{
  "abstract": "Objective: To determine whether continuous, regression-based measures of balance discordance refine prediction of prospective, recurrent falls after subacute stroke relative to a previously published threshold-based classification in the same cohort, and to characterize how a purely data-driven, dimensionality-reduction-based composite expresses the same underlying measures. Design: Secondary, observational analysis of a randomized controlled trial. Recurrent falls were modeled using Andersen-Gill Cox proportional hazards regression with robust standard errors clustered by participant. Setting: Five-site, National Institutes of Health/National Institute of Neurological Disorders and Stroke funded multicenter trial (Locomotor Experience Applied Post-Stroke, LEAPS). Participants: 384 adults with subacute stroke (of 408 randomized in the parent trial) with valid baseline balance confidence, walking, and balance scores and at least one recorded follow-up interval (2,357 person-intervals, 179 fall events). Main Outcome Measures: Prospective, recurrent falls over 12 months, ascertained via self-report falls diary. Balance discordance was computed as the residual from regressing balance confidence on objective walking distance, Berg Balance Scale performance, or both jointly (multivariable discordance); threshold-based classification used established cut-points on the same measures and principal component analysis served as secondary comparators. Results: Single-variable discordance was associated with lower fall hazard (hazard ratio [HR] = 0.79, 95% CI 0.63-0.99, p = .037), and multivariable discordance was associated with higher fall hazard (HR = 1.27, 95% CI 1.03-1.58, p = .026). None of three threshold-based classification indicators reached significance. Multivariable discordance and a three-component principal-component composite showed comparable model fit (concordance 0.616 vs. 0.618) and were substantially correlated (Rsquared = .49). Conclusions: Continuous, regression-based balance discordance predicted prospective, recurrent falls where a previously published threshold-based classification did not. The divergent direction of single- and multivariable findings suggests overconfidence relative to combined objective function, rather than confidence broadly, may be the more specific marker of fall risk.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Physical Therapy, Chapman University, Irvine, CA, USA"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 4,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "A. Hooyman"
    },
    {
      "name": "D. S. Peterson"
    },
    {
      "name": "J. K. Longhurst"
    },
    {
      "name": "F. Albrecht"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/a16a3j8nrxg7v.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.11.06.26367447",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.11.06.26367447v1.full",
  "id": "a16a3j8nrxg7v",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.11.06.26367447v1",
  "language": null,
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "rehabilitation medicine and physical therapy"
    ]
  ],
  "openalex": null,
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.11.06.26367447v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-11-06",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/a16a3j8nrxg7v.ris",
  "sources": [
    {
      "first_seen": "2026-11-10T00:22:06Z",
      "native_id": "10.64898/2026.11.06.26367447",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.11.06.26367447v1"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:rehabilitation medicine and physical therapy",
      "subfield": "general"
    }
  ],
  "title": "Regression-Based Balance Discordance Refines Prediction of Prospective Falls After Subacute Stroke: A Secondary Analysis of the LEAPS Trial",
  "title_text": "Regression-Based Balance Discordance Refines Prediction of Prospective Falls After Subacute Stroke: A Secondary Analysis of the LEAPS Trial",
  "type": "preprint",
  "updated_at": "2026-11-10T00:22:06Z",
  "url": "https://research.draconitic.com/paper/a16a3j8nrxg7v",
  "venue": "medRxiv",
  "versions": []
}