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Exploring the causes and impacts of falls among ambulators with spinal cord injury using photovoice: a mixed-methods
Hardeep Singh1,2, Arielle Shibi Rosen2,3, Geoff Bostick4
1Rehabilitation Sciences Institute, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada.
Objectives:
This 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.
Design:
A sequential explanatory mixed-methods design with two phases.
Setting:
A Canadian SCI rehabilitation hospital and community setting.
Participants:
Thirty-three ambulators with SCI participated in phase 1 and eight participants that fell in phase 1 participated in phase 2.
Methods:
In 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.
Results:
Of 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).
Conclusions:
Fall 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.
