Incorporation of a tool to measure fear of falling in the inpatient rehabilitation setting

Abstract

One-third of older adults fall each year, resulting in costly injuries and impaired quality of life. For those who have experienced a stroke, fall incidence is even higher. Excessive fear of falling (FOF) is one factor that leads to activity avoidance and increase the fall likelihood. The purpose of this project was to introduce the Falls Efficacy Scale-International (FES-I), a validated 16-item scale, into the inpatient rehabilitation setting , providing a mechanism for the assessment and management of FOF in post-stroke patients. Fear of falling assessment using the FES-I was completed on adult, post-stroke patients admitted for care January—February, 2018 with adjustments to the nursing and therapy plans of care for patients with high levels of FOF (score ≥27). Staff were surveyed about FOF knowledge and attitudes before and after introduction of FES-I. Initial education on FES-I was provided to 96 staff members. Surveys indicated increased knowledge on FOF and FES-I but no significant changes in attitudes noted between pre- and post-survey results. Of the 52 stroke patients admitted during the project, only 44% (n=23) were able to complete the FES-I with a mean score of 38.1 (out of 64). Seventeen (74%) patients were contacted following discharge with 94% able to recall at least one FOF reduction strategy. While the FES-I proved to be a simple, effective tool for the measurement of FOF during rehabilitation, most of the post-stroke patients were too impaired to allow for use of the FES-I. Additional study is recommended for the potential use of the FES-I in patients with other rehab diagnoses. Additionally, application of the FES-I to post-stroke patients should be considered further along the recovery continuum (e.g., outpatient rehabilitation or home health).