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The incidence and consequences of falls in stroke patients during inpatient rehabilitation: Factors associated with high risk,☆☆,,★★,

https://doi.org/10.1053/apmr.2002.29623Get rights and content

Abstract

Teasell R, McRae M, Foley N, Bhardwaj A. The incidence and consequences of falls in stroke patients during inpatient rehabilitation: factors associated with high risk. Arch Phys Med Rehabil 2002;83:329-33. Objectives: To determine the incidence of falls on a stroke rehabilitation unit; to assess the frequency and nature of injuries; and to identify risk factors predictive of falls, functional outcomes, and impairments. Design: Retrospective cohort study. Setting: An inpatient stroke rehabilitation unit. Participants: Two hundred thirty-eight consecutive stroke patient admissions. Interventions: Incident reports completed on patients who experienced a fall while on the unit were reviewed and resultant injuries categorized (abrasions, lacerations, fractures). Main Outcome Measures: Stroke impairments and admission functional assessments, FIM™ instrument, Berg Balance Scale (BBS), and Chedoke-McMaster (CM) Stroke Impairment Inventory of fallers were compared with nonfallers. Results: Of the 238 patients, 88 (37%) experienced at least 1 fall, and almost half of these (45 patients [19%]) experienced at least 2 falls. A total of 180 falls were reported over the 5-year period. Of the 180 reported falls, 33% occurred when patients were using their wheelchairs. Injuries occurred in 22% of the reported falls. These consisted of contusions (49%) and abrasions (41%), primarily of the upper (30.8%) and lower (25.6%) extremities. Only 1 fracture was reported. Fallers tended to have lower admission BBS scores (50% of patients with a score <30 fell vs 18% with a score >30, P <.01) and a lower score on the admission arm, leg, and foot components of the CM (P <.05). Patients who fell were also more likely to be apraxic (P <.014) and suffer from cognitive deficits (P <.01). Repeat fallers had lower admission FIM scores (P <.01) when compared with nonfallers. Conclusion: Although patients undergoing stroke rehabilitation experienced a significant number of falls, the incidence of serious injury was small. Patients who experienced at least 1 fall had significantly lower BBS, FIM, and CM arm, leg, and foot scores compared with nonfallers. These data suggest that groups of stroke patients who are at risk for falls within the rehabilitation setting can be identified by using a variety of impairment and functional assessments. This information may be potentially useful for designing interventions directed at reducing fall frequency among stroke survivors. © 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Section snippets

Methods

The study sample consisted of 238 patients who were were consecutively admitted to the rehabilitation unit at St. Joseph's Health Centre, London, Ont, Canada, from January 1, 1992 to December 31, 1996, after an acute hemorraghic or ischemic stroke. The diagnosis of stroke was confirmed by neurologic examination while patients were on the acute medical service, as well as by computed tomography scan or magnetic resonance imaging study. Patients admitted to the rehabilitation unit were considered

Results

The demographics of the study population are presented in table 1. A total of 180 falls were reported over the study period. Eighty-eight patients (37%) experienced at least 1 fall. Of these, 45 had only 1 fall, 25 had 2 falls, 9 had 3 falls, and 9 had 4 or more falls (fig 1).

. Average FIM scores for patients with 1, 2, 3, or 4 or more falls in a cohort. *P =.012.

Patients fell most frequently from their wheelchairs and beds, which accounted for 33% and 25% of all falls, respectively. Injuries

Discussion

Falls, a common problem among stroke rehabilitation patients, were prevalent in this study sample. Over one third of the patients suffered at least 1 fall and almost 1 in 5 suffered 2 or more falls during their hospitalization. Gresham et al43 noted that most falls experienced by stroke patients occurred during their stay in rehabilitation hospitals. This increased fall rate was thought to be associated with the increased mobility associated with rehabilitation.

Our study's fall rate of 180 in

Conclusions

Stroke rehabilitation patients are at high risk of falling. One third of them on the rehabilitation unit sustained at least 1 fall. However, the incidence of a serious injury caused by a fall was very small. All measures of functional impairment including 3 components of the CM scores, the BBS scores, and the FIM were significantly lower when fallers and nonfallers were compared. Additionally, fallers were more frequently documented as apraxic and demonstrated cognitive deficits when compared

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    Supported by the University of Western Ontario Physical Medicine and Rehabilitation Research Fund.

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    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.

    Reprint requests to Robert Teasell, MD, 339 Windermere Rd, London, Ont N6A 5A5, Canada, e-mail: [email protected].

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