Falls after spinal cord injury: a systematic review and meta-analysis of incidence proportion and contributing factors

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%, I-2= 0%) of ambulators and 69% (95% confidence interval 60-76%, I-2= 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.