Abstract：
OBJECTIVE: Chemotherapy-induced peripheral neuropathy (CIPN) remains a significant toxicity for women with breast cancer receiving taxane-based treatment. This analysis has been done within the context of an ongoing 16-week randomized clinical trial consisting of a gait, balance, and strength training exercise intervention for the lower extremities in women with persistent CIPN who received taxane-based chemotherapy for breast cancer. The aim of this analysis is to determine the baseline fall risk among 62 study participants with persistent taxane-induced CIPN assigned to the control group.
METHODS: This analysis used the baseline demographic, medical data, nerve conduction, gait, balance, and muscle strength variables of participants prior to randomization to develop an explanatory model of fall risk. The analytic approach utilized generalized linear modeling with Lasso to select baseline risk factors for future falls.
RESULTS: Characteristics of the study sample by intervention and control group revealed no significant differences between the groups at baseline. The only baseline risk factors that were significantly associated with future falls were near falls within the last month (β = 0.90, P = .056) with an odds ratio = 2.46, 95% confidence interval 0.31 to 17, and right ankle plantar flexion torque. (β = 0. 05, P = .006) with an odds ratio = 1.05, 95% confidence interval 1.01 to 1.10. Demographic and medical data, nerve conduction parameters, gait, balance, or muscle strength variables did not significantly influence fall risk in this population.
CONCLUSIONS: The potential for injury and disability from falls is a considerable concern among oncology clinicians and women with breast cancer and persistent CIPN. While falls and fall risk have been previously examined in other studies of breast cancer survivors, the majority of studies fail to capture the occurrence of \"near falls\" a significant predictor of fall risk. In addition, it is possible that ankle strength may prove to be a potential target for fall prevention in this population. Evidence-based interventions focused on improving neuropathic symptoms, physical function, and quality of life in persons with CIPN are still needed.
CONCLUSIONS: Oncology nurses and nurse practitioners should query patients who received taxane-based chemotherapy for not only the incidence and frequency of falls but the occurrence of near falls. A prompt referral to physical therapy may be useful in strengthening the lower extremities to improve balance and prevent falls.
METHODS: This analysis used the baseline demographic, medical data, nerve conduction, gait, balance, and muscle strength variables of participants prior to randomization to develop an explanatory model of fall risk. The analytic approach utilized generalized linear modeling with Lasso to select baseline risk factors for future falls.
RESULTS: Characteristics of the study sample by intervention and control group revealed no significant differences between the groups at baseline. The only baseline risk factors that were significantly associated with future falls were near falls within the last month (β = 0.90, P = .056) with an odds ratio = 2.46, 95% confidence interval 0.31 to 17, and right ankle plantar flexion torque. (β = 0. 05, P = .006) with an odds ratio = 1.05, 95% confidence interval 1.01 to 1.10. Demographic and medical data, nerve conduction parameters, gait, balance, or muscle strength variables did not significantly influence fall risk in this population.
CONCLUSIONS: The potential for injury and disability from falls is a considerable concern among oncology clinicians and women with breast cancer and persistent CIPN. While falls and fall risk have been previously examined in other studies of breast cancer survivors, the majority of studies fail to capture the occurrence of \"near falls\" a significant predictor of fall risk. In addition, it is possible that ankle strength may prove to be a potential target for fall prevention in this population. Evidence-based interventions focused on improving neuropathic symptoms, physical function, and quality of life in persons with CIPN are still needed.
CONCLUSIONS: Oncology nurses and nurse practitioners should query patients who received taxane-based chemotherapy for not only the incidence and frequency of falls but the occurrence of near falls. A prompt referral to physical therapy may be useful in strengthening the lower extremities to improve balance and prevent falls.
摘要：
目的：化疗引起的周围神经病变（CIPN）对于接受紫杉烷类药物治疗的乳腺癌患者来说仍然是一种显著的毒性反应。这项分析是在一项持续16周的随机临床试验的背景下进行的，该试验包括步态，balance,对于接受基于紫杉烷的乳腺癌化疗的持续CIPN女性患者的下肢和力量训练运动干预。这项分析的目的是确定62名持续紫杉烷诱导的CIPN的研究参与者的基线跌倒风险，这些参与者被分配到对照组。
方法：本分析使用基线人口统计，医疗数据,神经传导,步态,balance,和随机化前参与者的肌肉力量变量，以建立跌倒风险的解释模型。分析方法利用Lasso的广义线性建模来选择未来跌倒的基线风险因素。
结果：干预组和对照组的研究样本特征显示，基线时两组间无显著差异。与未来跌倒显着相关的唯一基线风险因素是最近一个月内跌倒（β=0.90，P=0.056），比值比=2.46，95％置信区间为0.31至17，以及右踝足底屈曲扭矩。(β=0。05，P=.006），比值比=1.05，95%置信区间为1.01至1.10。人口和医疗数据，神经传导参数，步态,balance,或肌肉力量变量对该人群的跌倒风险没有显著影响.
结论：在肿瘤科临床医生和患有乳腺癌和持续性CIPN的女性中，跌倒造成的损伤和残疾的可能性是一个相当大的问题。虽然以前在其他乳腺癌幸存者的研究中已经检查了跌倒和跌倒风险，大多数研究未能捕捉到“近跌倒”的发生是跌倒风险的重要预测因子。此外,踝关节力量可能被证明是该人群预防跌倒的潜在目标。循证干预措施侧重于改善神经性症状，物理功能，仍需要CIPN患者的生活质量。
结论：肿瘤科护士和护士从业人员不仅应询问接受紫杉烷化疗的患者跌倒的发生率和频率，还应询问近跌倒的发生情况。及时转诊物理治疗可能有助于加强下肢以改善平衡并防止跌倒。
方法：本分析使用基线人口统计，医疗数据,神经传导,步态,balance,和随机化前参与者的肌肉力量变量，以建立跌倒风险的解释模型。分析方法利用Lasso的广义线性建模来选择未来跌倒的基线风险因素。
结果：干预组和对照组的研究样本特征显示，基线时两组间无显著差异。与未来跌倒显着相关的唯一基线风险因素是最近一个月内跌倒（β=0.90，P=0.056），比值比=2.46，95％置信区间为0.31至17，以及右踝足底屈曲扭矩。(β=0。05，P=.006），比值比=1.05，95%置信区间为1.01至1.10。人口和医疗数据，神经传导参数，步态,balance,或肌肉力量变量对该人群的跌倒风险没有显著影响.
结论：在肿瘤科临床医生和患有乳腺癌和持续性CIPN的女性中，跌倒造成的损伤和残疾的可能性是一个相当大的问题。虽然以前在其他乳腺癌幸存者的研究中已经检查了跌倒和跌倒风险，大多数研究未能捕捉到“近跌倒”的发生是跌倒风险的重要预测因子。此外,踝关节力量可能被证明是该人群预防跌倒的潜在目标。循证干预措施侧重于改善神经性症状，物理功能，仍需要CIPN患者的生活质量。
结论：肿瘤科护士和护士从业人员不仅应询问接受紫杉烷化疗的患者跌倒的发生率和频率，还应询问近跌倒的发生情况。及时转诊物理治疗可能有助于加强下肢以改善平衡并防止跌倒。
