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Updated: Mar 22, 2026
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Computerized Adaptive Testing System of Functional Assessment of Stroke
Published on: January 7, 2019
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Comparative Predictive Validity of Fall-Risk Screening Assessments in Subacute Stroke
Prudence Plummer1, Megan E Schliep, Ehsan Sinaei
1MGH Institute of Health Professions, Boston, Massachusetts (P.P., M.E.S., E.S., L.J., M.C., L.A.); University of North Carolina at Chapel Hill, Chapel Hill, NC (V.S.M.); and Duke University, Durham, NC (J.A.).
Journal of Neurologic Physical Therapy : JNPT
|March 20, 2026
Summary
Predicting falls after stroke is challenging. A combination of gait speed, the step test + obstacle test (STOB), and the Functional Gait Assessment (FGA) may improve fall risk prediction in stroke survivors.
Area of Science:
- Neurology
- Rehabilitation Medicine
- Gerontology
Background:
- Accurate prediction of fall risk in stroke survivors is crucial for effective poststroke fall prevention.
- Current assessment tools may have limitations in identifying individuals at high risk of falling.
- Subacute stroke patients often face challenges with balance and mobility, increasing their fall risk.
Purpose of the Study:
- To compare the predictive validity of the Berg Balance Scale (BBS), Functional Gait Assessment (FGA), 10-m gait speed, and a novel step test + obstacle test (STOB) for predicting falls in subacute stroke survivors.
- To evaluate the ability of these tests to identify individuals likely to experience falls within three months post-discharge.
- To determine if a combination of tests offers enhanced accuracy in fall risk prediction.
Main Methods:
- Sixty-four ambulatory stroke survivors undergoing inpatient rehabilitation completed the BBS, FGA, 10-m gait speed, and STOB tests prior to discharge.
- Prospective follow-up for falls was conducted for three months post-discharge.
- Logistic regression and diagnostic accuracy metrics (sensitivity, specificity, AUC) were used to analyze the predictive performance of each test and their combinations.
Main Results:
- Twenty participants (31.3%) experienced falls within three months. The STOB demonstrated the best model fit (OR 8.0).
- The FGA (≤13) showed the highest sensitivity (0.85), while 10-m gait speed (≤0.47 m/s) had the highest specificity (0.89).
- A combination of impaired 10-m gait speed, STOB, FGA, and BBS scores yielded a high cumulative probability (94.5%) of future falls.
Conclusions:
- No single test reliably predicted future falls in stroke survivors at discharge.
- Combining gait speed, STOB, and FGA assessments may improve the accuracy of prognostic decision-making for fall risk.
- Further research is warranted to validate these combined assessment strategies in diverse stroke populations.
