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Butler Forslund E.1,2, Jørgensen V.1,3, Franzén E.1,3,4, Opheim A.3, Seiger Å.2,5, Ståhle A.3,4,6, Hultling C.5,7, Stanghelle J.3,8, Skavberg Roaldsen K.3,6,9, Wahman K.5,10
1Karolinska Institutet, Division of Physiotherapy, Neurobiology, Care Science and Society, Stockholm, Sweden, 2Rehab Station Stockholm / Spinalis, Research and Development Unit, Solna, Sweden, 3Sunnaas Rehabilitation Hospital, Department of Research, Oslo, Norway, 4Karolinska University Hospital, Huddinge, Sweden, 5Karolinska Institutet, Division of Neurodegeneration, Neurobiology, Care Science and Society, Huddinge, Sweden, 6Karolinska Institutet, Division of Physiotherapy, Neurobiology, Care Science and Society, Huddinge, Sweden, 7Karolinska Institutet University Hospital, Solna, Sweden, 8University of Oslo / Medical Faculty, Oslo, Norway, 9Oslo and Akershus University College of Applied Sciences, Oslo, Norway, 10Karolinska Institutet, Neurobiology, Care Science and Society, Stockholm, Sweden
Background: Knowledge regarding falls in wheelchair users with spinal cord injury (SCI) is scarce. Identification of incidence and risk factors for recurrent falls is important in order to prevent falls and related injuries in this group.
Purpose: To identify incidence of, and risk indicators for, recurrent falls in wheelchair users with traumatic SCI, and to describe the situation leading up to the falls.
Methods: A prospective multi-center study was performed with 149 wheelchair users (25 women) with SCI attending follow-up in Sweden and Norway. Included were wheelchair users with traumatic spinal cord injury ≥1 year post-injury, ≥18 years old. Excluded were individuals with motor complete injuries above C5. Falls were reported prospectively by text-messages every second week for one year and were investigated by semi-structured telephone interviews. Time to first fall was analyzed with Kaplan Meier (including Log Rank test). Incidence of falls and recurrent falls during one year, as well as risk indicators for recurrent (>2) falls were considered the main outcome, while demographic data, quality of life, risk willingness, functional independence, and exercise habits were considered as independent variables. Risk indicators were investigated with multivariate logistic regression analysis.
Results: Ninety-six participants (64%) of the total sample (n=149) fell, and 45 (32%) fell recurrently. Those who had fallen the previous year had shorter time to first fall. Multivariate logistic regression analysis showed that those who reported recurrent falls the previous year had 10.2 times increased odds ratio of recurrent falls (p 0.001) compared to those who had not fallen recurrently the previous year. No other risk indicators were associated (p 0.05) with recurrent falls in the multivariate model. Most falls happened while transferring one-self to/from the wheelchair or when driving wheelchair outdoors.
Conclusion(s): Falls and recurrent falls were common and previous recurrent falls was a strong predictor of future falls. Thus, further research on prevention of falls is needed in order to reduce falls and related injuries.
Implications: The staff at the SCI units should systematically ask for previous recurrent falls in order to identify those who are at risk of future recurrent falls and thereby at risk of injuries. Technical equipment and transfer skills have to be optimized for each individual.
Funding acknowledgements: Thanks to Rehab Station Stockholm, Sunnaas Rehabilitation Hospital, Neuro Sweden, Praktikertjänst, the Promobilia Foundation, the Spinalis Foundation and Karolinska Institutet.
Topic: Neurology: spinal cord injury
Ethics approval: The study was approved by ethics committee Stockholm, Sweden and Regional Ethics Committee in South East Norway
All authors, affiliations and abstracts have been published as submitted.
