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Researchers develop taxonomy of falls by stroke patients

Researchers were able to group falls in an inpatient stroke rehabilitation ward into seven categories based on patient characteristics and outcomes, according to a recent article.

The investigators with the Princess Margaret Hospital and the University of Otago, both in Christchurch, New Zealand, designed their study to develop a practical taxonomy of falls that would help clinicians choose fall-prevention strategies. For their study, which was published in the February issue of the journal Clinical Rehabilitation, the researchers retrospectively reviewed falls during a 21-month period in a 23-bed inpatient stroke rehab unit. They also collected data on each patient’s level of functioning at the time of the fall and information from admission and discharge.

They found 241 falls occurred in 122 patients during the study period, and 81% of falls (196 total) happened around the bed. Fifty-four patients experienced toileting-related falls, according to the research. In other locations, such as the dining room, hallways and therapy room, falls were less common.

Ninety-five percent (116) of those who fell had been identified as high-risk and had fall-prevention strategies enacted before their falls. Three falls resulted in major injury, such as fracture, dislocation, head injury or a laceration requiring sutures. No injuries occurred in 73% of the falls.

The researchers identified a taxonomy with seven types of falls with different, but overlapping, patient characteristics at the time of the fall and different outcomes.

One, which they called “I’m giving it a go,” was different from the other types, and the researchers noted it was associated with better functioning at the time of the fall and better outcomes. This fall occurred when the patient was doing an activity that matched or nearly matched with their mobility status. Also, this fall could occur during an activity listed as a rehabilitation goal for the patient, or one the patient has previously been successful doing. This category includes falls during a physical or occupational therapy session.

The researchers defined six other fall categories including:

• “I’m new here,” in which falls occur within a week of arriving at the stroke rehab unit. The patient does not have any other acute illness, but often is disoriented by the new environment.

• “I’m sick,” which covers falls that occur while a patient has an acute concurrent illness, including delirium, and the illness contributes to the fall.

• “I shouldn’t have,” in which the patient fell while attempting an activity beyond the patient’s mobility capacity.

• “It’s the meds” falls occur as a direct result of medications prescribed to the patient.

• “It wasn’t me” falls are outside of the patient’s control. These can include the patient being left unattended incorrectly, incorrect mobilization by a staff member, or environmental causes such as water on the floor or uneven carpet.

• “I’m very dependent” falls happen because of the patient’s high level of physical dependency on others for basic tasks, including those who need help with rolling, have poor sitting balance and need hoist transfers or a two-person transfer. This also includes patients with severe spatial difficulties who roll out of bed.

The researchers suggest each group of patients might need different fall-prevention strategies. Patients who suffered “I’m giving it a go” falls were more likely to have positive outcomes of returning home, walking independently and having higher functional abilities, according to the study.

“Some falls … may be a necessary part of calculated risk taking inherent in rehabilitation,” the authors wrote. “Unnecessarily restricting their attempts at independence may compromise their longer-term goals of independence.”

Patients who experienced “I’m dependent” falls were more likely to have poor FIM scores on discharge and to be discharged to institutionalized care. These patients were highly dependent on staff for mobility and had a high rate of urinary and fecal incontinence and visuospatial problems. It was unclear whether these patients’ outcomes were because of the severity of their strokes or influenced by their falls, the authors wrote.

Patients in the “I shouldn’t have” category had a higher proportion of recurring falls (65%) and were frequently described in documentation as “impulsive.” Outcomes for this group fell in a wide range from positive to poor.


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By | 2014-03-05T00:00:00-05:00 March 5th, 2014|Categories: National|0 Comments

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