Inpatient Falls During Post-Stroke Rehabilitation
Patients with stroke present specific challenges with regard to inpatient falls prevention.1-3 Risk factors associated with falls in post-stroke patients1 and the type of falls experienced2 differ from other inpatients. A new falls assessment tool, the Stroke Assessment of Fall Risk (SAFR) considers factors relevant to this population.3
A retrospective study of falls in post-stroke inpatients revealed differences from other inpatients and defined 7 different types of falls.2 Six of the fall types were related to the high dependency needs of post-stroke patients, visuospatial difficulties, or delirium. One fall group, labeled “I’m giving it a go”, was different and was associated with higher functioning at the time of fall and better clinical outcome. The finding that the type of falls differed in patients with stroke suggested that risk factors might also differ in this population. This was shown explicitly in other research that reviewed published cases of falls in patients with stroke.1 Evidence indicated a relationship between falls and impaired balance, visuospatial hemineglect, and impaired performance of the activities of daily living. The role of cognitive function, incontinence, visual field deficits, and stoke type were less certain, and age, gender, stroke location, and impaired vision or hearing were not related to fall risk. Post-stroke patients have a fall-risk profile that is significantly different from other inpatients.1
The SAFR fall-risk assessment tool uses specific criteria that are relevant to post-stroke patients.3 The effectiveness of the tool was demonstrated recently in a prospective quality improvement study of post-stroke patients in an inpatient stroke rehabilitation setting. A total of 419 patients with confirmed evidence of stroke were included in the one-year study and 68 (16%) of the participants fell at least once. The SAFR had a positive predictive value (PPV) of 0.29, and a negative predictive value (NPV) of 0.94, which was significantly more accurate than the Fall Harm Risk Score (PPV, 0.19; NPV, 0.86). The sensitivity and specificity of the SAFR were 0.78 and 0.63 respectively. The evidence-based SAFR may provide more accurate prediction of falls in stroke rehabilitation patients.
1. Campbell GB, Matthews JT. An integrative review of factors associated with falls during post-stroke rehabilitation. J Nurs Scholarsh. 2010;42(4):395-404.
2. Hanger HC, Wills KL, Wilkinson T. Classification of falls in stroke rehabilitation – not all falls are the same. Clin Rehabil. 2014; 28(2):183-195.
3. Breisinger TP, Skidmore ER, Nivonkuru C, Campbell GB. The stroke assessment of fall risk (SAFR): predictive validity in inpatient stroke rehabilitation. Clin Rehabil. 2014; pii: 0269215514534276.
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