An Integrative Review of Factors Associated With Falls During Post‐Stroke Rehabilitation

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.

Guidelines for Adult Stroke Rehabilitation and Recovery

“…Specific balance limitations identified during the evaluation will help determine the risk of falling and guide the selection and tailoring of balance-specific interventions. 308,591 Although balance training programs have been shown to be beneficial after stroke, no specific approach or program has been demonstrated to be superior, nor is the optimal timing clear. Balance training has been successfully implemented as group and one-on-one sessions, circuit training, and hospitalversus home-versus community-based programs.…”

Impaired Dynamic Balance Is Associated with Falling in Post-Stroke Patients

“…Therefore, a number of studies have focused on fall prevention during inpatient stroke rehabilitation (Andersson et al 2006;Czernuszenko and Czlonkowska 2009). Campbell and Matthews (2010) reported that the falls during inpatient stroke rehabilitation was considered as potential risk factors of impairment of balance and self-care. In particular, a fall leads to the fear of falling again and sustaining serious injuries such as a hip fracture and head injury (Dennis et al 2002;Poole et al 2002).…”

The Trunk Impairment Scale – modified to ordinal scales in the Norwegian version

“…Impaired balance increases the risk of falls [9], and may thus imply social problems and high economic costs [10].…”