Classification of falls in stroke rehabilitation – not all falls are the same

Abstract

Objective: To develop a practical taxonomy of falls and to determine whether these different fall groups have different outcomes. Design: Descriptive study examining patient characteristics at the time of each fall and iterative development of falls taxonomy. Setting: An inpatient stroke rehabilitation ward. Methods: All falls over 21 months were reviewed retrospectively. Case notes were reviewed and each patient’s level of functioning at the time of fall, together with admission profile and discharge outcomes, were collected. Outcomes for fallers (as opposed to falls) were compared using the predominant fall type. Results: There were 241 falls in 122 patients and most falls occurred around the bed (196 (81%) falls). Toileting-related falls occurred in 54 patients (22.4%). The taxonomy proposes seven main fall types. One fall type (‘I’m giving it a go’) appeared quite different and was associated with better functioning at time of fall and better outcomes. Other fall types were related to high dependency needs, visuospatial difficulties or delirium. Medication-related falls were uncommon in this cohort. Conclusions: The falls taxonomy developed showed four main types of falls with different, but overlapping, patient characteristics at time of fall with different outcomes. Different fall-prevention strategies may be required for each group.