Camillieri Susan, Weiss Cara, Zervas Michael, Dennis Branden
NYU Langone Health, Rusk Rehabilitation, New York, NY 10003, United States.
Phys Ther. 2025 Aug 5;105(8). doi: 10.1093/ptj/pzaf096.
Falls are commonly reported incidents that affect the safety of patients during inpatient hospitalization. Inpatient rehabilitation (IR) units report the highest fall rates when compared with other hospital units. Falls commonly result in patient injury and elevate episode costs. There is a dearth of information regarding characteristics of patients who fall during physical therapy sessions, which represents a unique subset of falls.
The aim of the study was to describe the nature of falls, characteristics of fallers, and characteristics of therapists who experienced patient falls, which occurred during physical therapy sessions in IR.
This was an observational study which included a retrospective analysis of medical records.
This study examined falls occurring within 2 IR departments at a large hospital system located in an urban setting in the United States.
This study involved patients receiving adult IR with diagnoses including, but not limited to, stroke, traumatic brain injury, and spinal cord injury.
This study examined characteristics of patients who fell as compared with patients who did not fall, quantified the conditions surrounding falls, and described physical therapists who experienced patient falls.
Mann-Whitney U tests, chi-square tests, and binomial logistic regression analyses were performed to compare characteristics of faller and non-faller groups.
Among the 6238 unique patient admissions, a total of 40 falls were identified. The rate of falling was 0.43 falls per 1000 patient days. The majority of falls occurred because of buckling (47.5%) and during gait training (40.0%). Falls most often occurred close to discharge (mode = 6 days prior). Fallers were younger than nonfallers (exponential power of B, ie, Exp[B], = 1.02; 95% CI = 1.01-1.04). Diagnoses representing the largest proportion of fallers included brain dysfunction/stroke (30.0%) and spinal cord injury/peripheral nerve injury (30.0%). Fallers had comorbid diabetes mellitus type 2 (Exp[B] = 2.70; 95% CI = 1.45-5.04) and received renal dialysis (Exp[B] = 3.23; 95% CI = 1.14-9.17) in a higher proportion than nonfallers. Fallers were often high functioning, the majority receiving at most minimal assistance (72.5%). Falls most often occurred with therapists who had 1 to 2 years of experience (27.5% of falls).
The rate of falls during therapy was lower than the rate of falls previously reported in similar settings. Therapists should exercise caution when managing younger patients and patients with certain diagnoses. Therapists should screen for buckling risk when prescribing higher-risk activities. Therapists with various levels of experience should receive fall prevention training.
Therapists can use frequently occurring patient characteristics to screen for falling and use additional precautionary measures, particularly for patients with specific diagnoses, at higher risk for knee buckling, and of a younger age.
跌倒在住院期间是常见事件，会影响患者安全。与其他医院科室相比，住院康复（IR）科室的跌倒发生率最高。跌倒通常会导致患者受伤并增加治疗费用。关于在物理治疗期间跌倒患者的特征信息匮乏，而这是跌倒中的一个独特子集。
本研究旨在描述跌倒的性质、跌倒者的特征以及经历患者跌倒的治疗师的特征，这些跌倒发生在住院康复的物理治疗期间。
这是一项观察性研究，包括对病历的回顾性分析。
本研究调查了美国一个城市环境中的大型医院系统内两个住院康复科室发生的跌倒事件。
本研究涉及接受成人住院康复治疗的患者，诊断包括但不限于中风、创伤性脑损伤和脊髓损伤。
本研究比较了跌倒患者与未跌倒患者的特征，量化了跌倒时的情况，并描述了经历患者跌倒的物理治疗师。
进行曼 - 惠特尼U检验、卡方检验和二项逻辑回归分析，以比较跌倒者和未跌倒者组的特征。
在6238例独特的患者入院病例中，共识别出40例跌倒事件。跌倒发生率为每1000患者日0.43次跌倒。大多数跌倒发生是由于屈曲（47.5%）和在步态训练期间（40.0%）。跌倒最常发生在接近出院时（众数 = 提前6天）。跌倒者比未跌倒者更年轻（B的指数幂，即Exp[B] = 1.02；95%置信区间 = 1.01 - 1.04）。跌倒者中占比最大的诊断包括脑功能障碍/中风（30.0%）和脊髓损伤/周围神经损伤（30.0%）。跌倒者患2型糖尿病（Exp[B] = 2.70；95%置信区间 = 1.45 - 5.04）和接受肾透析（Exp[B] = 3.23；95%置信区间 = 1.14 - 9.17）的比例高于未跌倒者。跌倒者通常功能较高，大多数最多接受极少的帮助（72.5%）。跌倒最常发生在有1至2年经验的治疗师治疗期间（占跌倒事件的27.5%）。
治疗期间的跌倒发生率低于之前在类似环境中报告的跌倒发生率。治疗师在管理年轻患者和某些诊断的患者时应谨慎。在开具有更高风险的活动处方时，治疗师应筛查屈曲风险。不同经验水平的治疗师都应接受跌倒预防培训。
治疗师可以利用常见的患者特征来筛查跌倒风险，并采取额外的预防措施，特别是对于有特定诊断、膝关节屈曲风险较高和年龄较小的患者。
