物理治疗与身体康复杂志

Post Stroke Risk Factors of Fall during Rehabilitation in Elderly Patients

Abstract

Ashraf Thoker.

Aim: The present study investigated the incidence, characteristics, and risk factors predictive of falls in different patient populations hospitalized in a geriatric rehabilitation hospital.

Purpose: The aims were to evaluate evidence of risk factors for falls among patients in stroke rehabilitation and to offer recommendations for clinical practice and future research.

Method: An integrative review of the literature published from 1991 to 2020 was conducted that describes empirical investigations of risk factors for post stroke falls during patient rehabilitation. We searched Medline, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycInfo, and Embase databases, using the search terms “accidental falls, ”fall risk, ”risk factors, ”risk assessment, ”stroke,” and “cerebrovascular disorders.” We extracted information regarding study design, sample, potential risk factors, analytic methods, findings, and limitations from the 20 articles that met the inclusion criteria, and was rated the level of evidence for each study.

Findings: Available empirical evidence points to impaired balance, visuospatial hemineglect, and impaired performance of activities of daily living as risk factors for falls during inpatient rehabilitation for stroke. Associations between falls and cognitive function, incontinence, visual field deficits, and stroke type were less clear, while relationships between falls and age, gender, stroke location, and impaired vision and hearing were not supported.

Conclusion: The relatively sparse literature pertaining to risk factors for falls among stroke rehabilitation inpatients indicates that deficits affecting balance, perception, and self care significantly increase the likelihood of falls. Particularly intriguing is the less well established role of post stroke cognition in falls in this population. A conceptual model is needed to guide scientific inquiry and clinical practice in this area. Rehabilitation professionals have long known that stroke survivors often sustain falls during their inpatient rehabilitation stay and that these falls may have catastrophic consequences. Preventing such falls is crucial, and identifying key risk factors for falls during post-stroke rehabilitation will ultimately enable clinicians to better target fall prevention efforts with patients and their families. This integrative review reveals the need for further research to better delineate the multifactorial nature of fall risk during inpatient stroke rehabilitation, with particular attention to the largely unexplored domains of cognition. Clinical

Relevance: When clinicians in the inpatient stroke rehabilitation setting evaluate which patients are at greatest risk to fall, stroke specific risk factors such as impaired balance, visuospatial hemineglect, and self care deficits may be better predictors than more general risk factors such as age, incontinence, and sensory impairments. Patients with these stroke. specific deficits may benefit from the use of aggressive fall prevention interventions.