Abstract
Objectives
To (1) determine fall characteristics (eg, cause, location, witnesses) of inpatients
with spinal cord injury (SCI) and whether they were different for ambulatory persons
vs wheelchair users; (2) visualize the total number of daily falls per clock-hour
for different inpatients’ features (eg, cause of injury, age); (3) compare clinical
and demographic characteristics of inpatients who experienced a first fall event vs
inpatients who did not experience such event; and (4) identify first fall event predictors.
Design
Retrospective observational cohort study.
Setting
Institution for inpatient neurologic rehabilitation.
Participants
Persons with SCI (N=1294) admitted to a rehabilitation facility between 2005 and 2022.
Interventions
Not applicable.
Main Outcome Measures
Functional independence measure (FIM), Hospital Anxiety and Depression Scale (HADS),
American Spinal Injury Association Impairment Scale (AIS), and Spinal Cord Independence
Measure (SCIM) at admission. Kaplan-Meier survival curves and Cox proportional hazards
models were used.
Results
A total of 502 fall events were experienced by 369 ambulatory inpatients (19.8%) and
wheelchair users (80.2%) in 63.9% of cases being alone, with cause, situation, and
location significantly different in both groups. Clock-hour visualizations revealed
an absolute peak at 12 AM (complete or incomplete injuries, with paraplegia or tetraplegia)
but a relative peak at 9 AM mainly including incomplete patients with paraplegia.
Of the (n=1294) included patients, 16.8% experienced at least 1 fall. Fallen patients
reported higher levels of HADS depression, lower total SCIM, and longer time since
injury to admission, with no differences in age, sex, educational level, FIM (quasi-significant),
and AIS grade. Multivariable Cox proportional hazards identified time since injury
to admission and AIS grade D as significant predictors of first fall event.
Conclusions
Falls identification, characterization, and clock-hour visualization can support decisions
for mitigation strategies specifically addressed to inpatients with SCI. Fall predictors
were identified as a first step for future research.
Keywords
List of abbreviations:
ADL (activity of daily living), AIS (American Spinal Injury Association Impairment Scale), FIM (functional independence measure), HADS (Hospital Anxiety and Depression Scale), IQR (interquartile range), SCI (spinal cord injury), SCIM (Spinal Cord Independence Measure), TSI (time since injury to rehabilitation admission)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: January 31, 2023
Accepted:
January 5,
2023
Received in revised form:
December 29,
2022
Received:
July 25,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
No project funding to be acknowledged.
Disclosures: none.
Identification
Copyright
© 2023 by the American Congress of Rehabilitation Medicine.
