Article

The Relationship Between Functional Independence Scores on Admission and Patient Falls After Stroke

National Rehabilitation Hospital, Washington, DC, USA.
Topics in Stroke Rehabilitation (Impact Factor: 1.45). 02/2005; 12(2):65-71. DOI: 10.1310/G89Q-80VR-P5P7-9PTH
Source: PubMed

ABSTRACT

This study explores the relationships between patient admission scores on the FIM tool for patients admitted with stroke and their risk for falling within the first 5 days of admission to an acute rehabilitation hospital.

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    • "A key limitation of three of the studies examining impaired balance (Nyberg & Gustafson, 1997; Olsson et al., 2005; Teasell et al., 2002) is that bedridden or immobile patients were excluded, even though stroke patients often sustain falls from bed. Indeed, " immobile " patients in acute rehabilitation would likely still be participating in therapeutic activities such as bed-to-chair and bedto-toilet transfers, and these activities are often associated with falls (Campbell, Breisinger, & Meyers, 2006; Czernuszenko & Czlonkowska, 2009; Rabadi et al., 2008; Sze et al., 2001; Zdobysz et al., 2005). Similarly, Teasell et al. excluded patients who died during rehabilitation, which may have obscured important information, particularly if death resulted from a fall. "
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    ABSTRACT: Accidental falls are common among persons admitted for inpatient stroke rehabilitation, and they can cause serious physical and psychological consequences. The role of post-stroke cognitive function in the occurrence of falls after stroke is not clear. The purpose of this dissertation was to evaluate the extent to which post-stroke cognition predicts falls during inpatient rehabilitation, and to explore the nature of the relationships among impaired balance, hemineglect, activities of daily living (ADL) performance deficit, executive cognitive dysfunction, and falls during inpatient rehabilitation after stroke. Data were pooled from five simultaneously occurring studies at five of the UPMC Rehabilitation Institute’s inpatient units. The Chedoke-McMaster Stroke Assessment Postural Control Scale (balance impairment), Line Bisection Test (hemineglect), motor Functional Independence Measure (ADL performance deficit), Repeatable Battery for the Assessment of Neuropsychological Status and Delis-Kaplan Executive Function System (non-executive and executive cognitive function, respectively) were administered to 180 participants shortly after admission to inpatient rehabilitation, and subsequent occurrence of participant falls was recorded. Using logistic regression and controlling for relevant sociodemographic and clinical covariates, we found no significant predictive relationship between post-stroke cognition and falls, and no significant interaction between post-stroke executive cognitive function and other risk factors for falls (balance impairment, hemineglect, and ADL disability). The most parsimonious predictive model of falls during stroke rehabilitation included educational level in years (p = .01), stroke severity (National Institutes of Health Stroke Scale, p = .04), use of fall prevention interventions during the inpatient rehabilitation stay (p = .01), and ADL disability (p = .04). Future studies should address limitations of this dissertation, especially the lack of sample representativeness due to possible sampling bias and the need for remediation of large amounts of missing data through imputation. Future investigations are also needed to explore optimal methods for measuring cognitive domains most likely to be associated with falls, particularly when stroke-related communication deficits exist, and to further understand the strong association we found between use of fall prevention interventions and the occurrence of falls. Finally, exploration of mechanisms underlying associations between socioeconomic status and falls during inpatient rehabilitation is warranted.
    Preview · Article · Apr 2013
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    • "A key limitation of three of the studies examining impaired balance (Nyberg & Gustafson, 1997; Olsson et al., 2005; Teasell et al., 2002) is that bedridden or immobile patients were excluded, even though stroke patients often sustain falls from bed. Indeed, " immobile " patients in acute rehabilitation would likely still be participating in therapeutic activities such as bed-to-chair and bedto-toilet transfers, and these activities are often associated with falls (Campbell, Breisinger, & Meyers, 2006; Czernuszenko & Czlonkowska, 2009; Rabadi et al., 2008; Sze et al., 2001; Zdobysz et al., 2005). Similarly, Teasell et al. excluded patients who died during rehabilitation, which may have obscured important information, particularly if death resulted from a fall. "
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    ABSTRACT: Purpose: Our aims were to evaluate evidence of risk factors for falls among patients in stroke rehabilitation and to offer recommendations for clinical practice and future research. Method: We conducted an integrative review of the literature published from 1990 to 2009 that describes empirical investigations of risk factors for post-stroke falls during inpatient rehabilitation. We searched Medline, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycInfo, and Embase databases, using the search terms “accidental falls,”“fall risk,”“risk factors,”“risk assessment,”“stroke,” and “cerebrovascular disorders.” We extracted information regarding study design, sample, potential risk factors, analytic methods, findings, and limitations from the 14 articles that met our inclusion criteria, and we rated the level of evidence for each study. Findings: Available empirical evidence points to impaired balance, visuospatial hemineglect, and impaired performance of activities of daily living as risk factors for falls during inpatient rehabilitation for stroke. Associations between falls and cognitive function, incontinence, visual field deficits, and stroke type were less clear, while relationships between falls and age, gender, stroke location, and impaired vision and hearing were not supported. Conclusions: The relatively sparse literature pertaining to risk factors for falls among stroke rehabilitation inpatients indicates that deficits affecting balance, perception, and self-care significantly increase the likelihood of falls. Particularly intriguing is the less well established role of post-stroke cognition in falls in this population. A conceptual model is needed to guide scientific inquiry and clinical practice in this area. Clinical Relevance: When clinicians in the inpatient stroke rehabilitation setting evaluate which patients are at greatest risk to fall, stroke-specific risk factors such as impaired balance, visuospatial hemineglect, and self-care deficits may be better predictors than more general risk factors such as age, incontinence, and sensory impairments. Patients with these stroke-specific deficits may benefit from the use of aggressive fall prevention interventions.
    Full-text · Article · Dec 2010 · Journal of Nursing Scholarship
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    • "A next step was to introduce a formal post-fall assessment protocol which was identified as appropriate through a team consensus conference. Risk assessment typically consists of admission assessments for known risks, ensuring attention to patients' mental and mobility status related to medications, age, or postoperative condition (JBI, 2006;McCarter-Bayer et al., 2005;Zdobysz et al., 2005). However, despite awareness of these general risks, many risk assessment tools have been found to be inaccurate or to have limited usefulness because of the variability of different units and factors such as new staff, patient acuity and occupancy rates (JBI, 2006). "
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    ABSTRACT: This paper reports on a falls prevention and management program at one regional Western Australian hospital. The report focuses on the processes and outcomes of a quality management initiative to reduce falls in hospital to illustrate the nexus between research and quality improvement in clinical practice. The Falls Prevention program was based on statistical evidence of the level of risk in the hospital and development of an evidence-based multidimensional, multidisciplinary program to reduce the risks of falling and the number of falling events. Evaluative data demonstrate the effectiveness of the program in terms of a substantial reduction in falls. The program illustrates the value of evidence-based practice, particularly in relation to evidence-based management practice. It supports the merits of creating an organisational climate where all clinicians are encouraged to use research data to plan strategies for quality improvement and risk management and, in the process, advance clinical nursing knowledge development.
    Full-text · Article · May 2007 · Collegian Journal of the Royal College of Nursing Australia
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