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Original Research| Volume 97, ISSUE 4, P561-566, April 2016

Do Falls Experienced During Inpatient Stroke Rehabilitation Affect Length of Stay, Functional Status, and Discharge Destination?

  • Jennifer S. Wong
    Correspondence
    Corresponding author Jennifer S. Wong, MSc, 550 University Ave, Room 12-019, Toronto, ON, Canada, M5G 2A2.
    Affiliations
    Toronto Rehabilitation Institute – University Health Network, Toronto, ON, Canada

    Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
    Search for articles by this author
  • Dina Brooks
    Affiliations
    Toronto Rehabilitation Institute – University Health Network, Toronto, ON, Canada

    Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada

    Department of Physical Therapy, University of Toronto, Toronto, ON, Canada

    West Park Healthcare Centre, Toronto, ON, Canada

    Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Toronto, ON, Canada
    Search for articles by this author
  • Avril Mansfield
    Affiliations
    Toronto Rehabilitation Institute – University Health Network, Toronto, ON, Canada

    Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada

    Department of Physical Therapy, University of Toronto, Toronto, ON, Canada

    Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Toronto, ON, Canada

    Evaluative Clinical Sciences, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
    Search for articles by this author
Published:December 19, 2015DOI:https://doi.org/10.1016/j.apmr.2015.12.005

      Abstract

      Objective

      To compare length of stay, functional status, and discharge destination between individuals who fell during inpatient stroke rehabilitation and those who did not fall.

      Design

      Retrospective cohort study.

      Setting

      Rehabilitation hospital.

      Participants

      Individuals who fell during inpatient stroke rehabilitation (n=106; fallers group; mean age, 67.8±12.9y; mean time poststroke, 26.4±28.3d) were matched to individuals who did not fall (n=106; nonfallers group; mean age, 67.3±13.6y; mean time poststroke, 21.9±28.8d) on age and functional status (N=212).

      Interventions

      Not applicable.

      Main Outcome Measures

      Total length of stay, FIM assessed at discharge, and discharge destination.

      Results

      The mean length of stay for fallers was 11 days longer than nonfallers (P=.0017). Nonfallers and fallers did not differ on discharge total FIM scores (P=.19), and both groups were discharged home after inpatient rehabilitation (nonfallers: 77%; fallers: 74%; P=.52).

      Conclusions

      This study suggests that falls experienced during inpatient stroke rehabilitation may have contributed to a longer length of stay; however, falls did not affect discharge functional status or discharge destination.

      Keywords

      List of abbreviations:

      ALC (alternate level of care), BBS (Berg Balance Scale), LOS (length of stay)
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      References

        • Czernuszenko A.
        • Czlonkowska A.
        Risk factors for falls in stroke patients during inpatient rehabilitation.
        Clin Rehabil. 2009; 23: 176-188
        • Nyberg L.
        • Gustafson Y.
        Patient falls in stroke rehabilitation. A challenge to rehabilitation strategies.
        Stroke. 1995; 26: 838-842
        • Suzuki T.
        • Sonoda S.
        • Misawa K.
        • Saitoh E.
        • Shimizu Y.
        • Kotake T.
        Incidence and consequence of falls in inpatient rehabilitation of stroke patients.
        Exp Aging Res. 2005; 31: 457-469
        • Sze K.H.
        • Wong E.
        • Leung H.Y.
        • Woo J.
        Falls among Chinese stroke patients during rehabilitation.
        Arch Phys Med Rehabil. 2001; 82: 1219-1225
        • Teasell R.
        • McRae M.
        • Foley N.
        • Bhardwaj A.
        The incidence and consequences of falls in stroke patients during inpatient rehabilitation: factors associated with high risk.
        Arch Phys Med Rehabil. 2002; 83: 329-333
        • Weerdesteyn V.
        • de Niet M.
        • van Duijnhoven H.J.
        • Geurts A.C.
        Falls in individuals with stroke.
        J Rehabil Res Dev. 2008; 45: 1195-1213
        • Zdobysz J.A.
        • Boradia P.
        • Ennis J.
        • Miller J.
        The relationship between functional independence scores on admission and patient falls after stroke.
        Top Stroke Rehabil. 2005; 12: 65-71
        • Andersson A.G.
        • Kamwendo K.
        • Seiger A.
        • Appelros P.
        How to identify potential fallers in a stroke unit: validity indexes of 4 test methods.
        J Rehabil Med. 2006; 38: 186-191
        • Rapport L.J.
        • Webster J.S.
        • Flemming K.L.
        • et al.
        Predictors of falls among right-hemisphere stroke patients in the rehabilitation setting.
        Arch Phys Med Rehabil. 1993; 74: 621-626
        • Batchelor F.A.
        • Mackintosh S.F.
        • Said C.M.
        • Hill K.D.
        Falls after stroke.
        Int J Stroke. 2012; 7: 482-490
        • Mackintosh S.F.
        • Hill K.
        • Dodd K.J.
        • Goldie P.
        • Culham E.
        Falls and injury prevention should be part of every stroke rehabilitation plan.
        Clin Rehabil. 2005; 19: 441-451
        • Ramnemark A.
        • Nyberg L.
        • Borssen B.
        • Olsson T.
        • Gustafson Y.
        Fractures after stroke.
        Osteoporos Int. 1998; 8: 92-95
        • Watanabe Y.
        Fear of falling among stroke survivors after discharge from inpatient rehabilitation.
        Int J Rehabil Res. 2005; 28: 149-152
        • Forster A.
        • Young J.
        Incidence and consequences of falls due to stroke: a systematic inquiry.
        BMJ. 1995; 311: 83-86
        • Davenport R.J.
        • Dennis M.S.
        • Wellwood I.
        • Warlow C.P.
        Complications after acute stroke.
        Stroke. 1996; 27: 415-420
        • McLean D.E.
        Medical complications experienced by a cohort of stroke survivors during inpatient, tertiary-level stroke rehabilitation.
        Arch Phys Med Rehabil. 2004; 85: 466-469
        • Kwakkel G.
        • Kollen B.
        • Lindeman E.
        Understanding the pattern of functional recovery after stroke: facts and theories.
        Restor Neurol Neurosci. 2004; 22: 281-299
        • Teasell R.
        • Foley N.
        • Hussein N.
        • Speechley M.
        The elements of stroke rehabilitation. Evidence-based review of stroke rehabilitation.
        16th ed. 2013 (Available at: www.ebrsr.com. Accessed February 17, 2015.)
        • Batchelor F.
        • Hill K.
        • Mackintosh S.
        • Said C.
        What works in falls prevention after stroke?: a systematic review and meta-analysis.
        Stroke. 2010; 41: 1715-1722
        • Verheyden G.S.
        • Weerdesteyn V.
        • Pickering R.M.
        • et al.
        Interventions for preventing falls in people after stroke.
        Cochrane Database Syst Rev. 2013; 5: CD008728
        • Keith R.A.
        • Granger C.V.
        • Hamilton B.B.
        • Sherwin F.S.
        The functional independence measure: a new tool for rehabilitation.
        Adv Clin Rehabil. 1987; 1: 6-18
        • Ory M.G.
        • Schechtman K.B.
        • Miller J.P.
        • et al.
        Frailty and injuries in later life: the FICSIT trials.
        J Am Geriatr Soc. 1993; 41: 283-296
        • Maeda N.
        • Kato J.
        • Shimada T.
        Predicting the probability for fall incidence in stroke patients using the Berg Balance Scale.
        J Int Med Res. 2009; 37: 697-704
        • Sutherland J.M.
        • Walker J.
        Challenges of rehabilitation case mix measurement in Ontario hospitals.
        Health Policy. 2008; 85: 336-348
        • Berg K.O.
        • Wood-Dauphinee S.L.
        • Williams J.I.
        • Maki B.
        Measuring balance in the elderly: validation of an instrument.
        Can J Public Health. 1992; 83: S7-S11
        • Hill A.M.
        • Hoffmann T.
        • Hill K.
        • et al.
        Measuring falls events in acute hospitals-a comparison of three reporting methods to identify missing data in the hospital reporting system.
        J Am Geriatr Soc. 2010; 58: 1347-1352
        • Ottenbacher K.J.
        • Hsu Y.
        • Granger C.V.
        • Fiedler R.C.
        The reliability of the functional independence measure: a quantitative review.
        Arch Phys Med Rehabil. 1996; 77: 1226-1232
        • Beninato M.
        • Gill-Body K.M.
        • Salles S.
        • Stark P.C.
        • Black-Schaffer R.M.
        • Stein J.
        Determination of the minimal clinically important difference in the FIM instrument in patients with stroke.
        Arch Phys Med Rehabil. 2006; 87: 32-39
        • Gettens S.
        • Fulbrook P.
        Fear of falling: association between the Modified Falls Efficacy Scale, in-hospital falls and hospital length of stay.
        J Eval Clin Pract. 2015; 21: 43-50
        • Grant C.
        • Goldsmith C.H.
        • Anton H.A.
        Inpatient stroke rehabilitation lengths of stay in Canada derived from the National Rehabilitation Reporting System, 2008 and 2009.
        Arch Phys Med Rehabil. 2014; 95: 74-78
        • Pereira S.
        • Graham J.R.
        • Shahabaz A.
        • et al.
        Rehabilitation of individuals with severe stroke: synthesis of best evidence and challenges in implementation.
        Top Stroke Rehabil. 2012; 19: 122-131
        • Hayward K.S.
        • Kuys S.S.
        • Barker R.N.
        • Brauer S.G.
        Clinically important improvements in motor function are achievable during inpatient rehabilitation by stroke patients with severe motor disability: a prospective observational study.
        NeuroRehabilitation. 2014; 34: 773-779
        • Mackintosh S.F.
        • Hill K.D.
        • Dodd K.J.
        • Goldie P.A.
        • Culham E.G.
        Balance score and a history of falls in hospital predict recurrent falls in the 6 months following stroke rehabilitation.
        Arch Phys Med Rehabil. 2006; 87: 1583-1589
        • Rabadi M.H.
        Risk factors for falls in stroke patients during inpatient rehabilitation.
        Clin Rehabil. 2009; 23 (author reply 464): 463
        • Aizen E.
        • Shugaev I.
        • Lenger R.
        Risk factors and characteristics of falls during inpatient rehabilitation of elderly patients.
        Arch Gerontol Geriatr. 2007; 44: 1-12
        • Vassallo M.
        • Sharma J.C.
        • Briggs R.S.
        • Allen S.C.
        Characteristics of early fallers on elderly patient rehabilitation wards.
        Age Ageing. 2003; 32: 338-342
        • Hess D.R.
        Retrospective studies and chart reviews.
        Respir Care. 2004; 49: 1171-1174