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Original research
Allogeneic haematopoietic stem cell transplantation and patient falls: impact of lower extremity muscle strength
  1. Shin Kondo1,2,
  2. Tatsuro Inoue3,
  3. Takashi Saito1,2,
  4. Yuka Kawamura1,
  5. Ayane Katayama1,
  6. Masafumi Nakamura4,
  7. Ryohei Sumitani4,
  8. Mamiko Takahashi4,
  9. Masahiro Oura4,
  10. Kimiko Sogabe4,
  11. Takeshi Harada4,
  12. Shiro Fujii4,
  13. Shingen Nakamura5,
  14. Hirokazu Miki6,
  15. Kumiko Kagawa7,
  16. Nori Sato8,
  17. Rei Ono2,
  18. Masahiro Abe4 and
  19. Shinsuke Katoh9
  1. 1Division of Rehabilitation, Tokushima University Hospital, Tokushima, Japan
  2. 2Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe, Japan
  3. 3Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan
  4. 4Department of Hematology, Tokushima University Hospital, Tokushima, Japan
  5. 5Department of Community Medicine and Medical Science, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
  6. 6Division of Transfusion Medicine and Cell Therapy, Tokushima University Hospital, Tokushima, Japan
  7. 7Department of Hematology, Tokushima Prefectural Central Hospital, Tokushima, Japan
  8. 8Department of Rehabilitation Medicine, Tokushima University Hospital, Tokushima, Japan
  9. 9Department of Rehabilitation Medicine, Red Cross Tokushima Hinomine Rehabilitation Center for People with Disabilities, Tokushima, Japan
  1. Correspondence to Mr. Shin Kondo, Division of Rehabilitation, Tokushima University Hospital, Tokushima, Japan; skondo{at}tokushima-u.ac.jp

Abstract

Objectives Patients undergoing allogeneic haematopoietic stem cell transplantation (allo-HSCT) have a higher risk of falls than those receiving other therapies for haematological disorders. This study aimed to investigate the impact of pretransplant lower extremity muscle strength (LEMS) on post-transplant falls.

Methods In this retrospective cohort study, patients aged ≥18 years who underwent allo-HSCT were included. All data were extracted from medical records. LEMS was defined as the knee extension force measured by a handheld dynamometer divided by the patient’s weight. The receiver operating characteristic (ROC) curve was used to calculate the optimal LEMS cut-off value for prediction of falls. Patients were categorised into low and normal LEMS groups based on the cut-off value. The impact of pretransplant LEMS on post-transplant falls was analysed using a Cox proportional hazards model.

Results In total, 101 patients were analysed. During the observation period, falls occurred in 32 patients (31.7%). The ROC curve analysis results showed that the optimal LEMS cut-off value for prediction of falls was 45.4% per body weight. In multivariate analysis, pretransplant low LEMS was a significant predictor of falls in model 1 with patient characteristics as a confounding factor and model 2 with medications-inducing falls as a confounding factor, respectively (model 1: HR 3.23, 95% CI 1.37 to 7.64; model 2: HR 2.82, 95% CI 1.20 to 6.59).

Conclusions Pretransplant LEMS was a significant predictor of post-transplant falls. The results of this study may help to prevent falls in patients undergoing allo-HSCT.

  • Leukaemia
  • Lymphoma
  • Haematological disease
  • Hospital care
  • Rehabilitation
  • Supportive care

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

https://doi.org/10.1136/bmjspcare-2022-003582

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

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    Footnotes

    • Contributors SKo, TI and TS designed, analysed and interpreted the data, and wrote the manuscript. YK, AK, MN, RS, MT, MO, KS, TH, SF, SN, HM, KK, NS, RO, MA and SKa assisted with data collection and commented on the manuscript. All authors read and approved the final manuscript. SKo is responsible for the overall content and accepts full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.