What are the perceptions and experiences of falls amongst people with stroke who live in the community?

Inverted U-shaped relationship between Barthel Index Score and falls in Chinese non-bedridden patients: a cross-sectional study

BACKGROUND

Performing activities of daily living comprise an important risk factor for falls among non-bedridden stroke inpatients in rehabilitation departments.

OBJECTIVES

To explore the correlation between Barthel Index score and the occurrence of falls in non-bedridden stroke rehabilitation inpatients.

METHODS

In this cross-sectional study, information of patients grouped as non-bedridden patients by the Longshi Scale was collected.

RESULTS

A total of 3097 patients were included in this study, with a fall incidence of 10.43%. After adjusting covariates, the total score of Barthel Index and falls in non-bedridden inpatients after stroke presented an inverted U-shaped curve relationship, in which inflection point was 60. The effect sizes on the left and right sides of infection point were 1.02 (95%CI 1.00-1.04) and 0.97 (95%CI 0.96-0.99), respectively.

CONCLUSIONS

Non-bedridden stroke patients with moderate activities of daily living (ADL) capacity may be at particularly increased risk of falls in rehabilitation departments.

Fall experiences from the perspectives of people with osteoarthritis: in their own words

PURPOSE

To explore real-life experiences of people with osteoarthritis (OA) to increase understanding of how they perceive contributing factors to falls, circumstances at time of falls, and consequences of falls.

MATERIALS AND METHODS

Four focus groups of 3-7 people with OA from the Chicago, IL, USA, and neighboring areas were conducted remotely via web-based videoconferencing. Inclusion criteria included history of falls in previous 12 months and hip and/or knee OA. Focus group transcripts were coded and analyzed using a modified grounded theory approach to identify themes.

RESULTS

Focus group participants (n = 17) described experiences associated with fall-related events that resulted in the identification of four themes: (1) perception of falls and fall risks can be influenced by OA symptoms, (2) ability to remember circumstances of falls are influenced by consequences, (3) behaviors and attitudes that address OA symptoms and avoidance of falls are similar and (4) OA symptoms and falls have common psychological impacts on lives.

CONCLUSION

Our study highlights how people with OA define falls, perceive contributing factors to falls, and describe general and OA-related factors that contributed to their fall experiences. The shared experiences contributed to the creation of themes that represented various aspects of the circumstances and impact of falls. Consideration for the identified themes may enhance recording and reporting of falls, contribute to development of improved fall risk assessment tools, and prioritize research into the biopsychosocial effects of falls in people with OA.IMPLICATIONS FOR REHABILITATIONInformation about circumstances of a fall such as location, activity, and symptoms of osteoarthritis may be beneficial in creating tailored fall prevention training and education.Falls are a common problem for people with lower limb osteoarthritis that can lead to negative changes in activity and quality of life.The psychological impact of osteoarthritis symptoms may be contributing to fear of falling and decrease participation in daily activities.Awareness of the perceptions people with osteoarthritis have about their symptoms may provide educational and training opportunities to address the benefits of different therapeutic treatments.Awareness of perceptions people with osteoarthritis have about their risk of falling may provide educational and training opportunities to address the benefits of different therapeutic treatments.

Identifying priorities for balance interventions through a participatory co-design approach with end-users

BACKGROUND

Most individuals living with spinal cord injuries/diseases (SCI/D) or stroke experience at least one fall each year; hence, the development of interventions and technologies that target balance control is needed. The purpose of this study was to identify and explore the priorities for balance-focused interventions and technologies from the perspectives of end-users to assist with the design of an intervention that combines functional electrical stimulation (FES) with visual feedback training for standing balance.

METHODS

Two individuals with SCI/D, one individual with stroke, two physical therapists (PT) and one hospital administrator were recruited. Participants attended three focus group meetings that followed a participatory co-design approach. A semi-structured interview guide, developed from the FAME (Feasibility, Appropriateness, Meaningfulness, Effectiveness, Economic Evidence) framework, was used to lead the discussion, querying participants' experiences with balance deficits and interventions, and FES. Meetings were audio-recorded and transcribed verbatim. An iterative and reflexive inductive thematic analysis was applied to the transcripts by three researchers.

RESULTS

Four themes were identified: (1) Balance is meaningful for daily life and rehabilitation. Participants acknowledged various factors influencing balance control and how balance deficits interfered with participation in activities. End-users stressed the importance of continuing to work on one's balance after discharge from hospital-based rehabilitation. (2) Desired characteristics of balance interventions. Participants explained that balance interventions should be tailored to an individual's unique needs and goals, relevant to their lives, balance their safety and risk, and be engaging. (3) Prior experiences with FES to inform future therapeutic use. Participants with stroke or SCI/D described initial apprehension with FES, but experienced numerous benefits that motivated them to continue with FES. Challenges with FES were mentioned, including wires, cost, and time of set up. (4) Potential role of FES in balance interventions. Participants felt that FES would complement balance interventions; however, they had not experienced this combination of therapies previously.

CONCLUSIONS

End-users described how their experiences with balance deficits, rehabilitation, and FES informed their priorities for balance interventions. The findings inform the design and implementation of future balance interventions for individuals with SCI/D or stroke, including an intervention involving FES and visual feedback training.

The Application of the Omaha System in Community Rehabilitation Nursing for Patients With Stroke and Previous Falls

Objective

This study aimed to explore the use of the Omaha System in rehabilitation and nursing methods and the effects on patients within the community who had experienced stroke and previous falls.

Methods

This study enrolled 42 patients who had experienced stroke and previous falls and had returned to the community after being discharged from the Department of Neurology and Rehabilitation of the Affiliated Hospital of Nanchang University from January to July 2018. The patients were randomly divided into two groups: an experimental group (n = 21) and a control group (n = 21). Patients in the control group received routine community rehabilitation care, and patients in the experimental group received community rehabilitation care on the basis of the Omaha System. Intervention lasted for 1 year. The Omaha outcome score, the ability to perform activities of daily living (ADL) (measured via the Modified Barthel Index [MBI]), and the incidence of falls for each group were compared before and after the intervention.

Results

After 1 year of intervention, the Omaha outcome score and MBI of both groups were higher than before; the Omaha outcome score and MBI of the experimental group were higher than those of the control group; the differences were statistically significant (P < 0.05). No fall occurred in either of the two groups.

Conclusion

The Omaha System can comprehensively evaluate the health problems of patients, guide nursing intervention, and quantitatively evaluate the effect of nursing intervention; it is therefore worthy of promotion.

Cross-Cultural Adaptation and Reliability of the Home Falls and Accidents Screening Tool (HOME FAST) in Assessing Fall-Risk Home Hazards for Stroke Using Technologies over a Conventional Home Visit

Objective

This study is aimed at translating the Home Falls and Accidents Screening Tool (HOME FAST) into the three main languages spoken in Malaysia and investigating its reliability through an alternative technology-based evaluation.

Methods

Translation into three languages and cross-cultural adaptation of the HOME FAST was conducted via the five steps adopted from the Mapi Institute. For interrater reliability, occupational therapists who attended a face-to-face home hazard workshop were recruited. Each therapist rated the HOME FAST by using the provided combination of videos and photographs of stroke survivors manoeuvring in their home. For test-retest reliability, the same occupational therapists were invited to rate the same combination of photographs and videos again. Reliability was analysed using Gwet's AC₁ and Bland and Altman's plot to describe agreement.

Results

The translation challenges were minimal and rectifiable. A Bahasa Melayu, Mandarin, and Tamil versions of the HOME FAST were developed. Overall interrater reliability for both video (AC₁ = 0.91) and photograph (AC₁ = 0.91) were good. The test-retest reliability yielded similar outcome (video: overall AC₁ = 0.92 and photograph: overall AC₁ = 0.93).

Conclusion

Using alternative technology (video and photograph) to do a home hazard assessment was feasible. However, the asynchronous nature of these methods has limitations in clarifying certain aspects in the home. Moving forward, potential investigation on other technologies such as telehealth for synchronous and real-time interaction is warranted.

Patients' thoughts on their falls in a rehabilitation hospital: a qualitative study of patients with stroke

BACKGROUND

Patients with stroke in rehabilitation wards are at an increased risk of falling. Although patients' participation in establishing medical safety is considered crucial, there is limited evidence on their perspectives of falls. This study aims to comprehensively elucidate the subjective falling experience of patients with stroke who have been admitted to rehabilitation wards.

METHODS

Twenty-three consecutive patients with stroke (44 to 90 years) who experienced a fall during hospitalisation were interviewed within 1 week after the fall, and thematic analysis was used to analyse the data.

RESULTS

Five themes surrounding fall events were extracted from the narratives: 'Psychological background before the action', 'Support for the action', 'Direct causes of the fall', 'Patients' awareness after the fall', and 'Changes in attitudes and behaviours after the fall'. 'Psychological background before the action' comprised hastiness or hesitation to call for help. Participants often took an action based on 'Support for the action' derived from their past experiences of moving safely, their confidence, and/or motivation to challenge themselves to move. 'Direct causes of the fall' consisted of unfamiliar actions, training fatigue, the surrounding environment, reduced physical function due to paralysis, lack of attention, overconfidence in their ability, and insufficient prediction of falls. 'Patients' awareness after the fall' consisted of re-affirming difficult movements, the need for rehabilitation, a reduced ability to move, an increased risk of falling, the need for attention while moving, a fear of falling, and a lack of lessons learned from falling. Finally, patients demonstrated 'Changes in attitudes and behaviours after the fall' such as embodying a positive attitude to cope with the risk of falling or behavioural changes to reduce the risk of falling.

CONCLUSIONS

Comprehensive information on patients' perspectives before and after the fall was elucidated, uncovering many aspects including the psychological background for why patients engaged in risky behaviours resulting in falls, presence of positive thinking, and behaviour after the fall. By incorporating the patients' views on fall incidences and their assessment, we can develop appropriate prevention strategies against falls.

Validation of a translated Chinese version of the Participation Strategies Self-Efficacy Scale: a cross-sectional study

PURPOSE

To examine the psychometric properties of a Chinese version of the Participation Strategies Self-Efficacy Scale (PS-SES) among stroke survivors.

METHODS

The PS-SES was translated into Chinese. A cross-sectional descriptive study was conducted with 336 stroke survivors recruited from the neurology departments of five hospitals in China. Reliability, concurrent validity, and construct validity of the scale were determined.

RESULTS

The Chinese version of the PS-SES (PS-SES-C) showed good internal consistency and test-retest reliability, with a Cronbach's α of 0.98 and an intraclass correlation coefficient of 0.79. There was a moderate to strong positive correlation between the PS-SES-C and Chinese version of the General Self-Efficacy Scale (r = 0.59, p < .001), positive correlations between the PS-SES-C and Chinese versions of the Modified Barthel Index (r = 0.59, p < .001), Rivermead Mobility Index (r = 0.70, p < .001), and Reintegration to Normal Living Index (r = 0.70, p < .001), and a negative correlation between the PS-SES-C and National Institutes of Health Stroke Scale (r = -0.63, p < .001). Known-group validity and factorial validity were also supported.

CONCLUSIONS

The PS-SES-C is a reliable and valid instrument for assessing self-efficacy in managing the participation of Chinese stroke survivors.Implications for rehabilitationSelf-efficacy significantly predicts activity and participation in stroke survivors and is a major outcome measure in many stroke rehabilitation programmes.The translated Chinese version of the Participation Strategies Self-efficacy Scale is a valid and reliable tool to evaluate stroke survivors' self-efficacy in managing participation.The Chinese version of the Participation Strategies Self-efficacy Scale can be used to assess stroke recovery among the Chinese population in clinical and research settings.