Establishment And Verification Of Fall Risk Prediction Model With Dynamic Nomogram For Stroke Patients Of Rehabilitation Period

Objective1.To construct a fall risk assessment index system for stroke patients during the rehabilitation period and form a fall risk factor questionnaire by studying and analyzing the risk factors of falls in stroke patients during the rehabilitation period.2.To construct a fall risk prediction model for stroke patients during rehabilitation,so as to provide a basis for safety management of stroke patients.Methods1.Through systematic review of the literature,focus group discussion and Delphi expert consultation,a fall risk assessment index system for stroke patients during rehabilitation was constructed,on the basis of which the first draft of the fall risk questionnaire was prepared,and the questionnaire was perfected by pre-survey to finally form the fall risk questionnaire for stroke patients during rehabilitation.2.Using the observational study and convenient sampling method,a total of 488 stroke patients during rehabilitation period who were admitted to a Grade 3A hospital in Haikou from March 2022 to September 2022 were selected as the research objects.They filled in the fall risk questionnaire and completed related functional tests.Taking the investigation as the starting point,the patients were followed up by telephone two months later for the incidence of fall outcomes.SPSS 25.0 software was used for univariate and multivariate analysis of the collected data to screen out independent risk factors,and then R Studio software was used to draw a nomogram and establish a dynamic nomogram model.The Bootstrap method was used to repeat1000 times,the area under the ROC curve(AUC)was used to evaluate the discrimination,calibration of the model was evaluated by calibration curve and Hosmer-Lemeshow goodness-of-fit test.Decision curve analysis(DCA)was used to evaluate the clinical usefulness of the model.Results1.The constructed fall risk assessment index system for stroke patients during the rehabilitation period mainly included six primary indicators such as basic information of patients,medication categories,mobility and limb function,psychological and cognitive,disease-related factors and environment-related factors,and 31 secondary indicators under them.The positive coefficients of experts in the two rounds of consultation were 0.87 and 1.00 respectively,the mean authority coefficient of experts was 0.91,and the Kendall’s W coefficients of primary and secondary indicators in the second round of consultation were 0.203 and 0.344,respectively.2.A total of 469 valid questionnaires were collected.Among 469 patients with stroke during rehabilitation period,115 patients had falls,with an incidence of 24.4%,and the total number of fall events was 163.The results of the multifactorial regression analysis showed that the risk of falls was higher in the other three age groups relative to age <60 years: age 60 to 69 years(OR=2.049,P=0.034),age 70 to79 years(OR=2.795,P=0.002)and age ≥80 years(OR=3.650,P=0.004);a history of falls within the last 3 months(OR=3.282,P<0.001);higher risk of falls in anxiety-positive patients compared to anxiety-negative patients(OR=2.908,P=0.018);higher risk of falls in patients with BBS score<40(OR=3.596,P<0.001).In conclusion,age,history of falls within the last 3 months,anxiety,and BBS score were independent risk factors for falls in patients recovering from stroke.The R Studio software was used to establish a dynamic nomogram model for fall risk of stroke patients during rehabilitation,and the ROC curve was drawn to evaluate the discrimination of the model,The AUC of the model was 0.756(95%CI:0.715-0.795),the sensitivity was 66.09%,the specificity was 73.16%,P<0.001.Using the Bootstrap method,the AUC was 0.761(95% CI: 0.760-0.763),the calibration curve basically matched the diagonal dashed line with a slope equal to 1,the Hosmer-Lemeshow fit test showed that X~2=2.040,P=0.958.The decision curve analysis showed that the net benefit of the DCA curve was higher than that of the two extreme curves,suggesting better model differentiation,calibration and clinical usefulness.Conclusions1.The fall risk assessment index system for stroke patients during rehabilitation period constructed in this study provides a reference for comprehensively assessing the fall risk of stroke patients during rehabilitation period and preventing falls.2.The independent risk factors for falls in stroke patients during rehabilitation period were age,history of falls within the last 3 months,anxiety,Berg Balance Scale score <40.3.This study constructs a dynamic nomogram prediction model for stroke patients during the rehabilitation period,which has good discrimination,calibration and clinical practical value.As a simple and practical prediction tool,it can help medical staff to quickly identify high-risk fall patients in the early rehabilitation period of stroke patients,so as to prevent the occurrence of fall events.