Falls among Chinese stroke patients during rehabilitation

Objective: To investigate the incidence, circumstances, and risk factors of falls among Chinese stroke patients during inpatient rehabilitation. Design: Historical cohort study. Setting: A 25-bed stroke rehabilitation unit in Hong Kong. Participants: Six hundred seventy-seven patients admitted consecutively to the unit approximately 1 week after acute stroke. Interventions: All patients received conventional rehabilitation therapies, and a protocol to analyze the causes of falls and to advise on prevention was followed in the unit. Main Outcome Measures: A fall was defined as any unplanned "touch to the floor" of any part of a patient's body, excluding the feet. The fall rate and circumstances were studied. Demography, Abbreviated Mental Test score, Barthel Index score on admission, urinary incontinence, dysphasia, hemiplegia, hemiparesthesia, vision and hearing impairment, and the risk factors of stroke were analyzed by logistic regression for their relation to falls. Results: Seventy-eight patients (11.5%) had falls. The fall rate was 5.5 per 1000 patient days. Eighty-five percent of the falls occurred in daytime and 71% at the bedside. Moderate to severe disability on the Barthal Index admission (6-14) and dysphasia were associated with an increased risk of falls (odds ratio [OR] = 2.64; 95% confidence interval [CI], 1.26-5.51; OR = 1.81; 95% Cl, 1.03-3.17, respectively). Conclusions: Stroke patients in China had a significant fall rate during rehabilitation, but it was lower than rates reported in the Western stroke populations. The fall protocol followed in our unit might have reduced the incidence of repeated falls. The circumstances of falls were, however, similar. Moderate to severe disability on admission and dysphasia were 2 independent predictors for falls, and more intensive fall prevention efforts should focus on this group of patients.