Clinical Implications for Management of Falls in Hospital Patients with Communication Disability After Stroke: A Qualitative Meta-Synthesis

BACKGROUND: Falls in hospital are a common patient safety incident after stroke. Despite the reprevalence of communication disability following stroke, there is little guidance for health professionals to provide effective falls prevention strategies for this population.

OBJECTIVES: To provide a synthesis of findings across a selected set of related studies on falls in hospital patients with communication disabilities following stroke and guidance for health professionals to enhance falls prevention strategies for this group.

METHODS: A qualitative meta-synthesis of six integrated studies using a content thematic analysis.

RESULTS: Communication disability often lacks visibility in falls research, hospital policies, and clinical management. Whilst the relationship of communication disability as a risk factor for falls is unclear, communication disability contributes to falls and is a barrier to falls prevention and management. Suggestions for falls prevention include involving family members, tailored falls and stroke education programmes, and improved documentation of the functional impacts of communication disability.

CONCLUSION: In recognising the complexities of falls in patients with communication disability, health professionals could provide more targeted, patient-specific falls prevention plans. Further research, inclusive of patients with communication disability following stroke, could provide important insights into their falls and falls management. Research examining the effectiveness of falls prevention strategies for this group is indicated.

IMPLICATIONS FOR PATIENT CARE: Insights from this review could enhance falls prevention programmes for patients with communication disabilities after stroke.

IMPACT: This meta-synthesis combined a set of integrated studies to provide guidance for the management and prevention of falls in hospital patients with communication disabilities after stroke. Three interconnected content themes were identified: (a) An invisible problem: communication disability is invisible, and consideration of this in research and falls management has been lacking; (b) Painting the falls picture: the nature of communication disability and falls; and (c) A complex problem: the multiple impacts of communication disability on falls management. Falls prevention themes identified in the individual studies that specifically target the needs of patients with communication disability after stroke are presented as 'The Way Forward: Potential Falls Prevention Strategies to Improve Care for Hospital Patients with Communication Disability Following Stroke'. The integration of these findings into clinical practice should mean that (a) healthcare professionals provide more patient-specific falls prevention plans that include considerations of communication disability, and (b) hospital managers should take steps towards improving falls prevention and management policies to include patients with communication disability following stroke.

REPORTING METHOD: This review is reported according to the Standards for Reporting Qualitative Research.

PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.