Beneficial falls in stroke patients: evaluation using a mixed method design

Abstract

Purpose To use a mixed method design to evaluate how clinicians judge falls in stroke patients as a beneficial event, and to identify patient-specific characteristics associated with beneficial falls. Methods The definition of beneficial falls was based on interviews with six experienced clinicians in stroke rehabilitation. Interview data were analyzed using the grounded theory approach, with outcomes used to develop a checklist to judge falls as beneficial. We subsequently used the checklist to identify falls sustained by patients in our rehabilitation unit as beneficial events. The characteristics of beneficial fallers were investigated in this retrospective study. Results According to experienced clinicians, beneficial falls result from patient-specific factors and level of independence. Beneficial falls are not associated with after-effects or a diagnosis of cognitive impairment, do not result in physical injury and post-fall syndrome, and do not alter the course of rehabilitation. These falls are considered to enhance patients' self-awareness of their physical status and abilities. Among the 123 stroke patients who experienced a fall in our study group, 23 patients (18.7%) were identified as beneficial fallers according to our checklist. The majority had a left hemiplegia and perceptual impairments, and were at low risk of recurrent falls and made functional gains during rehabilitation. Conclusions Based on our results, we created a 10-item checklist to differentiate beneficial from adverse falls. This differentiation is important to target fall prevention programs to adverse fallers in rehabilitation units.

From the concept of Independence to the questioning of its use in practice: scoping review

“…Identificación de posibles usos del concepto -A partir del análisis de los datos, los investigadores identificaron las áreas que abordan el concepto, siendo estas áreas más prácticas, donde existe un contacto directo entre el profesional y el paciente. Entre estas áreas encontramos enfermería (13) , medicina (4,5) , psicología (14,15) , fisioterapia (16) , ciencias farmacéuticas (12,17) , terapia ocupacional (18,19) , ciencias de la salud (20)(21)(22) , educación física (23) y sociología (24,25) . Otras áreas como la ingeniería, a pesar de no trabajar directamente con el paciente, invierten en investigación y en la realización de medios / estrategias adaptativas, capaces de responder a la independencia (26,27) .…”