Fitzgerald SG (Tampa VAMC), Nelson AL
(Tampa VAMC), Gavin-Dreschnack D
(Tampa VAMC), Mitchell D
(Augusta VAMC), Sabharwal S
(VA Boston HCS), Kirby L
(Nova Scotia Rehabilitation Centre, Dalhousie University )
For a person with a spinal cord injury (SCI) who relies on a wheelchair for mobility, a wheelchair fall affects function, independence, and quality of life. The purpose was to determine the unique risk factors associated with wheelchair–related falls among veterans with SCI.
A prospective study involving three VA SCI centers was recently completed. Data were collected through surveys and interviews at baseline and monthly over a one-year period. Baseline characteristics that were significant in a univariate analysis were used as predictors in logistic regression models to determine fall likelihood.
Of the 702 patients enrolled, 659 subjects provided data for follow-up analysis. The primarily male (96%) population was 55 + 13 years old, and had their SCI for an average of 21 + 13 years. 47% of the injury levels were cervical and 46% thoracic. The majority of subjects used manual wheelchairs (62%) an average of 10.9 + 4.3 hours a day. 553 fall events were reported by 204 individuals. 95 (14%) subjects were injured as a result of the fall. Regression models showed that fall occurrence was predicted by increased pain in the past two months, increased alcohol use, higher FIM sub-motor scores, having a previous fall, shorter wheelchair length, fewer years of SCI, and not having one’s first wheelchair. Injurious falls were predicted by increased pain in the past two months, higher FIM sub-motor scores, having a previous fall, non-flat home entrance, and a diagnosis of arthritis. In both models, 83% of the variance was explained by the predictors.
This study is the first to develop statistical models for predicting falls and injurious falls in SCI. Results suggest that those at risk have greater function and lifestyles that may predispose them to increased exposure and thus falling. Interventions of the modifiable risk factors, such as wheelchair skills training, may result in falls or fall-related injury.
Findings from this study will be used to develop an instrument to identify fall risk in persons with SCI. The predictive model will also be used to develop interventions targeting modifiable risk factors for tips, falls, and fall-related injuries in SCI.