Regression-Based Balance Discordance Refines Prediction of Prospective Falls After Subacute Stroke: A Secondary Analysis of the LEAPS Trial
- 1Department of Physical Therapy, Chapman University, Irvine, CA, USA
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.
Related
- Cardiovascular exercise mitigates inflammation in the early subacute phase of stroke recovery: a secondary analysis of a randomized controlled trial
- Discordance between reported discrimination and translational-readiness evidence in AI-based ASCVD prediction: a systematic review with structured methodological audit
- Vision-Related Quality of Life and Dry Eye Symptoms After Treatment with Lyophilized Amniotic Membrane Eye Drops: A Secondary Analysis of a Prospective Cohort Study
- Is metformin use associated with cognitive, physical and cardiovascular outcomes in older adults with type 2 diabetes? A secondary analysis of the SCOPE multicentre prospective cohort study
- Can fluoxetine's diminished efficacy in pediatric depression be explained by study sites, baseline severity, age, and psychological interventions? A secondary exploratory meta-regression
BibTeX
@misc{hooyman2026regressionbased,
title = {{Regression-Based Balance Discordance Refines Prediction of Prospective Falls After Subacute Stroke: A Secondary Analysis of the LEAPS Trial}},
author = {A. Hooyman and D. S. Peterson and J. K. Longhurst and F. Albrecht},
howpublished = {medRxiv},
year = {2026},
month = nov,
doi = {10.64898/2026.11.06.26367447},
url = {https://www.medrxiv.org/content/10.64898/2026.11.06.26367447v1},
note = {CC BY},
}
RIS
TY - UNPB
TI - Regression-Based Balance Discordance Refines Prediction of Prospective Falls After Subacute Stroke: A Secondary Analysis of the LEAPS Trial
AU - A. Hooyman
AU - D. S. Peterson
AU - J. K. Longhurst
AU - F. Albrecht
PY - 2026
DA - 2026/11/06
PB - medRxiv
DO - 10.64898/2026.11.06.26367447
UR - https://www.medrxiv.org/content/10.64898/2026.11.06.26367447v1
AB - 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.
ER -