Alia Khan1, Clara Pujol1, Mark Laylor2, Nikola Unic1, Maureen Pakosh3, Jaclyn Dawe1, Kristin E Musselman4,5. 1. SCI Mobility Lab, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada. 2. Department of Kinesiology, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, ON, Canada. 3. Library & Information Services, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada. 4. SCI Mobility Lab, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada. Kristin.Musselman@uhn.ca. 5. Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada. Kristin.Musselman@uhn.ca.
Abstract
INTRODUCTION: Falls are detrimental to the well-being of individuals with spinal cord injury (SCI). To establish effective fall prevention initiatives, a comprehensive understanding of falls after SCI is needed. OBJECTIVES: To report the incidence proportion of falls and summarize the factors contributing to falls in individuals with SCI. STUDY DESIGN: Systematic review and meta-analysis. METHODS: Eight databases were searched. Abstracts/full articles were screened by two researchers independently. Data concerning study design, participant characteristics, and the incidence proportion, factors, and consequences of falls were extracted. Risk of bias was assessed using a domain-based approach that considered sampling and measurement bias. The incidence proportions of falls were pooled for ambulators and wheelchair users separately using random-effects meta-analyses, and compared descriptively for inpatients and community-dwelling individuals. Fall-related factors were organized according to the Biological, Behavioral, Social & Economic and Environmental Model of fall risk. RESULTS: The search resulted in 1706 articles; 24 unique studies were included. The risk of sampling bias was high. All but one study focused on community-dwelling individuals; 78% (95% confidence interval 73-83%, I2 = 0%) of ambulators and 69% (95% confidence interval 60-76%, I2 = 59%) of wheelchair users fell ≥1 over 12 months. In contrast, only 13% of inpatients fell. Most fall-related factors were categorized as biological (e.g., muscle weakness), behavioral (e.g., inattentiveness) or environmental (e.g., uneven surfaces). CONCLUSIONS: Falls are frequent among community-dwelling individuals with SCI. A variety of biological, behavioral, and environmental factors contribute to falls, some of which are modifiable and may be addressed through SCI-specific fall prevention initiatives.
INTRODUCTION: Falls are detrimental to the well-being of individuals with spinal cord injury (SCI). To establish effective fall prevention initiatives, a comprehensive understanding of falls after SCI is needed. OBJECTIVES: To report the incidence proportion of falls and summarize the factors contributing to falls in individuals with SCI. STUDY DESIGN: Systematic review and meta-analysis. METHODS: Eight databases were searched. Abstracts/full articles were screened by two researchers independently. Data concerning study design, participant characteristics, and the incidence proportion, factors, and consequences of falls were extracted. Risk of bias was assessed using a domain-based approach that considered sampling and measurement bias. The incidence proportions of falls were pooled for ambulators and wheelchair users separately using random-effects meta-analyses, and compared descriptively for inpatients and community-dwelling individuals. Fall-related factors were organized according to the Biological, Behavioral, Social & Economic and Environmental Model of fall risk. RESULTS: The search resulted in 1706 articles; 24 unique studies were included. The risk of sampling bias was high. All but one study focused on community-dwelling individuals; 78% (95% confidence interval 73-83%, I2 = 0%) of ambulators and 69% (95% confidence interval 60-76%, I2 = 59%) of wheelchair users fell ≥1 over 12 months. In contrast, only 13% of inpatients fell. Most fall-related factors were categorized as biological (e.g., muscle weakness), behavioral (e.g., inattentiveness) or environmental (e.g., uneven surfaces). CONCLUSIONS: Falls are frequent among community-dwelling individuals with SCI. A variety of biological, behavioral, and environmental factors contribute to falls, some of which are modifiable and may be addressed through SCI-specific fall prevention initiatives.
Authors: Patricia Noritake Matsuda; Aimee M Verrall; Marcia L Finlayson; Ivan R Molton; Mark P Jensen Journal: Arch Phys Med Rehabil Date: 2014-10-19 Impact factor: 3.966
Authors: Hardeep Singh; Heather M Flett; Michelle P Silver; B Catharine Craven; Susan B Jaglal; Kristin E Musselman Journal: BMC Health Serv Res Date: 2020-04-15 Impact factor: 2.655