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Risk Factors for Falls During Inpatient Rehabilitation

Lee, Jae Eun DrPH; Stokic, Dobrivoje S. MD, DSc

American Journal of Physical Medicine & Rehabilitation: May 2008 - Volume 87 - Issue 5 - p 341-353
doi: 10.1097/PHM.0b013e31816ddc01
CME Article • 2008 Series • Number 5: Falls

Lee JE, Stokic DS: Risk factors for falls during inpatient rehabilitation. Am J Phys Med Rehabil 2008;87:341–353.

Objective: To determine risk factors for falls during inpatient rehabilitation on the basis of admission data, and to assess the predictive value of the FIM instrument.

Design: One thousand four hundred seventy-two patients consecutively admitted to a large tertiary care rehabilitation center during 18 mos were included in this retrospective study. Events surrounding falls were reported by clinical staff. Demographic data, prehospital socioeconomic status, medical condition at admission, and admission FIM scores were analyzed using log-logistic regression model for their association with falls.

Results: One hundred forty (9.5%) patients fell at least once. Most falls occurred during daytime (85%), in a patient room (90%), and were unobserved (74%). About a half of all falls occurred during the first week of rehabilitation stay. Multivariate model revealed that diagnosis of stroke and amputation, age between 41 and 50 yrs, lower cognitive FIM scores, and a large number of medical comorbidities (≥9) were associated with a high risk for fall. The respective prevalence ratios were 1.79, 3.80, 2.01, 0.98, and 1.50.

Conclusions: The rate of falls varies considerably among different diagnostic groups admitted to inpatient rehabilitation. Mid-aged people with stroke and amputation, worse cognitive functions, and greater medical complexity are at a higher risk for falling. Admission FIM score may be of value for predicting falls in rehabilitation setting, which warrants further investigation.

From the Center for Neuroscience and Neurological Recovery, Methodist Rehabilitation Center, Jackson, Mississippi.

CME Objectives:

On completion of this article, the reader should be able to (1) describe the circumstances of falls and characteristics of patients who fell during inpatient rehabilitation; (2) identify significant risk factors for falls; and (3) recognize the association between the level of independence and falls.

Level: Advanced.

Accreditation: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Association of Academic Physiatrists designates this continuing medical education activity for a maximum of 1.5 credits in Category 1 of the Physician’s Recognition Award of the American Medical Association. Each physician should claim only those credits that he or she actually spent in the education activity.

Disclosures: Disclosure statements have been obtained regarding the authors’ relationships with financial supporters of this activity. There are no apparent conflicts of interest related to the context of participation of the authors of this article.

All correspondence and requests for reprints should be addressed to Dobrivoje S. Stokic, MD, DSc, Center for Neuroscience and Neurological Recovery, Methodist Rehabilitation Center, East Woodrow Wilson Dr., Jackson, MS, 39216.

Supported in part by the Wilson Research Foundation, Jackson, Mississippi.

© 2008 Lippincott Williams & Wilkins, Inc.