Article

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 Rehabilitation Clinicians 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.

Langue : ANGLAIS