Patients’ thoughts on their falls in a rehabilitation hospital: a qualitative study of patients with stroke

Abstract

Background Patients with stroke in rehabilitation wards are at an increased risk of falling. Although patients’ participation in establishing medical safety is considered crucial, there is limited evidence on their perspectives of falls. This study aims to comprehensively elucidate the subjective falling experience of patients with stroke who have been admitted to rehabilitation wards. Methods Twenty-three consecutive patients with stroke (44 to 90 years) who experienced a fall during hospitalisation were interviewed within 1 week after the fall, and thematic analysis was used to analyse the data. Results Five themes surrounding fall events were extracted from the narratives: ‘Psychological background before the action’, ‘Support for the action’, ‘Direct causes of the fall’, ‘Patients’ awareness after the fall’, and ‘Changes in attitudes and behaviours after the fall’. ‘Psychological background before the action’ comprised hastiness or hesitation to call for help. Participants often took an action based on ‘Support for the action’ derived from their past experiences of moving safely, their confidence, and/or motivation to challenge themselves to move. ‘Direct causes of the fall’ consisted of unfamiliar actions, training fatigue, the surrounding environment, reduced physical function due to paralysis, lack of attention, overconfidence in their ability, and insufficient prediction of falls. ‘Patients’ awareness after the fall’ consisted of re-affirming difficult movements, the need for rehabilitation, a reduced ability to move, an increased risk of falling, the need for attention while moving, a fear of falling, and a lack of lessons learned from falling. Finally, patients demonstrated ‘Changes in attitudes and behaviours after the fall’ such as embodying a positive attitude to cope with the risk of falling or behavioural changes to reduce the risk of falling. Conclusions Comprehensive information on patients’ perspectives before and after the fall was elucidated, uncovering many aspects including the psychological background for why patients engaged in risky behaviours resulting in falls, presence of positive thinking, and behaviour after the fall. By incorporating the patients’ views on fall incidences and their assessment, we can develop appropriate prevention strategies against falls.

Brain activation of the PFC during dual-task walking in stroke patients: A systematic review and meta-analysis of functional near-infrared spectroscopy studies

“…So they become involuntarily nervous and concentrated when challenged with complex tasks. The fear of falling may massively increase their focus to cope with unfamiliar or unpredictable situations (Aihara et al, 2021 ). Eventually the patient exhibits a cautious gait and an increase in the control of walking (Rosén et al, 2005 ; Schinkel-Ivy et al, 2016 ).…”

Association Between Falling and Activities of Daily Living Measured by the Longshi Scale in Patients Poststroke

“…This study also showed that patients with stroke in the domestic LS group experienced more falls than those in the bedridden and community groups. One possible explanation is that patients in domestic environments have more opportunities to participate in daily activities than bedridden patients, such as toileting, dressing, showering, using stairs, and turning 3. Walking and transfers were the most frequent activities at the time of falling 23.…”

“…One possible explanation is that patients in domestic environments have more opportunities to participate in daily activities than bedridden patients, such as toileting, dressing, showering, using stairs, and turning. 3 Walking and transfers were the most frequent activities at the time of falling. 23 Furthermore, domestic patients are more likely to have functional disorders than community patients, such as sensory impairment, deficiency of balance, and inattention to details and obstacles of surroundings.…”

“…There are more than 2 million new patients who suffer a stroke in China annually 1. Falls may occur at various stages poststroke, which are associated with adverse consequences, such as fracture, activity limitation, fear of falling, depression, and prolonged hospitalization 2,3. Falls have negative effects on the rehabilitation of patients who have suffered a stroke and increase the burden on family costs and the health care system 4.…”

Falls in Patients With Communication Disability Secondary to Stroke

“…Risk factors for falls in patients with stroke are known to be multifactorial and include difficulties with balance, neglect, and requiring assistance for activities of daily living (Campbell & Matthews, 2010; Denissen et al, 2019). The increased activity of patients as they undergo therapy to regain functional independence is suggested as a contributing factor to the high fall rates in inpatient rehabilitation stroke populations (Aihara et al, 2021; Suzuki et al, 2005; Sze et al, 2001). Hospital falls potentially result in a range of serious and preventable adverse consequences to both the patient and the health service, including injury, loss of functional capacity, increased length of stay, and cost of care (Constantinou & Spencer, 2020; K.…”