An examination of patient characteristics that contribute to falls in the inpatient traumatic brain injury rehabilitation setting

Purpose: To examine patient characteristics that contribute to falls in the inpatient traumatic brain injury (TBI) rehabilitation setting. Method: A three-round modified Delphi technique that engaged a multidisciplinary panel of 11 health experts was used. Group median score and disagreement index were used to measure agreement between participants about patient characteristics that contribute to falls. Results: All panel members participated in each questionnaire round. Several factors (such as, a fall since admission to hospital, cognitive impairment and motor impairment) were interpreted as contributing to falls in the TBI rehabilitation setting; but others were not (such as, antecedent falls and medication class). Some salient themes identified in participants' comments include: (1) the need to differentiate between what is an activity (e.g., mobility) and impairment (e.g., ataxic gait)-based falls risk factor; (2) over the course of a 24-h day and inpatient rehabilitation stay, a patient's risk of falling is not linear; and (3) Functional Independence Measure and predictors of TBI severity have varied sensitivity in predicting falls. Conclusions: In the TBI rehabilitation setting, falls result from a combination of many patient factors. Some factors are believed to be more relevant at different time points over a 24-h day and, at particular times during the course of a patient's rehabilitation. The utility and statistical significance of risk factor of falls are both important concepts when determining their clinical relevance.