Comparison of Fallers and Nonfallers at an Inpatient Rehabilitation Facility: A Retrospective Review

Abstract

Patients in an inpatient rehabilitation facility (IRF) are at increased fall risk. However, little IRF research has focused on fall risk.Purpose: The purpose of this study was to retrospectively examine differences between 35 patients who fell and 35 who did not during their IRF stay . Method:The following admission data were compared: age, gender, diagnosis, Morse Fall Scale score, and 18 Functional Independence Measure (FIM) scores. Independent t-tests were conducted for age and FIM scores, Mann-Whitney test was conducted for Morse scores, and chi-square tests were conducted for gender and diagnosis to examine differences between fallers and nonfallers.Findings: There were no significant differences between groups for age, gender, diagnosis, or Morse scores. However, there were significant differences for 12 FIM items, and FIM Motor, Cognitive, and Total scores. Findings:The results suggest that the Morse Scale may not be the most appropriate tool for assessing fall risk in an IRF. Conclusions and clinical relevance:Decisions about fall risk should consider admission FIM scores.

A Case-control Study Examining the Characteristics of Patients who Fall in an Inpatient Traumatic Brain Injury Rehabilitation Setting

“…These results fall short of some studies, 12 developed within rehabilitation settings. 7,37 Although being divergent from its original purpose, inclusion of individual FIM items in such instruments is a complicated clinical adaptation of FIM.…”

“…This finding concurs with several other studies encompassing a diverse range of rehabilitation settings. [3][4][5]7,12,[35][36][37][38][39] The most salient finding from the FIM data set is that, on the basis of FIM subscale scores, patients with a TBI in the rehabilitation setting with motor impairments alone are significantly more likely to fall compared with those with only cognitive impairments. In part, these results are reflected in 2 other data sets-(1) patients with history of falls on admission were more than 10 times more likely than patients without history of falls to have impaired mobility and require assistance for ADLs, transfers, and continence/toileting; and (2) 55% of patients without history of falls were admitted in PTA.…”

“…A recent study conducted within a community-based residential TBI rehabilitation center identified that total number of medications prescribed, anticholinergic medications, the number of medical complications, dietary restrictions, postinjury coma and coma greater than 24 hours, and bladder/bowel dysfunction were significantly associated with fallers. 11 In mixed inpatient rehabilitation settings where varying proportions of patients with a TBI are being rehabilitated, certain individual Functional Independence Measure (FIM) items, total and subscale scores, 5,7,12 and executive and visuospatial functioning impairments 13 have further been associated with fallers. Perhaps the most salient fall risk variable yet to be studied in the inpatient TBI rehabilitation context is post-traumatic amnesia (PTA).…”

Risk Analysis of Falls in Patients Undergoing Allogeneic Hematopoietic Stem Cell Transplantation

“…Inform ation on the follow ing variables w as extracted from each pa tien t's medical chart: (a) age and gender, (b) fall incident, (c) location and circum stances surrounding each incident, (d) date of the fall and medications used at that time, (e) tim e of the fall, (f) cause of the fall, (g) score on the Functional Inde pendence Measure (FIM) (Forrest et al, 2012;Kwan, Kaplan, Hudson-McKinney, Redman-Bentley, & Rosario, 2012), (h) patien t's response to the fall, and (i) re sult of the Picture-Frustration (P-F) Study (Rosenzweig, 1945). Inform ation on the follow ing variables w as extracted from each pa tien t's medical chart: (a) age and gender, (b) fall incident, (c) location and circum stances surrounding each incident, (d) date of the fall and medications used at that time, (e) tim e of the fall, (f) cause of the fall, (g) score on the Functional Inde pendence Measure (FIM) (Forrest et al, 2012;Kwan, Kaplan, Hudson-McKinney, Redman-Bentley, & Rosario, 2012), (h) patien t's response to the fall, and (i) re sult of the Picture-Frustration (P-F) Study (Rosenzweig, 1945).…”

The predictive value of fall assessment tools for patients admitted to hospice care

“…Fall assessment tools, which are commonly used to predict which patients are likely to fall or not, are designed for use in specific healthcare settings1–18 for a specific disease,7 13 19–22 for patients of a similar age3–6 10 14 16 20 23–25 or for general use 26–28. Previous reports compare the predictive values of one tool with another8 9 15 17 20 26 or evaluate the predictive value of a single tool,6 7 14 29 30 then fault the tool's predictive ability when it appears that the tool grossly overestimated or underestimated the likelihood of fall. Predictive ability is further confounded because risk is not recalculated and adjusted after implementation of fall prevention interventions.…”