Factors that influence the risk of falling after spinal cord injury: a qualitative photo-elicitation study with individuals that use a wheelchair as their primary means of mobility

Abstract

IntroductionFalls are a concern for wheelchair users with spinal cord injury (SCI). Falls can negatively impact the physical and psychological well-being of fallers. To date, the perspectives of wheelchair users with lived experiences of SCI on the contributors to falls has been understudied. Information about factors that influence fall risk would guide the development of effective fall prevention strategies.ObjectivesTo gain a comprehensive understanding of the factors that influenced the risk of falling as perceived by wheelchair users with SCI.DesignA qualitative study using photo-elicitation interviews.SettingA Canadian SCI rehabilitation hospital and the participants’ home/community environments.ParticipantsTwelve wheelchair users living in the community with chronic SCI.MethodsParticipants captured photographs of situations, places or things that they perceived increased and decreased their risk of falling. Semistructured photo-elicitation interviews were conducted to discuss the content of the photographs and explore perceptions of fall risk factors. A hybrid thematic analysis and the Biological, Behavioural, Social, Economic, and Environmental model were used as a framework to organise/synthesise the data.ResultsOverall, the findings indicated that the risk of falling was individualised, complex and dynamic to each person’s life situation. Four main themes were revealed in our analysis: (1) Falls and fall risk caused by multiple interacting factors; (2) Dynamic nature of fall risk; (3) Single factors were targeted to reduce falls and fall-related injuries; and (4) Fall prevention experiences and priorities.ConclusionsEach wheelchair user encountered numerous fall risk factors in their everyday lives. Information from this study can be used to set priorities for fall prevention. Fall prevention initiatives should consider a wheelchair user’s fall risks in a holistic manner, acknowledging that a person’s current situation, as well as anticipating their fall risks and fall prevention needs, will change over time.

Exploring the causes and impacts of falls among ambulators with spinal cord injury using photovoice: a mixed-methods study

“…Many fall prevention strategies highlighted by ambulators with SCI were similar to the strategies used by wheelchair users with SCI. 37 Also, other articulated strategies from this study are related to proper footwear, fatigue, and pain management. This study reinforces the notion that numerous factors can contribute to falls, and fall prevention must be a joined effort among physicians, therapists, ambulators, caregivers and employers.…”

“…This study reinforces the notion that numerous factors can contribute to falls, and fall prevention must be a joined effort among physicians, therapists, ambulators, caregivers and employers. 37 As some participants were sceptical of the utility of a fall prevention programme, a potential buy-in to fall prevention programmes should be further explored. This would allow interested ambulators to participate but would not compel anyone to receive training.…”

Current state of fall prevention and management policies and procedures in Canadian spinal cord injury rehabilitation

“…A controlled fall that is part of therapy is different than an unintended or unexpected fall during therapy and this distinction is not recognized in the policies/procedures of the sites or in the widely accepted definition outlined above [26]. In order to support a practical approach to fall prevention training in SCI rehabilitation [9,27], the widely accepted definition of a fall/near fall must differentiate between a controlled therapy fall versus an unexpected/ unintended fall.…”

“…Currently much of what is known about falls experienced by individuals with SCI is based on studies conducted in community settings [8]. Individuals with SCI encounter multiple fall risk factors including risk factors that pertain to SCI-related impairments and/or the activities an individual engages in [8,9]. Since traumatic SCI tends to be more prevalent in middle-age [10], individuals with SCI tend to be younger in age than other neurological populations and have unique rehabilitation needs [11].…”

“…Since traumatic SCI tends to be more prevalent in middle-age [10], individuals with SCI tend to be younger in age than other neurological populations and have unique rehabilitation needs [11]. Fall prevention/management initiatives should be tailored to address their unique fall risk [9]. In order to effectively prepare individuals with SCI for falls, effective, and targeted fall prevention should begin while an individual is in SCI rehabilitation [12,13].…”