An Exploration Of Falls-Risk After Stroke: A Mixed Methods Approach

This thesis aimed to inform the assessment of post-stroke falls-risk in those discharged to the community. It comprised five inter-linked studies: Prospective cohort study: A total of 128 recently discharged stroke survivors from five Dublin hospitals were followed for 12 months. During this time 44% of participants fell, 25% repeatedly. Of the fallers, 40% sought healthcare attention after a fall and 10% experienced a fracture. Systematic review of falls prediction models in the year after stroke: Twelve studies were identified that aimed to predict falls in acute or community settings using multivariable models. None presented a validated model with acceptable performance. External validation study of risk prediction models for post-stroke recurrent community falls: Two risk prediction models identified from the review were potentially applicable to the population of interest. These models were applied to the Irish cohort data and were found to have poor discrimination for recurrent falls. There is currently insufficient evidence to rule individuals out as at risk of recurrent falls at discharge Meta-ethnography exploring fall-related experiences of stroke survivors: Six qualitative papers were identified and synthesised. Falls and perceived fall consequences were described in the context of barriers to activity and community participation. The lack of research in the area did not allow for theoretical saturation Qualitative study exploring the experiences of post-stroke recurrent fallers: Nine participants from the cohort study were interviewed 20 months after discharge. Methods of Grounded Theory were employed. The results provided insights into the recovery experiences of recurrent fallers, the importance that they attach to falls and the way in which they self-assess and manage falls-risk. An integration of quantitative and qualitative findings revealed insights around the definition of falls-risk, the timing of falls-risk assessment, patient—professional communication about falls-risk and post-stroke recovery and community reintegration in the context of falls.