Developing a fall prevention program in an inpatient spinal cord injury rehabilitation unit: A participatory action research study

Abstract

Importance Spinal cord injury is a lifelong disability necessitating early management of falls during inpatient admissions. However, there is a paucity of research on fall prevention and management in Spinal cord injury rehabilitation. Objective(s) This study aimed at developing a fall prevention program in an inpatient rehabilitation Spinal cord injury unit. Method A participatory action research approach utilizing a before-and-after, mixed-method design was employed for this study. The study was performed at Rofaydeh Rehabilitation Hospital in Tehran, Iran, from 2021 to 2022. the study implemented Cohen’s four-stage model, encompassing the design of a change program, action, observation and evaluation, and feedback stages. A purposeful sampling method was utilized to select 19 nurses and members of the rehabilitation team from the hospital, ensuring maximum diversity. Data collection involved semi-structured interviews, focus groups, and a checklist for fall prevention measures. Qualitative content analysis, alongside descriptive (frequency, mean, and standard deviation) and inferential statistics (paired t-tests and Chi-square tests), were employed for data analysis. The study adhered to COREQ guidelines. Results Falls were most common among patients aged fifty years or older (P = 0.026). Throughout the study period, men were more likely to experience falls than women (P = 0.01). Preventive interventions have led to significant improvements in indicators of patient monitoring and care, patient education, and environmental safety, as demonstrated by a paired-sample t-test (P<0.001). Moreover, factors contributing to patients’ falls included "shortcomings in fall prevention policies" and "lack of knowledge and participation among patients and caregivers." Changes implemented in the Spinal Cord Injury unit involved enhancing interprofessional interactions, conducting educational workshops for patients and their companions, and identifying high-risk patients. These findings indicate a significant decrease in the incidence of falls following the intervention (P = 0.02). Conclusions The study found that a multifaceted intervention can increase knowledge about fall risks and substantially reduce both falls and associated minor injuries.