From the Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois (LAR, JP, JHS, JJS); and Center on Health, Aging, and Disability, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois (WDB, JJS).
Am J Phys Med Rehabil. 2019 Aug;98(8):649-656. doi: 10.1097/PHM.0000000000001161.
The aim of the study was to examine the circumstances surrounding the worst fall experienced by full-time manual wheelchair users in the past 12 mos, the recovery process, and influence on community participation.
A mixed-method research study was conducted. Semistructured interviews were conducted to understand the circumstances of the worst fall experienced and the recovery process. A quantitative fear of falling assessment and the community participation indicators were used to further evaluate the influence of the fall.
There were 20 manual wheelchair users (mean ± SD, 47 ± 13 yrs, 55% male). Falls most commonly occurred outside during wheelchair propulsion. Falls were attributed to both intrinsic and extrinsic factors. Seventy percent of participants reported a fear of falling and 80% required assistance to recovery. No significant correlations were found between fall frequency and community participation indicator scores. Participants who needed assistance to recover (56.70 ± 17.66) had lower community participation indicator importance scores compared with participants able to recover independently (88.93 ± 22.13), P = 0.05.
Falls are complex and most manual wheelchair users need assistance to recover. Comprehensive programs including education on prevention and postfall management are needed. Results may increase understanding of the circumstances associated with falls and inform the development of evidenced-based clinical practice guidelines.
本研究旨在探讨过去 12 个月中全职使用手动轮椅的患者经历的最严重跌倒的情况、恢复过程及其对社区参与的影响。
本研究采用混合方法研究。通过半结构化访谈了解最严重跌倒的情况和恢复过程。使用定量的跌倒恐惧评估和社区参与指标进一步评估跌倒的影响。
共有 20 名手动轮椅使用者（平均 ± 标准差，47 ± 13 岁，55%为男性）。跌倒最常发生在轮椅推进过程中户外。跌倒归因于内在和外在因素。70%的参与者报告有跌倒恐惧，80%需要帮助恢复。跌倒频率与社区参与指标得分之间无显著相关性。需要帮助恢复的参与者（56.70 ± 17.66）的社区参与指标重要性得分低于能够独立恢复的参与者（88.93 ± 22.13），P = 0.05。
跌倒情况复杂，大多数手动轮椅使用者需要帮助才能恢复。需要制定包括预防和跌倒后管理教育在内的综合计划。研究结果可能会增加对与跌倒相关情况的了解，并为制定基于证据的临床实践指南提供信息。
