 65.9%. In female, the critical value of 4 m-walking speed was 0.79 m/s, the AUC was 0.68 (0.62, 0.73), the sensitivity was 75.3%, and the specificity was 78.6%. Logistic regression analysis showed that after adjusting for age, BMI, smoking, alcohol consumption, exercise and disease history, compared with the elderly population below 4 m-walking speed threshold, the OR values of falls in male and female stroke patients above the 4 m-walking speed threshold were 2.97 (1.94, 4.56) and 2.25 (1.40, 3.60) respectively. Conclusions The incidence of fall is high in stroke patients. The threshold of 4 m-walking speed to predict the fall risk of male and female patients with stroke was 0.84 m/s and 0.79 m/s respectively. The determination of the threshold of 4 m-walking speed can provide reference for the prevention of falls in stroke patients and is worthy of clinical popularization and application.%目的 探讨预测脑卒中患者跌倒的4 m-步行速度测试临界值,并评价其临床意义.方法 采用便利抽样法选取2015年7月—2017年5月在温州医科大学附属第二医院神经外科和神经内科住院的1 079例脑卒中患者为研究对象.采用调查量表收集患者体格检查、体成分测量、血生化、肌力、4 m-步行速度等相关资料.根据4 m-步行速度测试结果绘制受试者工作特征曲线(ROC),确定脑卒中患者4 m-步行速度临界值,并使用Logistic回归分析该4 m-步行速度临界值对跌倒发生风险的预测价值.结果 脑卒中患者跌倒发生率为37.5% .男性脑卒中和女性脑卒中患者4 m-步行速度分别为(0.75±0.02) m/s和(0.82±0.06) m/s.ROC结果显示,男性脑卒中患者用于预测跌倒发生的4 m-步行速度临界值为0.84 m/s,曲线下面积(AUC)为0.71(0.65,0.75),敏感度为87.5%,特异度为65.9%;女性脑卒中患者用于预测跌倒发生的4 m-步行速度临界值为0.79 m/s,AUC为0.68(0.62,0.73),敏感度为75.3%,特异度为78.6%.Logistic回归分析显示,在调整年龄、BMI、吸烟、饮酒、运动锻炼、疾病史混杂因素后,与低于4 m-步行速度临界值的老年人群相比,高于4 m-步行速度临界值的男性和女性脑卒中患者跌倒的发生风险OR值分别为2.97(1.94,4.56)和2.25(1.40,3.60).结论 脑卒中患者跌倒的发生率较高;预测男性和女性脑卒中患者跌倒风险4 m-步行速度临界值分别为0.84 m/s和0.79 m/s,4 m-步行速度临界值确定可为脑卒中患者跌倒预防提供借鉴意义,值得临床推广应用.
展开▼
