title: Falls and fallers in traumatic brain injury (TBI) rehabilitation settings: an integrative review.
abstract: OBJECTIVE
  To critically appraise the research literature on the nature of falls and fallers in traumatic brain injury (TBI) rehabilitation settings.
  
  
  METHODS
  An integrative review of the literature using thematic analysis was undertaken. Papers identified via a systematic search strategy were independently appraised by two reviewers. A data extraction instrument was developed to record results and to aid identification of themes in the literature. Critical Appraisal Skills Programme instruments were utilised to conduct a methodological critique of the papers included.
  
  
  RESULTS
  Thirteen studies were identified as having between 4% and 100% TBI patients in their study cohorts. From these papers, up to 71% of falls took place in a patient's bedroom occurring in peaks and troughs over a 24-h period. With some divergent results, nine themes were identified describing faller characteristics including: (1) functional mobility impairments; (2) dizziness; (3) bladder and bowel dysfunction; (4) certain medications and number of medications prescribed; (5) executive functioning; (6) patient age; (7) fear of falling; (8) coma length following TBI; and (9) Functional Independence Measure (FIM™) total score, subscale scores and particular individual items.
  
  
  CONCLUSIONS
  Being a multifactorial phenomenon, falls are a complex clinical issue. Despite the heterogeneity of diagnosis related groups (DRGs) in the included studies, TBI patients were identified as a high falls risk patient population in several studies. Implications for Rehabilitation Due to multisystem impairments, falls in the traumatic brain injury (TBI) rehabilitation context are a multifactorial and significant clinical issue. When interpreting and generalising results from research into falls, clinicians need to be mindful that falls and faller characteristics may be dependent on study setting and patient population. There is need for context specific research into faller characteristics following a TBI; particularly in relation to post-traumatic amnesia.
authors.affiliation: a Sydney Nursing School, The University of Sydney , Sydney , New South Wales , Australia .|b Brain Injury Unit , Royal Rehab , Sydney , New South Wales , Australia , and.
authors.forename: Duncan
authors.initials: D
authors.lastname: McKechnie
authors.affiliation: a Sydney Nursing School, The University of Sydney , Sydney , New South Wales , Australia .|c Nursing Research and Development , Royal Rehab , Sydney , New South Wales , Australia.
authors.forename: Julie
authors.initials: J
authors.lastname: Pryor
authors.affiliation: a Sydney Nursing School, The University of Sydney , Sydney , New South Wales , Australia .|c Nursing Research and Development , Royal Rehab , Sydney , New South Wales , Australia.
authors.forename: Murray J
authors.initials: MJ
authors.lastname: Fisher
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D001930:Brain Injuries / Q000534:rehabilitation*; D056344:Executive Function; D006801:Humans
keywords: Brain injury; TBI; fall; faller; head injury