Falls in hospital patients with acquired communication disability secondary to stroke: A systematic review and meta‐analysis

Abstract

Background Falls are a common safety incident in people with stroke. Studies report that between 14% and 65% of people with stroke fall at least once during their hospital admission. Risk factors for falls in people with stroke have been reported to include neglect, balance and dependence for activities of daily living. Communication disability has been identified as a risk factor for patient safety incidents in hospital that has not been closely examined as a potential risk factor for falls in people with stroke. Aim To determine the association between communication disability secondary to stroke and falls in people with stroke in hospital. Methods & Procedures Systematic searches of five electronic databases were conducted in June 2019 using the key concepts of ‘falls’ and ‘stroke’ (PROSPERO CRD 42019137199). Included studies provided comparative data of falls in patients with stroke with and without communication disability. The methodological quality of the studies was examined using the Quality Assessment Tool for Studies with Diverse Designs (QATSDD). Both a narrative synthesis and a meta‐analysis were completed. Main Contribution A total of 15 studies met the criteria for inclusion and 11 were included in a meta‐analysis. Three studies found people with communication disability had an increased rate of falls in hospital. However, a meta‐analysis showed no significant association between a non‐specific classification of communication disability and an increased risk of falls. There was some indication from individual studies that higher risk of falls may be associated with severe communication disability, but there were insufficient data reported on the severity of the communication disability to draw robust conclusions. Conclusion & Implications The results of this systematic review suggest that a generic classification of communication disability following stroke is not a risk factor for falls. However, further research that is inclusive of this population and considers severity of communication disability more specifically is required.

Circumstances and outcomes of falls in hospital for adults with communication disability secondary to stroke: A qualitative synthesis

“…The severity of and type of physical injury was reported in 13 studies (Baetens et al, 2011;Bugdayci et al, 2011;Byers et al, 1990;Chaiwanichsiri et al, 2006;Czernuszenko, 2007;Czernuszenko & Czlonkowska, 2009;Nyberg & Gustafson, 1996; et al, 2020et al, , Sze et al 2001). These difficulties could impact a patient's ability to understand and follow the instructions required to transfer, use equipment and ambulate safely, resulting in a fall (Mion et al, 1989;Nyberg & Gustafson, 1995;Zdobysz et al, 2005).…”

Falls in Patients With Communication Disability Secondary to Stroke

“…It is estimated that communication disability (e.g., aphasia) affects approximately 64% of people with stroke, particularly those with left hemisphere stroke (Mitchell et al, 2020). Decreased ability to communicate with healthcare professionals can impact patient safety and the quality of care (Bartlett et al, 2008; Hemsley et al, 2013; Simmons-Mackie & Kagan, 2007; Sullivan et al, 2020). Patients with communication disability have unique factors that have the potential to contribute to falls in acute and rehabilitation hospitals, including problems communicating their basic needs (e.g., for using the toilet) and using the call bell to gain attention or assistance from staff (Hemsley et al, 2013; Sullivan & Harding, 2019; Sullivan et al, 2021).…”

“…Patients with communication disability are often excluded from falls research and where they are included, detailed reporting on communication disability is lacking (Hemsley et al, 2019). A recent systematic review and meta-analysis (Sullivan et al, 2020) found no association between communication disability and falls in acute or rehabilitation hospitals, but the included studies were limited by (a) failing to report on the severity of participants’ communication difficulties, and (b) excluding participants with severe strokes, a population more likely to experience both communication disability and falls (Mitchell et al, 2020; Sullivan et al, 2020). Subsequently, a review of prior research aiming to identify contributing factors, hazards, and outcomes of falls for patients with communication disability following stroke found no specific research to inform falls prevention strategies and further research (Sullivan et al, 2021).…”

Association Between Falling and Activities of Daily Living Measured by the Longshi Scale in Patients Poststroke

“…Falls are also connected with the level of functional dependence on activities of daily living (ADL) 11. ADL performance is one of the primary explanatory variables of falls in patients who have suffered a stroke 12.…”

“…2,3 Falls have negative effects on the rehabilitation of patients who have suffered a stroke and increase the burden on family costs and the health care Falls are also connected with the level of functional dependence on activities of daily living (ADL). 11 ADL performance is one of the primary explanatory variables of falls in patients who have suffered a stroke. 12 Recently, a pictorial and innovative tool, the Longshi Scale (LS), was designed to evaluate ADL of individuals.…”