Abstract WP354: Hospitalized Stroke Patient Falls Rates Reduced by 50% after Stroke Survivor Focus Group

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Kimberly Gray
Keyword(s):  
Focus Group ◽  
Stroke Patient ◽  
Fall Prevention ◽  
Stroke Survivor ◽  
Stroke Survivors ◽  
Prevention Strategies ◽  
Stroke Patients ◽  
Caregiver Support ◽  
Patient Falls ◽  
Fall Rates

Stroke survivors are well known to fall both in the hospital and in the community settings. Fall prevention literature recommends the use of a variety of interventions, or fall ’bundles’, to reduce hospitalized patient falls. The organization’s stroke collaborative practice team (SCPT) began monitoring hospitalized stroke patient fall rates in 2010. Even when the hospital’s organizational rates dropped, stroke patient fall rates did not. It was noted that there were no bundle strategies specifically targeting the array of disabilities that can be caused from a stroke, nor what is it clear what they should be. Thus, a falls focus group was conducted with the hospital’s stroke survivor and caregiver support group in 2011. The purpose of the meeting was to discuss their experiences with falls, review fall prevention strategies from our organization, and see if they had any suggestions that may prevent hospitalized stroke patients from falling. Over 20 stroke survivors and caregivers attended a videotaped meeting. All stroke survivors, and several caregivers, indicated with a show of hands, that they fell at home and/or while in the hospital. A robust discussion followed where many verbalized that as a result of their deficits, such as impulsivity, memory changes or aphasia, their felt our current fall bundle would not prevent a stroke patient from falling. They felt having someone in the room was a best practice and if no one could be in the room, they recommended using bed alarms. Based on their feedback, the SCPT created a new practice so all stroke patients would be placed on a bed alarm on admission. This allows everyone time to adjust to limitations cause by any new disabilities. Inpatient rehabilitation also added low beds. Data collected January to June 2011 showed on average 2 stroke patients fell each month. The new practices were implemented over the next several months. Data from November 2011- June 2012 showed fall rates dropped to approximately 1 a month, or a 50% reduction in hospitalized stroke patient falls. The value of the patient and family experience can be a powerful tool in improving performance and outcomes. Incorporating their feedback on fall prevention strategies in our organization has helped reduce hospitalized stroke patient falls.

scholarly journals AROUND THE WORLD IN 16 WAYS: Searching Internationally for Fall Prevention Strategies

2017 ◽  
pp. 24-29
Author(s):  
Caitlyn Allen ◽  
Susan Wallace
Keyword(s):  
Fall Prevention ◽  
The United States ◽  
Patient Harm ◽  
Prevention Strategies ◽  
Patient Falls ◽  
The Past ◽  
High Incidence ◽  
The World ◽  
Fall Rates ◽  
Innovative Techniques

Pennsylvania fall rates have remained relatively steady over the past six years, ranging from 3.09–3.33 falls per 1,000 patient days. Other studies estimate that hospital falls occur at a rate of 3.56 per 1,000 patient days1 and 700,000 to one million patients fall each year.2 Falls in Pennsylvania continue to be one of the biggest contributors to patient harm and the fourth most frequently reported adverse event. Looking more broadly, falls are also a frequent cause of patient harm across the United States and globally. A review of international fall prevention strategies revealed that while no single country has been able to eradicate patient falls, several had implemented measures showing moderate levels of success. Those struggling with a high incidence of falls may benefit from reviewing and adopting one or more of these innovative techniques.

scholarly journals Exploring the causes and impacts of falls among ambulators with spinal cord injury using photovoice: a mixed-methods study

BMJ Open ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. e039763 ◽  
Author(s):  
Hardeep Singh ◽  
Arielle Shibi Rosen ◽  
Geoff Bostick ◽  
Anita Kaiser ◽  
Kristin E Musselman
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Mixed Methods ◽  
Focus Group ◽  
Fall Prevention ◽  
Fall Risk ◽  
Phase 1 ◽  
Phase 2 ◽  
Prevention Strategies ◽  
Cord Injury

ObjectivesThis study explored: (1) fall circumstances experienced by ambulators with spinal cord injury (SCI) over a 6-month period, (2) the impacts of falls-related injuries and fall risk and (3) their preferences/recommendations for fall prevention.DesignA sequential explanatory mixed-methods design with two phases.SettingA Canadian SCI rehabilitation hospital and community setting.ParticipantsThirty-three ambulators with SCI participated in phase 1 and eight participants that fell in phase 1 participated in phase 2.MethodsIn phase 1, fall circumstances were tracked using a survey that was completed each time a participant fell during the 6-month tracking period. Phase 2 involved photovoice; participants took photographs of factors that influenced their fall risk and how their fall risk impacted their work/recreational activities. Participants discussed the photographs and topics related to fall prevention in an individual interview and a focus group.ResultsOf the 33 participants, 21 fell in 6 months. Falls commonly occurred in the home while participants were changing positions or walking. Most falls occurred in the morning or afternoon. In phase 2, interviews and focus group discussion revealed three themes: (1) falls are caused by bodily impairments (eg, impaired reactive response during slips and trips and weakness and altered sensation in legs/feet), (2) impacts of fall-related injuries and fall risk (eg, psychosocial effects of fall-related injuries, limiting community participation due to the risk of falling and activity-dependent concern of falling) and (3) approaches to fall prevention (eg, fall prevention strategies used, components of fall prevention and utility of professional fall prevention strategies/interventions).ConclusionsFall prevention interventions/strategies should focus on minimising a person’s fall risk within their home as most falls occurred in the home environment. Ambulators with SCI would benefit from education and awareness about common fall circumstances that they may encounter in their daily lives.

Fall-Prevention Strategies and Patient Characteristics That Impact Fall Rates After Total Knee Arthroplasty

2014 ◽  
Vol 119 (5) ◽  
pp. 1113-1118 ◽  
Author(s):  
Rebecca L. Johnson ◽  
Christopher M. Duncan ◽  
Kyle S. Ahn ◽  
Darrell R. Schroeder ◽  
Terese T. Horlocker ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Fall Prevention ◽  
Patient Characteristics ◽  
Prevention Strategies ◽  
Fall Rates ◽  
Total Knee

scholarly journals Hope, active coping and well-being in stroke-survivors and caregivers: An actor–partner model analysis

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 810-810
Author(s):  
Esther Chow ◽  
Sai-fu Fung
Keyword(s):  
Structural Equation ◽  
Medical Condition ◽  
Likelihood Estimation ◽  
Well Being ◽  
Stroke Survivor ◽  
Active Coping ◽  
Proactive Coping ◽  
Theoretical Development ◽  
Stroke Survivors ◽  
Stroke Patients

Abstract Purpose Stroke is a medical condition cause of suffering for both patients and their caregivers within the family. This paper aimed to assess the influence of the psychological construct of hope and active coping on hedonic wellbeing in patient with stroke and caregiver dyads by determining the dyadic patterns. Methods A baseline study including 200 stroke-survivor (Age 73.63; SD=7.22) and caregiver (62.49; SD=14.44) dyads with actor–partner interdependence model (APIM) estimated by structural equation modelling with maximum likelihood estimation. Herth Hope Index (HHI), Proactive Coping Inventory (PCI) and Personal Wellbeing Index (PWI) were used to measure hope, proactive coping and wellbeing, respectively. Results The APIM analysis revealed that both stroke patients and caregivers demonstrated double actor-only pattern. As such, stroke-survivors’ hope and active coping excreted an actor effect on their own wellbeing with beta = 0.48 (p < 0.01) and 0.16 (p < 0.01), respectively. Similarly, the caregiver also reported an actor effect between hope and wellbeing (beta = 0.84, p < 0.01) as well as active coping with wellbeing (beta = 0.37, p < 0.01). The overall SEM model also fulfilled the criteria for good model fit (χ2 (5.87), p = > 0.05, CFI = 0.98, TLI = 0.96 and RMSEA = 0.07). Conclusions The results suggest that both stroke patients and caregivers’ hedonic wellbeing are holding actor-oriented pattern with the hope and active coping. The implications for clinical practitioners, research and theoretical development are discussed.

scholarly journals Role of caregiver factors in outpatient medical follow-up post-stroke: observational study in Singapore

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Shilpa Tyagi ◽  
Gerald Choon-Huat Koh ◽  
Nan Luo ◽  
Kelvin Bryan Tan ◽  
Helen Hoenig ◽  
...  
Keyword(s):  
Observational Study ◽  
Management Strategies ◽  
Stroke Survivor ◽  
Stroke Survivors ◽  
Post Stroke ◽  
Memory Problems ◽  
Healthcare Needs ◽  
Stroke Study

Abstract Background Outpatient medical follow-up post-stroke is not only crucial for secondary prevention but is also associated with a reduced risk of rehospitalization. However, being voluntary and non-urgent, it is potentially determined by both healthcare needs and the socio-demographic context of stroke survivor-caregiver dyads. Therefore, we aimed to examine the role of caregiver factors in outpatient medical follow-up (primary care (PC) and specialist outpatient care (SOC)) post-stroke. Method Stroke survivors and caregivers from the Singapore Stroke Study, a prospective, yearlong, observational study, contributed to the study sample. Participants were interviewed 3-monthly for data collection. Counts of PC and SOC visits were extracted from the National Claims Database. Poisson modelling was used to explore the association of caregiver (and patient) factors with PC/SOC visits over 0–3 months (early) and 4–12 months (late) post-stroke. Results For the current analysis, 256 stroke survivors and caregivers were included. While caregiver-reported memory problems of a stroke survivor (IRR: 0.954; 95% CI: 0.919, 0.990) and caregiver burden (IRR: 0.976; 95% CI: 0.959, 0.993) were significantly associated with lower early post-stroke PC visits, co-residing caregiver (IRR: 1.576; 95% CI: 1.040, 2.389) and negative care management strategies (IRR: 1.033; 95% CI: 1.005, 1.061) were significantly associated with higher late post-stroke SOC visits. Conclusion We demonstrated that the association of caregiver factors with outpatient medical follow-up varied by the type of service (i.e., PC versus SOC) and temporally. Our results support family-centred care provision by family physicians viewing caregivers not only as facilitators of care in the community but also as active members of the care team and as clients requiring care and regular assessments.

Fall prevention education for older people being discharged from hospital: Educators’ perspectives

2021 ◽  
pp. 001789692110327
Author(s):  
Jacqueline Francis-Coad ◽  
Den-Ching A Lee ◽  
Terry P Haines ◽  
Meg E Morris ◽  
Steven M McPhail ◽  
...  
Keyword(s):  
Hospital Discharge ◽  
Fall Prevention ◽  
Older Patients ◽  
Education Programme ◽  
Prevention Strategies ◽  
Post Intervention ◽  
Prevention Education ◽  
Barriers And Enablers ◽  
Education Delivery ◽  
Fall Prevention Education

Objective: Falls are a significant problem for many older patients after hospital discharge. The purpose of this study was to evaluate the fidelity and impact of a tailored patient fall prevention education programme from the perspective of the educators who delivered the programme. Design: Qualitative sequential design. Setting: Three rehabilitation hospitals in Western Australia. Method: Three experienced physiotherapists trained as ‘educators’ to deliver a tailored fall prevention education programme to 195 older patients prior to hospital discharge, together with monthly telephone follow-up for 3 months after discharge. Educator–patient interactions were recorded in a standardised educator diary. Post-intervention, educators participated in a mini-focus group, providing their perspectives regarding education delivery and its impact on patient abilities to engage in fall prevention strategies. Data were analysed using deductive content analysis. Results: Educators followed up 184 (94%) patients, identifying multiple barriers and enablers affecting patient engagement in planned fall prevention strategies. Key barriers included unresolved medical conditions, reluctance to accept assistance on discharge, delays in assistive service provision, patient beliefs and perceptions about falls and, in some cases, patients’ absolving responsibility for recovery. Enablers were related to programme design, the completion of hospital discharge processes and support networks following discharge. Conclusion: Educators identified several barriers and enablers to programme delivery, receipt and enactment by older patients that contributed to the fidelity of the education programme. The consistent need for more patient support to enable improved enactment of plans and assist with safe recovery long after discharge warrants further attention at policy and health system levels.

scholarly journals Associations Between Foot Placement Asymmetries and Metabolic Cost of Transport in Hemiparetic Gait

2016 ◽  
Vol 31 (2) ◽  
pp. 168-177 ◽  
Author(s):  
James M. Finley ◽  
Amy J. Bastian
Keyword(s):  
Walking Speed ◽  
Metabolic Cost ◽  
Positive Association ◽  
Stroke Survivor ◽  
Gas Analysis ◽  
Stroke Survivors ◽  
Cost Of Transport ◽  
Foot Placement ◽  
Hemiparetic Gait ◽  
All Speeds

Stroke survivors often have a slow, asymmetric walking pattern. They also walk with a higher metabolic cost than healthy, age-matched controls. It is often assumed that spatial-temporal asymmetries contribute to the increased metabolic cost of walking poststroke. However, elucidating this relationship is made challenging because of the interdependence between spatial-temporal asymmetries, walking speed, and metabolic cost. Here, we address these potential confounds by measuring speed-dependent changes in metabolic cost and implementing a recently developed approach to dissociate spatial versus temporal contributions to asymmetry in a sample of stroke survivors. We used expired gas analysis to compute the metabolic cost of transport (CoT) for each participant at 4 different walking speeds: self-selected speed, 80% and 120% of their self-selected speed, and their fastest comfortable speed. We also computed CoT for a sample of age- and gender-matched control participants who walked at the same speeds as their matched stroke survivor. Kinematic data were used to compute the magnitude of a number of variables characterizing spatial-temporal asymmetries. Across all speeds, stroke survivors had a higher CoT than controls. We also found that our sample of stroke survivors did not choose a self-selected speed that minimized CoT, contrary to typical observations in healthy controls. Multiple regression analyses revealed negative associations between speed and CoT and a positive association between asymmetries in foot placement relative to the trunk and CoT. These findings suggest that interventions designed to increase self-selected walking speed and reduce foot-placement asymmetries may be ideal for improving walking economy poststroke.

scholarly journals Incident Cancer in a Cohort of 3,247 Cancer Diagnosis Free Ischemic Stroke Patients

2015 ◽  
Vol 39 (5-6) ◽  
pp. 262-268 ◽  
Author(s):  
Adnan I. Qureshi ◽  
Ahmed A. Malik ◽  
Omar Saeed ◽  
Malik M. Adil ◽  
Gustavo J. Rodriguez ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Ischemic Stroke ◽  
General Population ◽  
Annual Rate ◽  
Stroke Survivors ◽  
Stroke Patients ◽  
Incident Cancer ◽  
Race Ethnicity ◽  
Age Adjusted Rates

Background: Subclinical cancer can manifest as a thromboembolic event and may be detected at a later interval in ischemic stroke survivors. We determined the rate of incident cancer and effect on cardiovascular endpoints in a large cohort of ischemic stroke survivors. Methods: An analysis of 3,680 adults with nondisabling cerebral infarction who were followed for two years within the randomized, double-blinded VISP trial was performed. The primary intervention was best medical/surgical management plus a daily supplementation of vitamin B6, vitamin B12, and folic acid. We calculated age-adjusted rates of incidence of cancer among ischemic stroke survivors and standardized incidence ratios (SIR) with 95% confidence intervals (CI) based on comparison with age-adjusted rates in the general population. The significant variables from univariate analysis were entered in a Cox Proportional Hazards analysis to identify the association between various baseline factors and incident cancer after adjusting age, gender, and race/ethnicity. A logistic regression analysis evaluated the association between incident cancer and various endpoints including stroke, coronary heart disease, myocardial infarction, and death after adjusting age, gender, and race/ethnicity. Results: A total of 3,247 patients (mean age ± SD of 66 ± 11; 2,013 were men) were cancer free at the time of enrollment. The incidence of new cancer was 0.15, 0.80, 1.2, and 2.0 per 100 patients at 1 month, 6 months, 1 year, and 2 years, respectively. The age-adjusted annual rate of cancer in patients with ischemic stroke was higher than in persons in the general population at 1 year (581.8/100,000 persons vs. 486.5/100,000 persons, SIR 1.2, 95% CI 1.16-1.24) and 2 years (1,301.7/100,000 vs. 911.5/100,000, SIR 1.4, 95% CI 1.2-1.6) after recruitment. There was a higher risk for death (odds ratio (OR) 3.1, 95% CI 1.8-5.4), and composite endpoint of stroke, coronary heart disease, and/or death (OR 1.4, 95% CI 1.0-2.2) among participants who developed incident cancer compared with those who were cancer free after adjusting for potential confounders. Conclusions: The annual rate of age-adjusted cancer incidence was higher among ischemic stroke patients compared with those in the general population. The odds of mortality were three folds higher among stroke survivors who developed incident cancer.

scholarly journals The Experience and Perception of Physiotherapists in Nigeria re: Fall Prevention in Recurrent-Faller Older Adults

2019 ◽  
Author(s):  
Perpetua Obi ◽  
Henrietha Nwankwo ◽  
Diaemeta Emofe ◽  
Isreal Adandom ◽  
Michael Kalu
Keyword(s):  
Older Adults ◽  
Older Adult ◽  
Fall Prevention ◽  
Developing World ◽  
Phenomenological Approach ◽  
Developing Nations ◽  
Prevention Strategies ◽  
Face To Face ◽  
Rehabilitation Professionals ◽  
History Of

Background: Effective fall prevention practices are essential for reducing falls among older adults. Rehabilitation professionals like physiotherapists are essential members of the fall prevention team, yet little is known about the experiences of physiotherapists practicing fall prevention in developing nations. Objective: To explore the experiences of physiotherapists in Nigeria who practice fall prevention among older adults. Method: We adopted a phenomenological approach to the traditional qualitative design in this study. We purposefully selected and conducted face-to-face interview with twelve physiotherapists who have treated at least one older adult who reported falling two or three times within last six months. Data was analyzed using thematic analysis. Results: Four themes emerged from our participants: characteristics of recurrent fallers, fall prevention practices, hindrances to fall prevention, and strategies to promote fall prevention practices. In practice, understanding the characteristics (risk factors) of older adults with a history of recurrent falls is important for effective fall prevention practices among physiotherapists. Among other characteristics, our participants believed that older adults who have patronized “traditional bone setters/healer” are at the higher risk of having multiple falls. Conclusion: This study adds to the sparse amount of literature concerning the experience of physiotherapist in fall prevention practices in the developing world. More importantly, the findings of this study will strengthen or stimulate discussion around development of fall prevention strategies specific to the developing world context.

scholarly journals COPING STRATEGIES BY STROKE CAREGIVERS: EVIDENCE FROM A QUALITATIVE STUDY IN SARAWAK, MALAYSIA

2020 ◽  
Vol 20 (1) ◽  
pp. 48-54
Author(s):  
Md Mizanur Rahman ◽  
Zabidah binti Putit ◽  
Norliza binti Suut ◽  
Mohamad Taha Arif ◽  
Asri bin Said ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Coping Strategies ◽  
Qualitative Data ◽  
Service Providers ◽  
Stroke Survivor ◽  
Stroke Survivors ◽  
Rehabilitation Centre ◽  
Emotion Suppression ◽  
Self Blame ◽  
Community Rehabilitation

Caring for stroke survivors is inevitably a burden to caregivers. It is not uncommon for stroke survivors who are discharged from the hospital and found themselves at home without any help and care from the supposed caregivers. However, in instances where there are available and willing caregivers, a sudden and unpredictable task of caring for stroke survivors require the stroke caregivers to apply their coping strategies due to the demanding nature of looking after a survivor. This study aimed to determine coping strategies undertaken by stroke caregivers in caring for stroke survivors. This was an exploratory qualitative study and data was collected from the caregivers of stroke survivor using a semi-structured guided questionnaire. A total of 18 caregivers were included in the study. The data were collected from November 2015 until June 2016 at a selected community rehabilitation centre in Kuching, Sarawak. The qualitative data analysis revealed that the coping strategies undertaken by stroke caregivers include change of role in life, self-motivation, sharing with other people, crying, trying to forget things that happen, hoping survivors will get better, emotion suppression and self-blame. The study highlighted the experiences by the caregivers for caring for stroke patients and focused on the coping strategies undertaken by the caregivers. Better ununderstanding of these experiences does help the service providers to provide better support and resources for caregivers in caring for stroke survivors.

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