Reduced trailing limb angle is associated with near-falls during walking in stroke survivors.

BACKGROUND: Fall prevention is a primary goal of rehabilitation for stroke survivors. However, previous studies have mainly relied on retrospective fall history, creating a temporal mismatch between gait assessment and instability events that may obscure gait characteristics associated with near-falls. RESEARCH QUESTION: Which gait-related factors are associated with near-falls in stroke survivors from the perspectives of trunk excursion, propulsion, and gait symmetry? METHODS: A total of 157 subacute stroke survivors were included, comprising 82 participants with near-falls during gait analysis and 75 without near-falls. Trunk angular excursion, propulsion-related variables including trailing limb angle (TLA) and late braking force (LBF), gait symmetry indices, and gait speed were obtained during normal walking trials. Univariable and multivariable logistic regression analyses were performed. A sensitivity analysis additionally adjusted for cane use, ankle-foot orthosis use, lower-extremity motor recovery, and time since stroke. Receiver operating characteristic (ROC) analysis was conducted to evaluate the discriminative ability of TLA. RESULTS: Reduced TLA and LBF, increased trunk angular excursion, greater gait asymmetry, and slower gait speed were associated with near-falls in univariable analyses. In the multivariable model, reduced TLA (odds ratio [OR]=0.18, 95% confidence interval [CI]=0.08-0.39, p < 0.001) and greater trunk rotational excursion (OR=2.12, 95% CI=1.17-3.87, p = 0.014) were independently associated with near-falls, whereas swing time symmetry index was not. These associations remained significant after adjustment for clinical confounders. TLA alone demonstrated good discriminative ability for identifying near-falls (AUC=0.884, 95% CI=0.826-0.934), with an optimal cutoff value of 3.26°. CONCLUSIONS: Reduced TLA and greater trunk rotational excursion were independently associated with near-falls during walking in stroke survivors. TLA showed good discriminative ability and may help identify individuals at increased risk of near-falls.