Study Of Fall Risks And Fall Prediction Model In Adult Patients With Hemophilia

Background:Hemophilia is a rare hereditary hemorrhagic disease,which mainly manifested by spontaneous or post-traumatic bleeding of joints and muscles.In China,the time of diagnosis in patients of hemophilia is later than that of showing symptom,and most patients receive clotting factor injections only when they are bleeding.Thus,the rate of joint deformity is high and there is a risk of falling.Researches in developed countries on the falling of hemophilia patients point out that,hemophilia patients’ incidence of falling is 32.4%-50.0%,which is close to that of the elderly.Such injuries as bruise,hematomas,fractures caused by falling bring them huge burden.Having retrieved the database,the researcher finds that there is still not any researches on fall in adult patients with hemophilia in China,which means that there is a huge blank in the data related to the falling incidence and risk factors of hemophilia patients.Applying fall risk assessment tools can recognize fall risk.Existed falling assessments are mostly based on group specificity which is not suitable for falling risk assessment of adult patients with hemophilia.The research aims at studying the present situation and risk factors of falling incidence of adult hemophilia patients,and building preliminary fall risk prediction model in patients with hemophilia.The research conclusion is expected to provide basic data and clinical references for fall-nursing of hemophilia patients.Objective:(1)Describe the falling situation of adult hemophilia patients.(2)Discover risk factors causing the falling of adult hemophilia patients.(3)Try to build the fall prediction model in adult patients with hemophilia.Methods:The research is a descriptive research.In the way of convenient sampling,163 adult hemophilia patients treated at the hemophilia clinic of Peking Union Medical College Hospital from Sept.2018 to Mar.2019 are selected as research objects.The researcher apply self-designed general information questionnaires,disease information questionnaires,falling history questionnaires,Berg balance scale,Timed-up-and-go test etc.to collect information.The researcher guided patients to fill in these information questionnaires,then completed those forms,scales and assessments.Adopting the Binary Logistic Regression,the researcher builds fall risk prediction model in patients with hemophilia.Results:163 adult hemophilia patients are all males,average age of them is 31(24,39).In the past year,39.3%of them fell down,82.7%of the fell-down injured.The result of single factor analysis shows that the falling incidence of adult patients with hemophilia is affected by disabled lower limb joints(P<0.001),the hip joint is the target joint or not(P<0.001),assistive devices(P=0.002),function independence scores(P<0.001),falling efficacy scores(P<0.001),Berg balance scale scores(P<0.001)and stand up-walk timing experiment time(P<0.001).Binary Logistic Regression analysis is used to build a model for falling risk prediction of adult hemophilia patients.AUC=0.859(95%CI:0.802～0.917),Youden Index=0.601,sensitivity=0.813,specificity=0.788.Conclusion:There is a high falling risk for adult hemophilia patients,and falling injuries are serious,to which medical staffs and patients should pay much attention.Also,interventions based on risk factors should be applied.Adopting Binary Logistic Regression Analysis,the research builds out a risk prediction model which could be used in clinical assessment.