title: An integrative review of factors associated with falls during post-stroke rehabilitation.
abstract: OBJECTIVE
  Our aims were to evaluate evidence of risk factors for falls among patients in stroke rehabilitation and to offer recommendations for clinical practice and future research.
  
  
  METHODS
  We conducted an integrative review of the literature published from 1990 to 2009 that describes empirical investigations of risk factors for post-stroke falls during inpatient rehabilitation. We searched Medline, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycInfo, and Embase databases, using the search terms "accidental falls,""fall risk,""risk factors,""risk assessment,""stroke," and "cerebrovascular disorders." We extracted information regarding study design, sample, potential risk factors, analytic methods, findings, and limitations from the 14 articles that met our inclusion criteria, and we rated the level of evidence for each study.
  
  
  RESULTS
  Available empirical evidence points to impaired balance, visuospatial hemineglect, and impaired performance of activities of daily living as risk factors for falls during inpatient rehabilitation for stroke. Associations between falls and cognitive function, incontinence, visual field deficits, and stroke type were less clear, while relationships between falls and age, gender, stroke location, and impaired vision and hearing were not supported.
  
  
  CONCLUSIONS
  The relatively sparse literature pertaining to risk factors for falls among stroke rehabilitation inpatients indicates that deficits affecting balance, perception, and self-care significantly increase the likelihood of falls. Particularly intriguing is the less well established role of post-stroke cognition in falls in this population. A conceptual model is needed to guide scientific inquiry and clinical practice in this area.
  
  
  CONCLUSIONS
  When clinicians in the inpatient stroke rehabilitation setting evaluate which patients are at greatest risk to fall, stroke-specific risk factors such as impaired balance, visuospatial hemineglect, and self-care deficits may be better predictors than more general risk factors such as age, incontinence, and sensory impairments. Patients with these stroke-specific deficits may benefit from the use of aggressive fall prevention interventions.
authors.affiliation: University of Pittsburgh, School of Nursing, 3500 Victoria Street, Pittsburgh, PA 15261, USA. gbc3@pitt.edu
authors.forename: Grace B
authors.initials: GB
authors.lastname: Campbell
authors.forename: Judith Tabolt
authors.initials: JT
authors.lastname: Matthews
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control / Q000706:statistics & numerical data*; D000368:Aged; D003072:Cognition Disorders / Q000150:complications; D015577:Geriatric Assessment; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D009730:Nursing Assessment; D015399:Nursing Research / Q000458:organization & administration; D010468:Perceptual Disorders / Q000150:complications; D004856:Postural Balance; D012107:Research Design; D018570:Risk Assessment; D012307:Risk Factors; D012648:Self Care; D012678:Sensation Disorders / Q000150:complications; D020521:Stroke / Q000150:complications; D000071939:Stroke Rehabilitation