Risk factors for falls in stroke patients during inpatient rehabilitation

Objectives: To assess the incidence and circumstances of falls among stroke patients in a rehabilitation ward, the frequency of fall-related fractures, the relationship between falls and rehabilitation outcomes, and risk factors for falls. Design: Prospective observational study. Setting: Neurological rehabilitation ward. Patients: In total 1155 patients (56% men; mean age 61.5 +/- 14.3 years) admitted to the neurological rehabilitation ward after a stroke. Median (interquartile range) time since stroke onset was 36.5 (68) days. Main measures: Patients' falls were registered during hospitalization (1-74 days) and variables relating to the type and symptoms of stroke, current medications, neurological deficit (Scandinavian Stroke Scale) and disability (Barthel Index) were collected from medical records. Results: A total of 252 falls were recorded for 189 (16.3%) patients and 45 patients experienced 108 repeated falls. The incidence rate for falls was 7.6/1000 patient-days (95% confidence interval (CI) 6.6-8.5). Most patients fell while being transferred (33.9%) and while seated (21.5%), and 1.2% of falls resulted in fractures (n=3). Increased risk of both first and multiple falls was strongly associated with initial Barthel score below 15 (hazard ratio (H R) 5.2 and 4.5, respectively) and time since stroke onset >= 12 weeks (HR 2.3 and 2.3, respectively). First falls were significantly associated with visuo-spatial neglect (HR 1.5). Repeated falls were related to age greater than 65 years (HR 1.4). Conclusions: Patients with severe stroke-related disability in the early period after stroke are prone to falls during rehabilitation. Multiple falls are most frequent in patients over 65 years of age.