University of Pittsburgh, School of Nursing, 3500 Victoria Street, Pittsburgh, PA 15261, USA.
J Nurs Scholarsh. 2010 Dec;42(4):395-404. doi: 10.1111/j.1547-5069.2010.01369.x. Epub 2010 Oct 13.
Our aims were to evaluate evidence of risk factors for falls among patients in stroke rehabilitation and to offer recommendations for clinical practice and future research.
We conducted an integrative review of the literature published from 1990 to 2009 that describes empirical investigations of risk factors for post-stroke falls during inpatient rehabilitation. We searched Medline, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycInfo, and Embase databases, using the search terms "accidental falls,""fall risk,""risk factors,""risk assessment,""stroke," and "cerebrovascular disorders." We extracted information regarding study design, sample, potential risk factors, analytic methods, findings, and limitations from the 14 articles that met our inclusion criteria, and we rated the level of evidence for each study.
Available empirical evidence points to impaired balance, visuospatial hemineglect, and impaired performance of activities of daily living as risk factors for falls during inpatient rehabilitation for stroke. Associations between falls and cognitive function, incontinence, visual field deficits, and stroke type were less clear, while relationships between falls and age, gender, stroke location, and impaired vision and hearing were not supported.
The relatively sparse literature pertaining to risk factors for falls among stroke rehabilitation inpatients indicates that deficits affecting balance, perception, and self-care significantly increase the likelihood of falls. Particularly intriguing is the less well established role of post-stroke cognition in falls in this population. A conceptual model is needed to guide scientific inquiry and clinical practice in this area.
When clinicians in the inpatient stroke rehabilitation setting evaluate which patients are at greatest risk to fall, stroke-specific risk factors such as impaired balance, visuospatial hemineglect, and self-care deficits may be better predictors than more general risk factors such as age, incontinence, and sensory impairments. Patients with these stroke-specific deficits may benefit from the use of aggressive fall prevention interventions.
评估脑卒中康复患者发生跌倒的危险因素，并为临床实践和未来研究提供建议。
对 1990 年至 2009 年间发表的描述脑卒中后住院康复期间跌倒危险因素的实证研究进行综合评价。我们在 Medline、Cumulative Index to Nursing and Allied Health Literature（CINAHL）、PsycInfo 和 Embase 数据库中使用了“意外跌倒”、“跌倒风险”、“危险因素”、“风险评估”、“中风”和“脑血管疾病”等搜索词。我们从符合纳入标准的 14 篇文章中提取了研究设计、样本、潜在危险因素、分析方法、研究结果和局限性等信息，并对每项研究的证据水平进行了评价。
现有实证证据表明，平衡受损、视空间忽视和日常生活活动能力下降是脑卒中住院康复期间发生跌倒的危险因素。而跌倒与认知功能、尿失禁、视野缺损和脑卒中类型之间的关系则不太明确，而跌倒与年龄、性别、脑卒中部位以及视力和听力受损之间的关系则没有得到支持。
有关脑卒中住院康复患者跌倒危险因素的文献相对较少，这表明影响平衡、感知和自我护理的缺陷显著增加了跌倒的可能性。脑卒中后认知功能在该人群中对跌倒的作用尚未得到充分证实，这一点尤其引人注目。需要建立一个概念模型来指导该领域的科学研究和临床实践。
当住院脑卒中康复环境中的临床医生评估哪些患者跌倒风险最大时，与脑卒中相关的危险因素，如平衡受损、视空间忽视和自我护理缺陷，可能比年龄、尿失禁和感觉障碍等更一般的危险因素更好地预测跌倒。具有这些脑卒中特异性缺陷的患者可能受益于积极的跌倒预防干预措施。
