Abou Libak, Rice Laura A
Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois.
Arch Rehabil Res Clin Transl. 2022 Apr 13;4(2):100195. doi: 10.1016/j.arrct.2022.100195. eCollection 2022 Jun.
To identify risk factors for falls and fall-related injuries for wheelchair users with spinal cord injury (SCI).
Cross-sectional study.
Community setting.
Fifty-nine community dwelling wheelchair users (N=59), 47.5% male, median age of 52.5 years (IQR, 21 years) with chronic SCI, median time since injury of 16.6 years (IQR, 27.3 years).
No intervention.
Outcomes were incidence of falls and fall-related injuries. Participants reported on falls and fall-related injuries experienced in the previous 6 months. Independent variables were self-reported and performance-based measures. Self-reported measures included demographics, characteristics of SCI, fear of falling, psychological measures, functional independence, wheelchair skills, environmental barriers, quality of life, and community participation. Performance-based measures included transfer quality and sitting balance assessments. Logistic regression analyses were conducted to identify factors influencing falls and fall-related injuries.
In total, 152 falls and 30 fall-related injuries were reported from a total of 37 fallers. After logistic regression analysis, the model with the greatest levels of clinical utility and discriminative ability for falls (sensitivity 81%; specificity 55%; area under the receiving operating characteristic curve [AUC] statistics=0.73; 95% CI, 0.60-0.86) included the variables of shorter time since SCI, high mobility level, and having received education on fall prevention. The model for fall-related injuries (sensitivity 79%; specificity 75%; AUC statistics=0.77; 95% CI, 0.59-0.96) included the variables of older male individual, lower physical health score, and having received education on fall prevention.
The regression models presented may be used to identify wheelchair users with SCI at greater risk of falls and fall-related injuries. The findings may help to refer those in need to tailored fall and fall-related injury prevention programs. The findings presented in this study were based on a relatively small sample convenience; therefore, further prospective studies with a larger sample size are warranted.
确定脊髓损伤（SCI）轮椅使用者跌倒及跌倒相关损伤的风险因素。
横断面研究。
社区环境。
59名社区居住的轮椅使用者（N = 59），男性占47.5%，慢性SCI患者的中位年龄为52.5岁（四分位间距，21岁），受伤后的中位时间为16.6年（四分位间距，27.3年）。
无干预。
结局为跌倒及跌倒相关损伤的发生率。参与者报告了过去6个月内经历的跌倒及跌倒相关损伤情况。自变量为自我报告和基于表现的测量指标。自我报告的测量指标包括人口统计学、SCI特征、跌倒恐惧、心理测量指标、功能独立性、轮椅技能、环境障碍、生活质量和社区参与度。基于表现的测量指标包括转移质量和坐位平衡评估。进行逻辑回归分析以确定影响跌倒及跌倒相关损伤的因素。
总共37名跌倒者报告了152次跌倒和30次跌倒相关损伤。经过逻辑回归分析，对跌倒具有最大临床实用性和判别能力的模型（敏感性81%；特异性55%；接受者操作特征曲线下面积[AUC]统计值 = 0.73；95% CI，0.60 - 0.86）包括SCI后时间较短、活动能力水平高以及接受过跌倒预防教育等变量。跌倒相关损伤的模型（敏感性79%；特异性75%；AUC统计值 = 0.77；95% CI，0.59 - 0.96）包括老年男性个体、身体健康评分较低以及接受过跌倒预防教育等变量。
所呈现的回归模型可用于识别SCI轮椅使用者中跌倒及跌倒相关损伤风险较高的人群。这些发现可能有助于将有需要的人转介至量身定制的跌倒及跌倒相关损伤预防项目。本研究中的发现基于相对较小的便利样本；因此，有必要进行更大样本量的进一步前瞻性研究。
