Comparative Predictive Validity of Fall-Risk Screening Assessments in Subacute Stroke.

Approximately one-third of ambulatory stroke survivors discharged home from inpatient rehabilitation experienced a fall within 3 months.

• 64 ambulatory stroke survivors discharging home from inpatient rehabilitation completed all tests before discharge.
• 20 participants (31.3%) were classified as fallers at 3 months.
• Falls were tracked prospectively for 3 months post-discharge.

The novel step test + obstacle test (STOB) had the best overall model fit among the four fall-risk screening assessments evaluated.

• STOB had an odds ratio of 8.0 (95% CI 2.4–26.8) for predicting faller status.
• The STOB cutoff used was ≥3.
• Despite best model fit, no single test demonstrated strong discriminative power for predicting future falls.

The Functional Gait Assessment (FGA) with a cutoff of ≤13 had the highest sensitivity among all individual tests.

• FGA ≤13 achieved a sensitivity of 0.85 for classifying faller status.
• This cutoff was identified using existing and optimized cutoff analyses.
• Logistic regression was used to estimate the odds of being a faller with a failed test.

A gait speed cutoff of ≤0.47 m/s on the 10-m gait speed test had the highest specificity among all individual tests.

• 10-m gait speed ≤0.47 m/s achieved a specificity of 0.89 for classifying faller status.
• Sensitivity, specificity, likelihood ratios, area under the curve, accuracy, and posttest probabilities were all calculated for each test.
• Both existing and optimized cutoffs were evaluated.

A combination of four positive tests generated a cumulative diagnostic posttest probability of future falls of 94.5%.

• The combination included positive tests for 10-m gait speed (≤0.47 m/s), STOB (≥3), FGA (≤13), and BBS (≤43).
• The cumulative posttest probability of future falls was 94.5% when all four tests were positive.
• This multi-test combination was identified as potentially enhancing prognostic decision-making accuracy.

The four fall-risk screening tools compared were the Berg Balance Scale (BBS), Functional Gait Assessment (FGA), 10-m gait speed, and a novel step test + obstacle test (STOB).

• All four tests were completed by participants before discharge from inpatient rehabilitation.
• Logistic regression, sensitivity, specificity, likelihood ratios, area under the curve, accuracy, and posttest probabilities were calculated for each test.
• Both existing published cutoffs and optimized cutoffs were used in the analyses.