Co-designing approaches to enhance falls management after spinal cord injury in an Australian spinal injuries unit

Persons with spinal cord injury (SCI) are at risk of falls because of changes in sensation and motor function. While research exists on the consumer and clinician perspective of falls and fall prevention, these groups have not been brought together to determine how to effectively address this issue. The study aimed to co-design approaches to enhance falls management including prevention of falls and post fall management, after SCI in inpatient spinal rehabilitation.

Using an experience-based co-design process, six consumers and eight clinicians, including occupational therapists, each participated in multiple focus groups and/or individual interviews. Data were collected over three cycles and were used to (1) share and explore the experience and perspectives of falls after SCI, (2) determine possible approaches to enhance services currently offered, and (3) develop and refine principles to enhance falls management. Data analysis followed an interpretive description approach with constant comparative analysis. Following each cycle, researchers engaged in discussion, generated themes, and tested ideas in the following cycle.

This research was completed with people with lived experience of SCI. Co-investigators with lived experience of SCI were involved in the planning and conduct of the study.

It was agreed that falls management is required lifelong for persons with SCI, although the important role of inpatient preparation was highlighted. Different perspectives were shared with consensus met on key issues and actions to address falls in the inpatient setting. Practice principles produced included getting everyone on the same page, learning to move safely through experience-based learning, understanding it is more than just falls, and the need for individualised practice.

This work has combined experiences and perspectives from consumers and clinicians with approaches developed for future service improvement to enhance falls management for people with SCI in inpatient spinal rehabilitation PLAIN LANGUAGE SUMMARY: This work asked people with spinal cord injury and people working in the hospital about falls in hospital. It wanted to find ways to improve how people can plan for and deal with falls in hospital and when they leave hospital. A series of one-on-one and group interviews found out about problems with how hospitals help people with falls now and ways to make it better. We learnt that people with spinal cord injury and people working in the hospital both need to work together. Also, people with spinal cord injury want to practice tasks to prepare for and deal with falls. They want to learn about how to be assertive and want education to be made just for them. This study shows how hospitals can improve what they are doing about falls.