ABSTRACT. Spruit-van Eijk M, Zuidema SU, Buijck BI,
Koopmans RT, Geurts AC. To what extent can multimorbidity
be viewed as a determinant of postural control in stroke patients?
Arch Phys Med Rehabil 2012;93:1021-6.
Objective: To investigate the determinants of postural imbalance
after stroke in geriatric patients admitted for low-intensity
rehabilitation in skilled nursing facilities (SNFs), particularly
the role of multimorbidity.
Design: Cross-sectional study design.
Setting: Fifteen SNFs.
Participants: All patients who were admitted for rehabilitation
after stroke in one of the participating SNFs (N378) were
eligible.
Interventions: Not applicable.
Main Outcome Measures: The Berg Balance Scale (BBS) was
selected as a measure of standing balance and the Functional
Ambulation Categories (FAC) as a measure of walking
balance.
Results: Multimorbidity was present in 34% of the patients.
The patients with multimorbidity differed from the patients
without multimorbidity with respect to age, proprioception, and
vibration sense, but not for any of the cognitive tests, muscle
strength, or sitting balance. Patients with multimorbidity had,
on average, lower scores on both outcome measures. In linear
regression analyses, both the BBS and FAC were best explained
by multimorbidity, muscle strength, and the interaction
between muscle strength and static sitting balance (overall
explained variance 66% and 67%, respectively), while proprioception
added only to the variance of the FAC.
Conclusions: Multimorbidity was independently related to
postural imbalance after stroke in patients admitted for rehabilitation
in SNFs. Muscle strength and the interaction of
muscle strength with static sitting balance were important
determinants of both standing and walking balance, indicating
these factors as essential targets for rehabilitation.