Risk factors for falls in post-stroke patients treated in a neurorehabilitation ward.

BACKGROUND AND PURPOSE

Patients with neurological disorders, including post-stroke patients, are at high risk for falls. The purpose of the study was to estimate the number and type of falls and fall-related injuries in patients of a neurological rehabilitation ward and to identify risk factors for falls.

MATERIAL AND METHODS

353 consecutive post-stroke patients of the Neurorehabilitation Unit at the Institute of Psychiatry and Neurology in Warsaw were enrolled into the study and observed during the hospital stay. Falls occurring in patients during their hospital stay were registered and an analysis of fall-related data and the routinely obtained medical data was performed.

RESULTS

In the evaluated group, 35 (10%) patients suffered 50 falls, which corresponds to an incidence rate of 5.02 [95% confidence interval (95% CI): 3.70-6.52] falls per 1000 patient-days. Most falls occurred in patients' rooms (80%), most of them taking place while transferring from one place to another or while changing position. 2% of falls caused severe injury. There was a higher percentage of patients with unilateral neglect in the group of fallers (p=0.0007), who also demonstrated poorer performance in activities of daily living as expressed by the Rankin score (p <0.0002) and the Barthel Index (p <0.0001), and greater neurological deficit in the Scandinavian Stroke Scale (SSS) (p=0.002) at admission as well as at discharge from hospital than non-fallers. The risk of a fall showed greatest association with low Barthel Index at admission (<15/20; RR=10.3; 95% CI: 2.8-50.7), performance in the Rankin score of >3 (RR=5.12; 95% CI: 2,41-14,8), low SSS score on admission (0-39; RR=3.40; 95% CI: 1.62-9.14), and the presence of hemispatial neglect (RR=3.42; 95% CI: 1.23-6.53). The multiple-fallers group did not differ significantly from the group of single-fallers.

CONCLUSIONS

Among post-stroke patients, falls are a complication especially affecting persons with a large neurological deficit, severe disability and the neglect syndrome.