Hsuei-Chen Lee

Effects of a Multifactorial Fall Prevention Program on Fall Incidence and Physical Function in Community-Dwelling Older Adults With Risk of Falls

OBJECTIVE To evaluate effects of a multifactorial fall prevention program on fall incidence and physical function in community-dwelling older adults. DESIGN Multicenter randomized controlled trial. SETTING Three medical centers and adjacent community health centers. PARTICIPANTS Community-dwelling older adults (N=616) who have fallen in the previous year or are at risk of falling. INTERVENTIONS After baseline assessment, eligible subjects were randomly allocated into the intervention group (IG) or the control group (CG), stratified by the Physiological Profile Assessment (PPA) fall risk level. The IG received a 3-month multifactorial intervention program including 8 weeks of exercise training, health education, home hazards evaluation/modification, along with medication review and ophthalmology/other specialty consults. The CG received health education brochures, referrals, and recommendations without direct exercise intervention. MAIN OUTCOME MEASURES Primary outcome was fall incidence within 1 year. Secondary outcomes were PPA battery (overall fall risk index, vision, muscular strength, reaction time, balance, and proprioception), Timed Up & Go (TUG) test, Taiwan version of the International Physical Activity Questionnaire, EuroQol-5D, Geriatric Depression Scale (GDS), and the Falls Efficacy Scale-International at 3 months after randomization. RESULTS Participants were 76±7 years old and included low risk 25.6%, moderate risk 25.6%, and marked risk 48.7%. The cumulative 1-year fall incidence was 25.2% in the IG and 27.6% in the CG (hazard ratio=.90; 95% confidence interval, .66-1.23). The IG improved more favorably than the CG on overall PPA fall risk index, reaction time, postural sway with eyes open, TUG test, and GDS, especially for those with marked fall risk. CONCLUSIONS The multifactorial fall prevention program with exercise intervention improved functional performance at 3 months for community-dwelling older adults with risk of falls, but did not reduce falls at 1-year follow-up. Fall incidence might have been decreased simultaneously in both groups by heightened awareness engendered during assessments, education, referrals, and recommendations.

Readmission, mortality, and first-year medical costs after stroke

Background: Stroke is the leading cause of adult disability and mortality in Taiwan, resulting in a tremendous burden on the healthcare system. The purpose of this study was to characterize disease burden by evaluating readmissions, mortality, and medical cost during the first year after acute stroke under the National Health Insurance (NHI) program. Methods: This retrospective cohort study extracted information about patients hospitalized with acute stroke from claims data of 200,000 randomly sampled NHI enrollees in Taiwan, with a 1‐year follow‐up duration. The incidence of the first‐year adverse events (AEs) indicated by readmissions or mortality, and the amount of the first‐year medical cost (FYMC) were assessed with predictive factors explored. Additionally, we also estimated the cost per life and life‐year saved. Results: There were 2368 first‐ever stroke patients in our study, including those with subarachnoid hemorrhage (SAH) 3.3%, intracerebral hemorrhage (ICH) 17.9%, ischemic stroke (IS) 49.8%, and transient ischemic attack/other ill‐defined cerebrovascular diseases (TIA/unspecified) 29.0%; each stroke type was identified with an all‐cause AE of 59.0%, 63.0%, 48.6%, and 46.8%, respectively. Readmissions were mainly because of acute recurrent stroke or the late effects of previous stroke, respiratory disease/infections, heart/circulatory disease, and diseases of the digestive system. Advanced age, hemorrhagic stroke type, respiratory distress/infections, and greater comorbidities were predictive of increased AE risk. Admission to neurology/rehabilitation wards, undertaking neurosurgery, or use of inpatient/outpatient rehabilitation was less likely to incur AEs. Initial hospitalization, readmission, and ambulatory care constituted 44%, 29%, and 27%, respectively, of FYMC with the initial length of stay being the most reliable predictor. The FYMCs were NT

Factors Associated with Prolonged Hospital Stay for Acute Stroke in Taiwan

217,959,

Is clopidogrel better than aspirin following breakthrough strokes while on aspirin? A retrospective cohort study

246,358,

Cost-effectiveness analysis of stroke management under a universal health insurance system

168,003, and

Problems and fall risk determinants of quality of life in older adults with increased risk of falling

122,084 for SAH, ICH, IS, and TIA/unspecified, respectively. The cost per life saved were estimated to be NT

Feasibility of Using Tetrax Biofeedback Video Games for Balance Training in Patients With Chronic Hemiplegic Stroke

435,919,

Comparing the shoulder impingement kinematics between circular and pumping strokes in manual wheelchair propulsion

384,028,

Three-year survival after first-ever ischemic stroke is predicted by initial stroke severity: A hospital-based study

196,281, and

Inpatient rehabilitation utilization for acute stroke under a universal health insurance system.

138,888, whereas cost per life‐year saved were estimated to be NT