Association Between Trajectories of Activity-Level Recovery and Fall Risk: A Retrospective Cohort Study of Older Patients With Stroke in a Subacute Rehabilitation Setting.

Abstract

To identify distinct latent classes of activity-level recovery trajectories during subacute stroke rehabilitation using growth mixture modeling and examine their association with fall risk. Observational retrospective cohort study. Single subacute rehabilitation hospital. N=233 patients with stroke aged ≥65 years admitted between April 1, 2023, and March 31, 2025. Not applicable. Incidence of a first fall after admission. Four distinct activity-level recovery trajectories were identified: low baseline-rapid improvement (14.2%), very low baseline-slow improvement (36.1%), moderate baseline-steady improvement (32.6%), and high baseline-early plateau (17.2%). The baseline motor and cognitive functions differed significantly across the trajectory groups. Compared with the high baseline-early plateau trajectory, older patients in the low baseline-rapid improvement trajectory exhibited a significantly higher risk of falls (hazard ratio=3.57, 95% confidence interval, 1.09-11.73). Distinct activity-level recovery trajectories during subacute stroke rehabilitation exhibit different associations with fall risk. Rapid activity-level recovery correlates with a higher fall risk, suggesting that risk may increase during transitional phases of improvement in activity-level motor functioning. Together, these findings underscore the clinical relevance of recovery dynamics in understanding fall risk in the setting of subacute rehabilitation.