Risk Factors Associated With Falls and Fall-Related Injuries Among Wheelchair Users With Spinal Cord Injury

Abstract

Objective: To identify risk factors for falls and fall-related injuries for wheelchair users with spinal cord injury (SCI).

Design: Cross-sectional study.

Setting: Community setting.

Participants: Fifty-nine community dwelling wheelchair users (N=59), 47.5% male, median age of 52.5 years (IQR, 21 years) with chronic SCI, median time since injury of 16.6 years (IQR, 27.3 years).

Interventions: No intervention.

Main outcome measures: Outcomes were incidence of falls and fall-related injuries. Participants reported on falls and fall-related injuries experienced in the previous 6 months. Independent variables were self-reported and performance-based measures. Self-reported measures included demographics, characteristics of SCI, fear of falling, psychological measures, functional independence, wheelchair skills, environmental barriers, quality of life, and community participation. Performance-based measures included transfer quality and sitting balance assessments. Logistic regression analyses were conducted to identify factors influencing falls and fall-related injuries.

Results: In total, 152 falls and 30 fall-related injuries were reported from a total of 37 fallers. After logistic regression analysis, the model with the greatest levels of clinical utility and discriminative ability for falls (sensitivity 81%; specificity 55%; area under the receiving operating characteristic curve [AUC] statistics=0.73; 95% CI, 0.60-0.86) included the variables of shorter time since SCI, high mobility level, and having received education on fall prevention. The model for fall-related injuries (sensitivity 79%; specificity 75%; AUC statistics=0.77; 95% CI, 0.59-0.96) included the variables of older male individual, lower physical health score, and having received education on fall prevention.

Conclusions: The regression models presented may be used to identify wheelchair users with SCI at greater risk of falls and fall-related injuries. The findings may help to refer those in need to tailored fall and fall-related injury prevention programs. The findings presented in this study were based on a relatively small sample convenience; therefore, further prospective studies with a larger sample size are warranted.

Keywords: ADL, activities of daily living; AIS, American Spinal Injury Association Impairment Scale; AUC, area under the receiver operating characteristic curve; Accidental falls; FOF, fear of falling; OR, odds ratio; QOL, quality of life; Rehabilitation; Risk factors; SCI, spinal cord injury; SCIM III, Spinal Cord Independence Measure III; Spinal cord injuries; TAI, Transfer Assessment Instrument; WHOQOL-BREF, World Health Organization Quality of Life-Brief Version; WST, Wheelchair Skill Test; Wheelchairs.

Fig 1

(A) Potential participants contacted the research group and manifested their interest in participating in the study. (B) Potential participants were screened over the phone for eligibility criteria by a researcher. (C) Eligible participants were provided with a link to complete demographics and surveys. (D) A researcher delivered assessment packages to study participants who completed the surveys through drop-off or mail. (E) Participants met with the researcher to perform remote sitting balance and transfer assessments.

Fig 2

ROC analysis of the final model for risk of falls, AUC=0.73 (95% CI, 0.60-0.86), P<.01. Abbreviation: ROC, receiver operating characteristic.

Fig 3

ROC analysis of the final model for fall-related injury, AUC=0.77 (95% CI, 0.59-0.96), P=.01. Abbreviation: ROC, receiver operating characteristic.