Current state of fall prevention and management policies and procedures in Canadian spinal cord injury rehabilitation

Singh, Hardeep; Flett, Heather; Silver, Michelle Pannor; Craven, B. Catharine; Jaglal, Susan; Musselman, Kristin E.

doi:10.1186/s12913-020-05168-8

Cited by 7 publications

(6 citation statements)

References 35 publications

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“…The delivery of fall prevention education and training is a required organisational practice at hospitals involved with SCI rehabilitation. 23 Despite this requirement, fall prevention initiatives were deemed inadequate by healthcare administrators, 24 physical and occupational therapists 25 and individuals with SCI. 7 26 Fall prevention in the form of balance exercises is implemented during SCI rehabilitation, yet little time is spent on this intervention.…”

Section: Introductionmentioning

confidence: 99%

Protocol for a single group, mixed methods study investigating the efficacy of photovoice to improve self-efficacy related to balance and falls for spinal cord injury

Sessford

Chan²,

Kaiser³

et al. 2022

BMJ Open

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IntroductionMany individuals living with spinal cord injury (SCI) experience falls and a fear of falling, both of which can impact participation in daily activities and quality of life. A single group, convergent mixed methods study will be conducted to examine the effects of a photovoice intervention on falls self-efficacy among individuals living with chronic SCI. Secondary objectives include examining the effects of photovoice on fear of falling, participation and quality of life and exploring participants’ experiences and perceptions of the photovoice intervention through qualitative interviews.Methods and analysisAdults with SCI (n=40) will be divided into groups according to their mobility status (ie, those who ambulate and those who primarily use a wheelchair). The study will be conducted virtually over three consecutive phases, totalling 30 weeks. Each group will self-report falls for 12 weeks prior to and following the intervention (phases 1 and 3, respectively). The 6-week photovoice intervention (phase 2) will be comprised of two photo assignments, two individual interviews with a researcher and a peer mentor, and four group meetings. Participants will discuss these photos at the interviews and group meetings. Standardised questionnaires of falls self-efficacy, fear of falling, participation and life satisfaction will be administered at four time points (ie, beginning of each phase and the end of phase 3). Questionnaire scores will be examined over time using repeated-measures analysis of variance. A semistructured interview will be completed at the end of phase 3 to gain feedback on the photovoice intervention. Qualitative data will be analysed using reflexive thematic analysis.Ethics and disseminationEthics approval was obtained prior to study enrolment. Findings will be shared through peer-reviewed scientific publications and participant-directed knowledge translation activities.Trial registration numberNCT04864262.

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Section: Introductionmentioning

confidence: 99%

Protocol for a single group, mixed methods study investigating the efficacy of photovoice to improve self-efficacy related to balance and falls for spinal cord injury

Sessford

Chan²,

Kaiser³

et al. 2022

BMJ Open

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“…Reported fall rates for persons with a SCI in neurorehabilitation wards are as high as 24% [4]. These rates suggest it is vital that fall prevention begins during inpatient rehabilitation [5] and highlights the need for understanding the nature of falls during this phase of recovery.…”

Section: Introductionmentioning

confidence: 99%

Falls on an inpatient rehabilitation spinal injuries unit: the characteristics, circumstances, and consequences

et al. 2022

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Study design Retrospective audit Objectives To describe the nature of falls and fallers in a spinal injuries unit (SIU) and identify factors associated with having more than one fall (recurrent fallers) and falls with physical or psychological consequences (consequential falls). Setting An Australian inpatient rehabilitation SIU. Methods Data were retrospectively extracted from falls incident reports and electronic medical records over a 5-year period. Data were analysed descriptively to summarise participant and fall details. Univariate analyses identified candidate variables for further investigation in a multivariate model for recurrent fallers and consequential falls. Results Of the 566 persons admitted to the SIU, 132 (23%) participants experienced 207 falls over the 5 years. Of the fallers, 41 (31%) were recurrent fallers experiencing between 2 and 7 falls and 78 (59%) experienced a consequential fall. No significant variables were identified for recurrent fallers. For consequential falls, older age (OR = 1.038, 95% CI, 1.012 to 1.064, p = 0.004) and female gender (OR = 3.581, 95% CI, 1.269 to 10.103, p = 0.016) were significant, as well as falls that occurred on a Sunday (OR = 0.196, 95% CI, 0.061 to 0.630, p = 0.006). Falls while transferring were less likely to be consequential (OR = 4.100, 95% CI, 1.706 to 9.856, p = 0.002). Conclusions Nearly one quarter of SIU inpatients experienced a fall with almost a third of those who fell experiencing recurrent falls. Older age, female gender, and Sundays were risk factors for falls with consequence.

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“…Because of the detrimental effect of falls, there is an emphasis on fall prevention in SCI/D rehabilitation. 7 , 8 A key fall prevention initiative is the use of screening tools to gauge fall risk 8 ; however, tools that query the presence/absence of general fall risk factors were reported to lack clinical utility for the SCI/D population. 7 , 8 Clinicians report that almost all individuals with SCI/D score as having a high fall risk on these tools.…”

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confidence: 99%

“… 7 , 8 A key fall prevention initiative is the use of screening tools to gauge fall risk 8 ; however, tools that query the presence/absence of general fall risk factors were reported to lack clinical utility for the SCI/D population. 7 , 8 Clinicians report that almost all individuals with SCI/D score as having a high fall risk on these tools. 7 , 8 More sensitive, clinical measures may be more appropriate for assessing fall risk after SCI/D.…”

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confidence: 99%

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Evaluating Intrinsic Fall Risk Factors After Incomplete Spinal Cord Injury: Distinguishing Fallers From Nonfallers

Musselman

Arora

Chan

et al. 2021

Archives of Rehabilitation Research and Clinical Translation

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Objective To determine whether performance on measures of lower extremity muscle strength, sensory function, postural control, gait speed, and balance self-efficacy could distinguish fallers from nonfallers among ambulatory individuals with spinal cord injury or disease (SCI/D). Design Prospective cohort study. Setting Community. Participants Individuals (N=26; 6 female, aged 58.9±18.2y) with motor incomplete SCI/D (American Spinal Injury Association Impairment Scale rating C [n=5] or D [n=21]) participated. Participants were 7.5±9.1 years post injury. Seventeen participants experienced traumatic causes of spinal cord injury. Main Outcome Measures Participants completed laboratory-based and clinical measures of postural control, gait speed, balance self-efficacy, and lower extremity strength, as well as proprioception and cutaneous pressure sensitivity. Participants were then followed for up to 1 year to track falls using a survey. The survey queried the circumstances and consequences of each fall. If a participant’s number of falls equaled or exceeded the median number of falls experience by all participants, they were classified a faller. Results Median follow-up duration was 362 days and median time to first fall was 60.5 days. Fifteen participants were classified as fallers. Most falls occurred during the morning or afternoon (81%), at home (75%), and while walking (47%). The following laboratory-based and clinical measures distinguished fallers from nonfallers ( P <.05): measures of lower extremity strength, cutaneous pressure sensitivity, walking speed, and center of pressure velocity in the mediolateral direction. Conclusions There are laboratory-based and clinical measures that can prospectively distinguish fallers from nonfallers among ambulatory individuals with spinal cord injury. These findings may assist clinicians when evaluating their patients’ fall risk.

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Current state of fall prevention and management policies and procedures in Canadian spinal cord injury rehabilitation

Cited by 7 publications

References 35 publications

Protocol for a single group, mixed methods study investigating the efficacy of photovoice to improve self-efficacy related to balance and falls for spinal cord injury

Protocol for a single group, mixed methods study investigating the efficacy of photovoice to improve self-efficacy related to balance and falls for spinal cord injury

Falls on an inpatient rehabilitation spinal injuries unit: the characteristics, circumstances, and consequences

Evaluating Intrinsic Fall Risk Factors After Incomplete Spinal Cord Injury: Distinguishing Fallers From Nonfallers

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