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

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(TM) 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 I 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.