PAPER

"Stops walking when talking" as a predictor of falls in people with stroke living in the community

D Hyndman and A Ashburn

School of Health Professions and Rehabilitation Sciences, University of Southampton, Southampton, UK

Correspondence to:
Correspondence to:
Dr D Hyndman
Mail point 886, Level E Centre Block, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK; dh197{at}soton.ac.uk

Objective: To test "Stops walking when talking" (SWWT) as a predictor of falls among people with stroke living in the community.

Methods: People with stroke were identified through hospital records. Mobility, ADL (activites of daily living) ability, mental state, mood, and SWWT were assessed in a single session. Participants were followed prospectively for six months, using falls diaries and regular telephone calls.

Results: Sixty three participants (36 men, 27 women; mean (SD) age 68.4 (10.6)) were recruited. Four subjects had a brainstem lesion, 30 had right hemisphere, and 29 left hemisphere infarctions. Mean time since onset of stroke was 20 months (range 2–72). Twenty six subjects stopped walking when a conversation was started and 16 of them fell during the six month follow up period (11 experienced repeated falls). For all fallers (1) the positive predictive value of SWWT was 62% (16/26), the negative predictive value 62% (23/37), specificity 70% (23/33) and sensitivity 53% (16/30). For repeat fallers (2) the positive predictive value of SWWT was 42% (11/26), the negative predictive value 89% (33/37), specificity 69% (33/48) and sensitivity 73% (11/15). Those who stopped walking were significantly more disabled (p<0.001)—that is, they were more dependent in activities of daily living, had worse gross function as well as worse upper and lower limb function, and had depression (p = 0.012).

Conclusions: The specificity of the SWWT test was lower but sensitivity was higher than previously reported. Although the SWWT test was easy to use, its clinical usefulness as a single indicator of fall risk in identifying those community dwelling people with stroke most at risk of falls and in need of therapeutic intervention is questionable.

Abbreviations: ADL, activites of daily living; HAD, Hospital Anxiety and Depression scale; NPV, negative predictive value; PD, Parkinson’s disease; PPV, positive predictive value; RMA, Rivermead Motor Assessment; SWWT, stops walking when talking

Keywords: fall prediction; stroke; divided attention; community

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Neurobiology of "Stops walking when talking"

Ernest H. Friedman

JNNP Online, 6 Aug 2004 [Full text]