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Post-Stroke Cognition as a Fall Predictor During Inpatient Rehabilitation

Campbell, Grace B. (2013) Post-Stroke Cognition as a Fall Predictor During Inpatient Rehabilitation. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Accidental falls are common among persons admitted for inpatient stroke rehabilitation, and they can cause serious physical and psychological consequences. The role of post-stroke cognitive function in the occurrence of falls after stroke is not clear. The purpose of this dissertation was to evaluate the extent to which post-stroke cognition predicts falls during inpatient rehabilitation, and to explore the nature of the relationships among impaired balance, hemineglect, activities of daily living (ADL) performance deficit, executive cognitive dysfunction, and falls during inpatient rehabilitation after stroke.
Data were pooled from five simultaneously occurring studies at five of the UPMC Rehabilitation Institute’s inpatient units. The Chedoke-McMaster Stroke Assessment Postural Control Scale (balance impairment), Line Bisection Test (hemineglect), motor Functional Independence Measure (ADL performance deficit), Repeatable Battery for the Assessment of Neuropsychological Status and Delis-Kaplan Executive Function System (non-executive and executive cognitive function, respectively) were administered to 180 participants shortly after admission to inpatient rehabilitation, and subsequent occurrence of participant falls was recorded.
Using logistic regression and controlling for relevant sociodemographic and clinical covariates, we found no significant predictive relationship between post-stroke cognition and falls, and no significant interaction between post-stroke executive cognitive function and other risk factors for falls (balance impairment, hemineglect, and ADL disability). The most parsimonious predictive model of falls during stroke rehabilitation included educational level in years (p = .01), stroke severity (National Institutes of Health Stroke Scale, p = .04), use of fall prevention interventions during the inpatient rehabilitation stay (p = .01), and ADL disability (p = .04).
Future studies should address limitations of this dissertation, especially the lack of sample representativeness due to possible sampling bias and the need for remediation of large amounts of missing data through imputation. Future investigations are also needed to explore optimal methods for measuring cognitive domains most likely to be associated with falls, particularly when stroke-related communication deficits exist, and to further understand the strong association we found between use of fall prevention interventions and the occurrence of falls. Finally, exploration of mechanisms underlying associations between socioeconomic status and falls during inpatient rehabilitation is warranted.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Campbell, Grace B.gbc3@pitt.eduGBC3
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairMatthews, Judith T.jtmatt@pitt.eduJTMATT
Committee MemberSereika, Susan Mssereika@pitt.eduSSEREIKA
Committee MemberSkidmore, Elizabeth R.skidmore@pitt.eduSKIDMORE
Committee MemberStudenski, Stephanie Asas33@pitt.eduSAS33
Committee MemberWhyte, Ellen M.whyteem@upmc.eduEMW7
Date: 19 April 2013
Date Type: Publication
Defense Date: 22 March 2013
Approval Date: 19 April 2013
Submission Date: 13 April 2013
Access Restriction: 1 year -- Restrict access to University of Pittsburgh for a period of 1 year.
Number of Pages: 168
Institution: University of Pittsburgh
Schools and Programs: School of Nursing > Nursing
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: Stroke, falls, rehabilitation
Date Deposited: 19 Apr 2013 15:29
Last Modified: 19 Dec 2016 14:40


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