Abstract
Objective: To test "Stops walking when talking" (SWWT) as a predictor of falls among people with stroke living in the community.
Methods: People with stroke were identified through hospital records. Mobility, ADL (activites of daily living) ability, mental state, mood, and SWWT were assessed in a single session. Participants were followed prospectively for six months, using falls diaries and regular telephone calls.
Results: Sixty three participants (36 men, 27 women; mean (SD) age 68.4 (10.6)) were recruited. Four subjects had a brainstem lesion, 30 had right hemisphere, and 29 left hemisphere infarctions. Mean time since onset of stroke was 20 months (range 2–72). Twenty six subjects stopped walking when a conversation was started and 16 of them fell during the six month follow up period (11 experienced repeated falls). For all fallers (⩾1) the positive predictive value of SWWT was 62% (16/26), the negative predictive value 62% (23/37), specificity 70% (23/33) and sensitivity 53% (16/30). For repeat fallers (⩾2) the positive predictive value of SWWT was 42% (11/26), the negative predictive value 89% (33/37), specificity 69% (33/48) and sensitivity 73% (11/15). Those who stopped walking were significantly more disabled (p<0.001)—that is, they were more dependent in activities of daily living, had worse gross function as well as worse upper and lower limb function, and had depression (p = 0.012).
Conclusions: The specificity of the SWWT test was lower but sensitivity was higher than previously reported. Although the SWWT test was easy to use, its clinical usefulness as a single indicator of fall risk in identifying those community dwelling people with stroke most at risk of falls and in need of therapeutic intervention is questionable.
Full Text
The Full Text of this article is available as a PDF (56.5 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Bloem B. R., Grimbergen Y. A., Cramer M., Valkenburg V. V. "Stops walking when talking" does not predict falls in Parkinson's disease. Ann Neurol. 2000 Aug;48(2):268–268. doi: 10.1002/1531-8249(200008)48:2<268::aid-ana21>3.0.co;2-4. [DOI] [PubMed] [Google Scholar]
- Bowen A., Wenman R., Mickelborough J., Foster J., Hill E., Tallis R. Dual-task effects of talking while walking on velocity and balance following a stroke. Age Ageing. 2001 Jul;30(4):319–323. doi: 10.1093/ageing/30.4.319. [DOI] [PubMed] [Google Scholar]
- Clark R. D., Lord S. R., Webster I. W. Clinical parameters associated with falls in an elderly population. Gerontology. 1993;39(2):117–123. doi: 10.1159/000213521. [DOI] [PubMed] [Google Scholar]
- Forster A., Young J. Incidence and consequences of falls due to stroke: a systematic inquiry. BMJ. 1995 Jul 8;311(6997):83–86. doi: 10.1136/bmj.311.6997.83. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Haggard P., Cockburn J., Cock J., Fordham C., Wade D. Interference between gait and cognitive tasks in a rehabilitating neurological population. J Neurol Neurosurg Psychiatry. 2000 Oct;69(4):479–486. doi: 10.1136/jnnp.69.4.479. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Lamb S. E., Ferrucci L., Volapto S., Fried L. P., Guralnik J. M., Women's Health and Aging Study Risk factors for falling in home-dwelling older women with stroke: the Women's Health and Aging Study. Stroke. 2003 Feb;34(2):494–501. [PubMed] [Google Scholar]
- Lincoln N., Leadbitter D. Assessment of motor function in stroke patients. Physiotherapy. 1979 Feb;65(2):48–51. [PubMed] [Google Scholar]
- Lundin-Olsson L., Nyberg L., Gustafson Y. "Stops walking when talking" as a predictor of falls in elderly people. Lancet. 1997 Mar 1;349(9052):617–617. doi: 10.1016/S0140-6736(97)24009-2. [DOI] [PubMed] [Google Scholar]
- Lundin-Olsson L., Nyberg L., Gustafson Y. The Mobility Interaction Fall chart. Physiother Res Int. 2000;5(3):190–201. doi: 10.1002/pri.198. [DOI] [PubMed] [Google Scholar]
- Mayo N. E., Korner-Bitensky N., Kaizer F. Relationship between response time and falls among stroke patients undergoing physical rehabilitation. Int J Rehabil Res. 1990;13(1):47–55. doi: 10.1097/00004356-199003000-00005. [DOI] [PubMed] [Google Scholar]
- Nyberg L., Gustafson Y. Patient falls in stroke rehabilitation. A challenge to rehabilitation strategies. Stroke. 1995 May;26(5):838–842. doi: 10.1161/01.str.26.5.838. [DOI] [PubMed] [Google Scholar]
- Nyberg L., Gustafson Y. Using the Downton index to predict those prone to falls in stroke rehabilitation. Stroke. 1996 Oct;27(10):1821–1824. doi: 10.1161/01.str.27.10.1821. [DOI] [PubMed] [Google Scholar]
- Rapport L. J., Webster J. S., Flemming K. L., Lindberg J. W., Godlewski M. C., Brees J. E., Abadee P. S. Predictors of falls among right-hemisphere stroke patients in the rehabilitation setting. Arch Phys Med Rehabil. 1993 Jun;74(6):621–626. doi: 10.1016/0003-9993(93)90160-c. [DOI] [PubMed] [Google Scholar]
- Robertson I. H., Ridgeway V., Greenfield E., Parr A. Motor recovery after stroke depends on intact sustained attention: a 2-year follow-up study. Neuropsychology. 1997 Apr;11(2):290–295. doi: 10.1037//0894-4105.11.2.290. [DOI] [PubMed] [Google Scholar]
- Stack E., Ashburn A. Fall events described by people with Parkinson's disease: implications for clinical interviewing and the research agenda. Physiother Res Int. 1999;4(3):190–200. doi: 10.1002/pri.165. [DOI] [PubMed] [Google Scholar]
- Stapleton T., Ashburn A., Stack E. A pilot study of attention deficits, balance control and falls in the subacute stage following stroke. Clin Rehabil. 2001 Aug;15(4):437–444. doi: 10.1191/026921501678310243. [DOI] [PubMed] [Google Scholar]
- Tinetti M. E., Williams T. F., Mayewski R. Fall risk index for elderly patients based on number of chronic disabilities. Am J Med. 1986 Mar;80(3):429–434. doi: 10.1016/0002-9343(86)90717-5. [DOI] [PubMed] [Google Scholar]
- Zigmond A. S., Snaith R. P. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983 Jun;67(6):361–370. doi: 10.1111/j.1600-0447.1983.tb09716.x. [DOI] [PubMed] [Google Scholar]