Falls in a rehabilitation setting: functional independence and fall risk.
OBJECTIVE
With this study we wanted to determine the incidence, characteristics and consequences of falls in our rehabilitation setting.


METHODS
An observational study was carried out in a rehabilitation setting for postacute orthopedic and neurological inpatients. Three-hundred and twenty patients were enrolled. Falls risk factors (Downton index [DI] and other known parameters), disability (functional independence measure [FIM]) and balance (Berg balance scale [BBS]) were assessed at admission. Falls that occurred during the rehabilitation stay were prospectively classified (St. Louis Older Adult Service and Information System [OASIS] system) and analyzed.


RESULTS
Forty patients experienced a fall (12.5%). The faller group was characterized by a major clinical complexity; 70% of fallers were neurological patients and 30% presented cognitive impairment (mini mental state examination [MMSE] <24). They presented a statistically significant worse score on FIM (motor and cognitive), BBS and DI at admission, with 74% predictability of falls as measured by total FIM score and age. Falls recorded with the OASIS classification showed a prevalence (52.5%) for not bipedal (wheelchair transfer) and self-generated falls; 35% were intrinsic falls (caused by subject-specific factors) and 12.5% extrinsic falls (caused by environmental factors). Falls resulted in only minor clinical consequences, except for one rib fracture, but led to a significant increase in length of stay.


CONCLUSIONS
In a rehabilitation centre, for good management of resources and safe prescriptions of a patient's independence in activities of daily living, fall risk is better evaluated with appropriate scales.
Saverino
A
A
Rehabilitation Institute, IRCCS, Salvatore Maugeri Foundation, Via Missolungi 14, 16100 Genoa-Nervi, Italy. asaverino@fsm.it
Benevolo
E
E
Ottonello
M
M
Zsirai
E
E
Sessarego
P
P
D000057:Accident Proneness; D000058:Accidental Falls / Q000706:statistics & numerical data*; D000203:Activities of Daily Living; D000368:Aged; D016009:Chi-Square Distribution; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D004856:Postural Balance; D012047:Rehabilitation Centers; D018570:Risk Assessment; D012307:Risk Factors; D018709:Statistics, Nonparametric