Risk factors for falls in stroke patients during inpatient rehabilitation.
OBJECTIVE
To assess the incidence and circumstances of falls among stroke patients in a rehabilitation ward, the frequency of fall-related fractures, the relationship between falls and rehabilitation outcomes, and risk factors for falls.


METHODS
Prospective observational study.


METHODS
Neurological rehabilitation ward.


METHODS
In total 1155 patients (56% men; mean age 61.5 +/- 14.3 years) admitted to the neurological rehabilitation ward after a stroke. Median (interquartile range) time since stroke onset was 36.5 (68) days.


METHODS
Patients' falls were registered during hospitalization (1-74 days) and variables relating to the type and symptoms of stroke, current medications, neurological deficit (Scandinavian Stroke Scale) and disability (Barthel Index) were collected from medical records.


RESULTS
A total of 252 falls were recorded for 189 (16.3%) patients and 45 patients experienced 108 repeated falls. The incidence rate for falls was 7.6/1000 patient-days (95% confidence interval (CI) 6.6-8.5). Most patients fell while being transferred (33.9%) and while seated (21.5%), and 1.2% of falls resulted in fractures (n = 3). Increased risk of both first and multiple falls was strongly associated with initial Barthel score below 15 (hazard ratio (HR) 5.2 and 4.5, respectively) and time since stroke onset > or = 12 weeks (HR 2.3 and 2.3, respectively). First falls were significantly associated with visuo-spatial neglect (HR 1.5). Repeated falls were related to age greater than 65 years (HR 1.4).


CONCLUSIONS
Patients with severe stroke-related disability in the early period after stroke are prone to falls during rehabilitation. Multiple falls are most frequent in patients over 65 years of age.
Czernuszenko
Anna
A
Institute of Psychiatry and Neurology, Second Department of Neurology, Warsaw, Poland. anna.czernuszenko@gmail.com
Członkowska
Anna
A
D000058:Accidental Falls / Q000706:statistics & numerical data*; D000367:Age Factors; D000368:Aged; D015984:Causality; D015897:Comorbidity; D004185:Disability Evaluation; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007297:Inpatients; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020127:Recovery of Function; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology; D000071939:Stroke Rehabilitation