An examination of patient characteristics that contribute to falls in the inpatient traumatic brain injury rehabilitation setting

Abstract

Purpose: To examine patient characteristics that contribute to falls in the inpatient traumatic brain injury (TBI) rehabilitation setting.Method: A three-round modified Delphi technique that engaged a multidisciplinary panel of 11 health experts was used. Group median score and disagreement index were used to measure agreement between participants about patient characteristics that contribute to falls.Results: All panel members participated in each questionnaire round. Several factors (such as, a fall since admission to hospital, cognitive impairment and motor impairment) were interpreted as contributing to falls in the TBI rehabilitation setting; but others were not (such as, antecedent falls and medication class). Some salient themes identified in participants’ comments include: (1) the need to differentiate between what is an activity (e.g., mobility) and impairment (e.g., ataxic gait)-based falls risk factor; (2) over the course of a 24-h day and inpatient rehabilitation stay, a patient’s risk of falling is not linear; and (3) Functional Independence Measure and predictors of TBI severity have varied sensitivity in predicting falls.Conclusions: In the TBI rehabilitation setting, falls result from a combination of many patient factors. Some factors are believed to be more relevant at different time points over a 24-h day and, at particular times during the course of a patient’s rehabilitation. The utility and statistical significance of risk factor of falls are both important concepts when determining their clinical relevance.Implications for RehabilitationClinicians should be mindful that the rehabilitation context can present unique falls risk factors, some of which emerge at different times during a patient’s rehabilitation.Over the course of a patient’s rehabilitation their risk of falling is not linear; therefore, rehabilitation clinicians should undertake periodic falls risk screening.The utility value and statistical significance of falls risk factors are both important aspects to consider when determining their clinical utility.