Identifying fall prevention and management needs of people post-stroke who use wheelchairs and scooters
People post-stroke who use wheelchairs or scooters (WC/S) for mobility represent an understudied and underserved population in fall prevention research. While falls are widely documented among people post-stroke who are ambulatory, little is known about fall incidence, consequences, contributing factors, and fall prevention programs among people post-stroke who use WC/S full-time. The purpose of this dissertation was to identify the fall prevention and management needs of people post-stroke who use WC/S and to generate understanding and knowledge to guide development of tailored, evidence-informed fall prevention and management programming. This dissertation used a mixed-methods approach consisting of two phases. Phase I was a systematic review of fall incidence, consequences, contributing factors, and existing fall prevention and management programs for people post-stroke who use WC/S. Seven studies met inclusion criteria. Review findings revealed high fall incidence (up to 47% during inpatient rehabilitation), with falls commonly occurring during transfers and wheelchair operation. Injuries were typically minor but may have been underestimated due to the controlled inpatient environment. Risk factors included impaired balance and postural control, spatial and cognitive deficits, behavioral impulsivity, and inadequate WC/S transfer training. Few intervention studies were identified, and no comprehensive, community-based fall prevention programs existed for this population. Phase II included three complementary studies: (1) a convergent parallel mixed-methods study with people post-stroke who use WC/S (online survey + semi-structured interviews), identified their perception of fall risks, consequences, contributing factors, and fall recovery strategies based on the unique personal insights, (2) qualitative interviews with care partners and clinicians, gathered their perspectives on the perception of fall risks, consequences, contributing factors, and fall recovery strategies, and (3) qualitative interviews with three stakeholder groups (people post-stroke who use WC/S, care partners, and clinicians), explored their experiences with existing fall prevention programs they had received or delivered, and highlighted the key elements needed for a tailored fall prevention and management program. Quantitative findings demonstrated high levels of fall concerns, frequent environmental and transfer-related fall circumstances, and multidimensional fall consequences affecting physical, functional, psychosocial, and social domains. All three stakeholder groups reported people post-stroke who use WC/S had trouble recovering independently from falls and described prolonged time on the ground as a major safety concern. Qualitative data revealed that falls often occurred during toileting, transfers, reaching, or navigating uneven surfaces, and were strongly influenced by stroke-related impairments, inadequate training in safe WC/S skills, and environmental barriers. Across all groups: people post-stroke, care partners, and clinicians, there was consensus that current fall prevention education is insufficient, overly focused on ambulatory populations, and not delivered consistently in clinical care. All groups’ participants emphasized the need for WC/S-specific training, peer-supported learning, individualized problem-solving, care partner involvement, and practical, scenario-based education extending beyond inpatient rehabilitation. Findings across phases converged to demonstrate that people post-stroke who use WC/S face substantial and unique fall risks that are not addressed by existing fall prevention programs. This dissertation identified critical gaps in research and clinical practice and outlines key components for future interventions, including WC/S and transfer skills training, environmental navigation strategies, cognitive and behavioral fall risk management, fall recovery techniques, and comprehensive, community-based education. These findings provided essential groundwork for the development of tailored fall prevention and management programs that better reflect the needs and preferences of people post-stroke who use WC/S.
University of Illinois - Urbana-Champaign
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