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Factors Associated With Recurrent Falls in Individuals With Traumatic Spinal Cord Injury: A Multicenter Study

  • Author Footnotes
    ∗ Jørgensen and Forslund contributed equally to this work.
    Vivien Jørgensen
    Footnotes
    ∗ Jørgensen and Forslund contributed equally to this work.
    Affiliations
    Department of Neurobiology, Karolinska Institutet, Care Sciences and Society, Division of Physiotherapy, Stockholm, Sweden

    Department of Research, Sunnaas Rehabilitation Hospital, Nesodden, Norway
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  • Author Footnotes
    ∗ Jørgensen and Forslund contributed equally to this work.
    Emelie Butler Forslund
    Correspondence
    Corresponding author Emelie Butler Forslund, PT, MSc, Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, 23100, S-141 83 Huddinge, Sweden.
    Footnotes
    ∗ Jørgensen and Forslund contributed equally to this work.
    Affiliations
    Department of Neurobiology, Karolinska Institutet, Care Sciences and Society, Division of Physiotherapy, Stockholm, Sweden

    Rehab Station Stockholm/Spinalis Research and Development Unit, Stockholm, Sweden
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  • Erika Franzén
    Affiliations
    Department of Neurobiology, Karolinska Institutet, Care Sciences and Society, Division of Physiotherapy, Stockholm, Sweden

    Department of Research, Sunnaas Rehabilitation Hospital, Nesodden, Norway

    Karolinska University Hospital, Stockholm, Sweden
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  • Arve Opheim
    Affiliations
    Department of Research, Sunnaas Rehabilitation Hospital, Nesodden, Norway
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  • Åke Seiger
    Affiliations
    Rehab Station Stockholm/Spinalis Research and Development Unit, Stockholm, Sweden

    Department of Neurobiology, Karolinska Institutet, Care Sciences and Society, Division of Neurodegeneration, Stockholm, Sweden
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  • Agneta Ståhle
    Affiliations
    Department of Neurobiology, Karolinska Institutet, Care Sciences and Society, Division of Physiotherapy, Stockholm, Sweden

    Department of Research, Sunnaas Rehabilitation Hospital, Nesodden, Norway

    Karolinska University Hospital, Stockholm, Sweden
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  • Claes Hultling
    Affiliations
    Karolinska University Hospital, Stockholm, Sweden

    Department of Neurobiology, Karolinska Institutet, Care Sciences and Society, Division of Neurodegeneration, Stockholm, Sweden
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  • Johan K. Stanghelle
    Affiliations
    Department of Research, Sunnaas Rehabilitation Hospital, Nesodden, Norway

    Medical Faculty, University of Oslo, Oslo, Norway
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  • Author Footnotes
    † Wahman and Roaldsen contributed equally to this work.
    Kerstin Wahman
    Footnotes
    † Wahman and Roaldsen contributed equally to this work.
    Affiliations
    Rehab Station Stockholm/Spinalis Research and Development Unit, Stockholm, Sweden

    Department of Neurobiology, Karolinska Institutet, Care Sciences and Society, Division of Neurodegeneration, Stockholm, Sweden
    Search for articles by this author
  • Author Footnotes
    † Wahman and Roaldsen contributed equally to this work.
    Kirsti Skavberg Roaldsen
    Footnotes
    † Wahman and Roaldsen contributed equally to this work.
    Affiliations
    Department of Neurobiology, Karolinska Institutet, Care Sciences and Society, Division of Physiotherapy, Stockholm, Sweden

    Rehab Station Stockholm/Spinalis Research and Development Unit, Stockholm, Sweden
    Search for articles by this author
  • Author Footnotes
    ∗ Jørgensen and Forslund contributed equally to this work.
    † Wahman and Roaldsen contributed equally to this work.

      Highlights

      • Most persons with spinal cord injury should be considered at risk of falls.
      • Ambulatory, younger, and more active persons had higher risks of falls.

      Abstract

      Objective

      To identify factors associated with recurrent falls in individuals with traumatic spinal cord injury (SCI).

      Design

      Cross-sectional multicenter study.

      Setting

      Two specialized rehabilitation centers.

      Participants

      Included: individuals with traumatic SCI ≥1 year postinjury who were aged ≥18 years. Excluded: individuals with motor complete injuries above C5 or below L5. The study sample comprised participants (N=224; 151 wheelchair users, 73 ambulatory; 77% men; mean age ± SD, 50±15y; median time since injury, 15y [range, 1–56y]) who were consecutively recruited at regular follow-up.

      Interventions

      Not applicable.

      Main Outcome Measure

      Primary outcome was factors associated with recurrent falls (defined as low frequent [0–2] or recurrent [>2]) the previous year. Independent variables were demographic data, wheelchair user or ambulatory, work, health-related quality of life, risk willingness, alcohol consumption, ability to get up from the ground, and exercise habits.

      Results

      Fifty percent reported recurrent falls. In the final multiple logistic regression model, ambulation (odds ratio [OR]=2.67; 95% confidence interval [CI], 1.33–5.37), ability to get up from the ground (OR=2.22; 95% CI, 1.21–4.10), and regular exercise (OR=1.86; 95% CI, 1.05–3.31) were associated with recurrent falls (P≤.05), and with increasing age the OR decreased (OR=.97; 95% CI, .95–.99).

      Conclusions

      Individuals with SCI should be considered at risk of recurrent falls, and thereby at risk of fall-related injuries. Fall prevention programs should be focused on ambulatory, younger, and more active individuals who had the highest risks for recurrent falls.

      Keywords

      List of abbreviations:

      AIS (American Spinal Injury Association Impairment Scale), SCI (spinal cord injury), SCIM III (Spinal Cord Independence Measure version III)
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