Supplementary Material for: Gait Disorder among Elderly People, Psychomotor Disadaptation Syndrome: Post-Fall Syndrome, Risk Factors and Follow-Up – A Cohort Study of 70 Patients

<b><i>Introduction:</i></b> Falls among older people are a major health issue and the first cause of accidental death after 75 years of age. Post-fall syndrome (PFS) is commonly known and yet poorly studied. <b><i>Objective:</i></b> Identify risk factors for PFS and do a follow-up 1 year later. <b><i>Methods:</i></b> We included all patients over 70 years of age hospitalized after suffering a fall in a case-control study, and then followed them in a cohort study. PFS was retained in case of functional mobility decline (transferring, walking) occurring following a fall in the absence of an acute neurological, orthopedic or rheumatic pathology directly responsible for the decline. The data initially collected were: clinical (anamnestic, emergency and departmental/ward evolution, medical history, lifestyle, treatments, clinical examination items); and imaging if the patient had been subjected to brain imaging in the last 3 years prior to inclusion. Regarding the follow-up at 1 year, we collected from the general physician the occurrence and the characteristics of new falls, functional mobility assessment, hospitalization and death. <b><i>Results:</i></b> Inclusion took place from March 29, 2016 to June 7, 2016 and follow-up until June 30, 2017. We included 70 patients. A total of 29 patients exhibited a PFS (41.4 %). Risk factors for PFS included age, walking disorder prior to the fall, the use of a walking aid prior to the fall, no unaccompanied outdoor walk in the week before the fall, visual impairment making close reading impossible, stiffness in ankle dorsiflexion, grip strength and the fear of falling. Among patients with PFS, 52.9% could still perform a transfer at 1 year and 64.7% could still walk against 80.7% and 85.2%, respectively, for patients without PFS. <b><i>Conclusion:</i></b> The study showed the existence of body functions/structure impairments and activity limitations prior to the fall among patients exhibiting a PFS. This suggests the existence of a pre-fall syndrome, i.e., a psychomotor disadaptation syndrome existing prior to the fall. Among the 8 risk factors, fear of falling, vision impairment and muscle strength could be targeted for improvement. The diagnosis of PFS could be a marker of loss of functional mobility at 1 year.

**引言**：老年人跌倒是重大健康问题，也是75岁以上人群意外死亡的首要诱因。跌倒后综合征（Post-fall Syndrome, PFS）虽广为人知，却鲜有深入研究。**研究目的**：明确跌倒后综合征的危险因素，并开展为期1年的随访研究。**研究方法**：本研究采用病例对照研究纳入所有因跌倒住院的70岁以上患者，随后通过队列研究对其进行随访。若患者跌倒后出现功能活动能力下降（如转移、行走能力下降），且无急性神经、骨科或风湿类疾病直接导致该功能下降，则判定为跌倒后综合征。初始收集的资料包括：临床资料（病史回顾、急诊及病房病程记录、既往病史、生活方式、用药情况、临床检查指标）；以及入组前3年内接受过脑部影像学检查的患者的影像资料。针对1年随访阶段，我们从全科医师处收集了新发跌倒的发生情况与特征、功能活动能力评估结果、住院情况及死亡情况。**研究结果**：入组时间为2016年3月29日至2016年6月7日，随访持续至2017年6月30日。本研究共纳入70例患者，其中29例确诊为跌倒后综合征，占比41.4%。跌倒后综合征的危险因素包括：年龄、跌倒前存在行走障碍、跌倒前使用助行器具、跌倒前一周无独自户外行走史、无法进行近距离阅读的视力障碍、踝关节背屈僵硬、握力下降以及跌倒恐惧。在1年随访时，跌倒后综合征患者中仍能完成转移动作的比例为52.9%，仍能行走的比例为64.7%；而非跌倒后综合征患者的对应比例分别为80.7%和85.2%。**结论**：本研究证实，跌倒后综合征患者在跌倒前已存在身体功能/结构损伤及活动能力受限情况，提示存在跌倒前综合征，即跌倒前已存在的精神运动适应不良综合征。在本次研究识别的8项危险因素中，可针对跌倒恐惧、视力障碍及肌肉力量开展干预以改善预后。跌倒后综合征的诊断可作为1年随访时功能活动能力丧失的预测标志物。