A qualitative description of falls in a neuro-rehabilitation unit: the use of a standardised fall report including the International Classification of Functioning (ICF) to describe activities and environmental factors

Abstract

Purpose: Falls are a recognised problem for people with long-term neurological conditions but less is known about fall risk in young adults. This study describes fallers’ and falls’ characteristics in adults less than 60 years old, in a neuro-rehabilitation unit. Methods: This single-centre, longitudinal, observational study included 114 consecutive admissions to a UK neuro-rehabilitation unit over 20 months. The demographic and clinical characteristics of eligible patients included age, sex, diagnosis, hospital length of stay and the Functional Independence Measure (FIM). Falls were recorded prospectively in a fall report, using the activities and environmental domains of the International Classification of Functioning (ICF). Results: A total of 34 (30%) patients reported a fall, with 50% experiencing more than one fall. The majority of falls (60%) occurred during the first 2 weeks, during day-time (90%) and during mobile activities (70%). Overall, falls rate (95% confidence interval) was 1.33 (1.04 to 1.67) per 100 d of patient hospital stay. Factors associated with increased falls included becoming a walker during admission or being cognitively impaired. There were no serious fall-related injuries. Conclusion: The first 2 weeks of admission is a high risk time for fallers, in particular those who become walkers or are cognitively impaired. Prevention policies should be put in place based on fall characteristics.

Implications for Rehabilitation

• The ICF is a valuable instrument for describing subject and environmental factors during a fall-event.

• Falls are frequent events but do not usually cause serious injuries during inpatient rehabilitation.

• There is an increased fall risk for subjects with cognitive impairments or those relearning how to walk.

• Cognitive
• fall risk
• International Classification of Functioning
• mobility
• rehabilitation

Acknowledgements

The authors thank the whole NRU team and Claire Mongibeaux, in particular, for their help in collecting data. They also thank Roberto Valente who helped to set up their database.

Declaration of interest

This research was not funded and the authors report no declarations of interest. Diane Playford was supported by the National Institute for Health Research University College London Hospitals Biomedical Research Centre.