title: Wheelchair-related falls in veterans with spinal cord injury residing in the community: a prospective cohort study.
abstract: OBJECTIVE
  (1) To determine the incidence of wheelchair falls and fall-related injuries in persons with spinal cord injury (SCI) living in the community. (2) To predict wheelchair-related falls and associated injuries from specific parameters including characteristics of the wheelchair user, wheelchair type and features, health care practices, wheelchair activities, and physical environment.
  
  
  METHODS
  This prospective cohort study followed participants monthly over 1 year; data were collected through surveys, interviews, performance testing, observation, and medical records.
  
  
  METHODS
  Three Veterans' Administration hospitals.
  
  
  METHODS
  Convenience sample of community-dwelling persons with SCI who used a wheelchair as their primary means of mobility (N=702).
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Self-reports of wheelchair falls and fall-related injuries, Wheelchair User Characteristics Survey, Health Status Checklist, Health-Related Behaviors, Zuckerman Sensation Seeking Scale, Wheelchair and Equipment-Related Behaviors, Wheelchair Characteristics, Wheelchair Skills Test, and Physical Environment Assessment.
  
  
  RESULTS
  Of the 659 subjects who completed the study, 204 participants (31%) reported 553 fall events, and 95 subjects (14%) were injured as a result of wheelchair falls. A logistic regression model for predicting wheelchair falls identified 6 significant risk factors: pain in previous 2 months, alcohol abuse, greater motor function, history of previous fall, fewer SCI years, and shorter length of wheelchair. Eighty-two percent of the variance for wheelchair fall events was explained by these 6 variables. A logistic regression model for predicting injurious falls identified 4 significant risk factors: pain in previous 2 months, greater motor function, history of previous fall, and inaccessible home entrance. These 4 factors were able to explain 81% of the variance for injurious falls.
  
  
  CONCLUSIONS
  This is the first study to determine the incidence of wheelchair-related falls in community-dwelling people with SCI who use a wheelchair. Results indicate the incidence of falls was 31% and injurious falls was 14%. Those at greatest risk can be predicted from some readily available information regarding their clinical status, wheelchair features, and home environment.
authors.affiliation: Health Services Research & Development, James A. Haley Veterans Hospital, Tampa, FL, USA. audrey.nelson@va.gov
authors.forename: Audrey L
authors.initials: AL
authors.lastname: Nelson
authors.forename: Shirley
authors.initials: S
authors.lastname: Groer
authors.forename: Polly
authors.initials: P
authors.lastname: Palacios
authors.forename: Douglas
authors.initials: D
authors.lastname: Mitchell
authors.forename: Sunil
authors.initials: S
authors.lastname: Sabharwal
authors.forename: R Lee
authors.initials: RL
authors.lastname: Kirby
authors.forename: Deborah
authors.initials: D
authors.lastname: Gavin-Dreschnack
authors.forename: Gail
authors.initials: G
authors.lastname: Powell-Cope
mesh_terms: D000058:Accidental Falls / Q000401:mortality / Q000706:statistics & numerical data*; D000328:Adult; D000368:Aged; D001107:Architectural Accessibility / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009068:Movement; D010146:Pain / Q000150:complications / Q000453:epidemiology; D012111:Residence Characteristics; D018570:Risk Assessment; D012959:Socioeconomic Factors; D013119:Spinal Cord Injuries / Q000534:rehabilitation*; D014481:United States; D014728:Veterans; D014910:Wheelchairs; D014947:Wounds and Injuries / Q000209:etiology*