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Research ArticleOriginal Article
Open Access

Falls in individuals with stroke during inpatient rehabilitation at a tertiary care hospital in Saudi Arabia

Sami Ullah, Mohammed K. Al-Atwi, Ahmad Z. Qureshi, Sherif S. Tantawy, Amara Ilyas and Colleen A. Wunderlich
Neurosciences Journal April 2019, 24 (2) 130-136; DOI: https://doi.org/10.17712/nsj.2019.2.20180032
Sami Ullah
From the Department of Physical Medicine and Rehabilitation (Ullah, Al-Atwi, Qureshi, Tantawy), Rehabilitation Hospital, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia, from the Department of Physical Medicine and Rehabilitation (Ilyas), Mayo Hospital, Lahore, Pakistan, and from the Division of Pediatric Rehabilitation (Wunderlich), Department of Pediatrics, Palmetto Health Children Hospital, South Carolina, United States of America
MBBS, FCPS
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  • For correspondence: [email protected]
Mohammed K. Al-Atwi
From the Department of Physical Medicine and Rehabilitation (Ullah, Al-Atwi, Qureshi, Tantawy), Rehabilitation Hospital, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia, from the Department of Physical Medicine and Rehabilitation (Ilyas), Mayo Hospital, Lahore, Pakistan, and from the Division of Pediatric Rehabilitation (Wunderlich), Department of Pediatrics, Palmetto Health Children Hospital, South Carolina, United States of America
MBBS, SBPMR
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Ahmad Z. Qureshi
From the Department of Physical Medicine and Rehabilitation (Ullah, Al-Atwi, Qureshi, Tantawy), Rehabilitation Hospital, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia, from the Department of Physical Medicine and Rehabilitation (Ilyas), Mayo Hospital, Lahore, Pakistan, and from the Division of Pediatric Rehabilitation (Wunderlich), Department of Pediatrics, Palmetto Health Children Hospital, South Carolina, United States of America
MBBS, FCPS
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Sherif S. Tantawy
From the Department of Physical Medicine and Rehabilitation (Ullah, Al-Atwi, Qureshi, Tantawy), Rehabilitation Hospital, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia, from the Department of Physical Medicine and Rehabilitation (Ilyas), Mayo Hospital, Lahore, Pakistan, and from the Division of Pediatric Rehabilitation (Wunderlich), Department of Pediatrics, Palmetto Health Children Hospital, South Carolina, United States of America
MD
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Amara Ilyas
From the Department of Physical Medicine and Rehabilitation (Ullah, Al-Atwi, Qureshi, Tantawy), Rehabilitation Hospital, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia, from the Department of Physical Medicine and Rehabilitation (Ilyas), Mayo Hospital, Lahore, Pakistan, and from the Division of Pediatric Rehabilitation (Wunderlich), Department of Pediatrics, Palmetto Health Children Hospital, South Carolina, United States of America
MBBS, FCPS
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Colleen A. Wunderlich
From the Department of Physical Medicine and Rehabilitation (Ullah, Al-Atwi, Qureshi, Tantawy), Rehabilitation Hospital, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia, from the Department of Physical Medicine and Rehabilitation (Ilyas), Mayo Hospital, Lahore, Pakistan, and from the Division of Pediatric Rehabilitation (Wunderlich), Department of Pediatrics, Palmetto Health Children Hospital, South Carolina, United States of America
MD, ABPMR
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    Table 1

    Characteristics of the study population and a comparison of fallers and non-fallers.

    CharacteristicsFall statusP-value
    TotalFallersNon-fallers
    n (%)
    Number of patients146 (100)36 (24.7)110 (75.3)0.891
    Age (years) (Mean±SD)59.9±13.1659.64±9.4559.99±14.39
    Gender
     Male96 (65.8)28 (77.8)68 (61.8)0.080
     Female50 (34.2)8 (22.2)42 (38.2)
    Age Group
     ≤65 years98 (67.1)29 (80.6)69 (62.7)*0.048
     >65 years48 (32.9)7 (19.4)41 (37.3)
    Type of stroke
     Hemorrhagic20 (13.7)10 (27.8)10 (9.1)*0.005
     Ischemic stroke126 (86.3)26 (72.2)100 (90.9)
    Side of Stroke
     Left69 (47.3)20 (55.6)49 (44.5)0.111
     Right68 (46.6)12 (33.3)56 (50.9)
     Bilateral9 (6.2)4 (11.1)5 (4.5)
    HTN120 (82.1)30 (83.3)90 (81.8)0.837
    DM98 (67.1)26 (72.2)72 (65.5)0.453
    Previous stroke29 (19.8)12 (33.3)17 (15.5)*0.020
    Communication disorder81 (55.4)24 (66.7)67 (60.9)0.560
    Neglect5 (3.4)3 (8.3)2 (1.8)0.062
    Visual deficit9 (6.1)3 (8.3)6 (5.5)0.533
    Antidepressant use36 (24.5)9 (25)27 (24.5)0.956
    Antihypertensive use118 (80.8)30 (83.3)88 (80)0.659
    Diuretic use20 (13.6)5 (13.9)15 (13.6)0.969
    Benzodiazepine use7 (4.7)2 (5.6)5 (4.5)0.806
    Anticonvulsant use14 (9.5)4 (11.1)10 (9.1)0.747
    Length of hospital stay (days)51.15±24.655.47±21.649.75±25.50.282
    • SD - standard deviation, HTN - hypertension, DM - diabetes mellitus.

    • ↵* means significant difference.

    • View popup
    Table 2

    Characteristics of falls in stroke survivors receiving inpatient rehabilitation at a tertiary care facility in the region. N=36

    Characteristicsn (%)
    Number of falls
     One time30 (83.3)
     2 times5 (13.9)
     3 times1 (2.8)
    Time of falls
     7:00 AM-7:00 PM21 (58.3)
     7:00 PM-7:00 AM15 (41.7)
    Fall from
     Bed19 (52.8)
     Chair/wheelchair10 (27.8)
     Commode5 (13.9)
     Others2 (5.6)
    Fall type
     Assisted9 (25)
     Observed4 (11.1)
     Unobserved23 (63.9)
    Fall location
     Patient’s room29 (80.6)
     Therapy area1 (2.8)
     Home6 (16.7)
    Fall outcome
     Injury7 (19.4)
     No injury29 (80.6)
    • View popup
    Table 3

    Association between fall outcomes and clinical observations.

    VariablesOutcomes of fallsP-value
    Injured (n=7)Non-injured (n=29)
    n (%)
    Age (years) (Mean±SD)61.00±10.2359.31±9.420.678
    Gender
     Male7 (100)21 (72.4)0.115
     Female0 (0)8 (27.6)
    Type of stroke
     Hemorrhagic2 (28.6)8 (27.6)0.958
     Ischemic stroke5 (71.4)21 (72.4)
    Side of stroke
     Left3 (42.9)17 (58.6)*0.011
     Right1 (14.2)11 (37.9)
     Bilateral3 (42.9)1 (3.4)
    HTN5 (71.4)25 (86.2%)0.346
    DM5 (71.4)21 (72.4)0.958
    Previous stroke4 (57.1)8 (27.6)0.137
    Communication disorder4 (57.1)20 (69)0.551
    Patient fall risk
     High (Morse score >45)5 (71.4)17 (58.6)*0.005
     Moderate (Morse score 25-44)2 (28.6)11 (37.9)
     Low (Morse score ≤24)0.01 (3.4)
    Number of falls
     One time5 (71.4)25 (86.2)0.419
     Second time2 (28.6)3 (10.3)
     Third time0.01 (3.4)
    Fall time
     7 AM-7 PM3 (42.9)18 (62.1)*0.035
     7 PM-7 AM4 (57.1)11 (37.9)
    Length of hospital stay (days) (Mean±SD)70.14±30.6251.93±17.88*0.044
    • SD - standard deviation, HTN - hypertension, DM - diabetes mellitus,

    • ↵* means significant difference

    • View popup
    Table 4

    Significant independent risk factors of fallers undergoing stroke rehabilitation.

    CharacteristicsOR95% CIP-value
    Age >65 years2.8891.01-7.78*0.035
    Stroke type-hemorrhagic3.4161.22-9.53*0.019
    Previous stroke history3.4731.33-9.03*0.011
    • OR - odds ratio, CI - confidence interval

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Falls in individuals with stroke during inpatient rehabilitation at a tertiary care hospital in Saudi Arabia
Sami Ullah, Mohammed K. Al-Atwi, Ahmad Z. Qureshi, Sherif S. Tantawy, Amara Ilyas, Colleen A. Wunderlich
Neurosciences Journal Apr 2019, 24 (2) 130-136; DOI: 10.17712/nsj.2019.2.20180032

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Falls in individuals with stroke during inpatient rehabilitation at a tertiary care hospital in Saudi Arabia
Sami Ullah, Mohammed K. Al-Atwi, Ahmad Z. Qureshi, Sherif S. Tantawy, Amara Ilyas, Colleen A. Wunderlich
Neurosciences Journal Apr 2019, 24 (2) 130-136; DOI: 10.17712/nsj.2019.2.20180032
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