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LETTER TO THE EDITOR
Comparison of fallers and nonfallers at an inpatientrehabilitation facility: A retrospective review
The authors address an important topic in trying to
determine fall risk factors for a specialty practice area:
rehabilitation nursing. However, comparison of the Uni-
form Data System for Medical Rehabilitation (UDSmr)
Functional Independence Measure (FIM) with Morse Fall
Scale (MFS) lacks validity and precision. The FIM was
designed to determine the burden of care for those living
with disability(ies) and/or chronic diseases, not to deter-
mine the likelihood of a specific type of fall. The MFS
was designed to determine the likelihood of only one type
of fall, the anticipated physiologic fall (see Morse, 1997).
Therefore, to compare the two instruments, FIM and
MFS, is incongruent conceptually and scientifically. In
addition, without specification of type of falls when using
the MFS, the investigators negate its construct and pre-
dictive validity for the one type of fall, and thus the
results from this study, comparing fallers to nonfallers,
are inaccurate. When comparing fall risk screening tools
to nursing judgment about likelihood of falling, nursing
judgment of “front line nurses” is important (see Oliver
et al., 2010). Rehabilitation nurses would be better guided
to exercise clinical judgment that is specialty-based and
expert for assessment, not screening, to identify patient-
specific factors that make rehabilitation patients at known
risk for anticipated physiologic falls, such as hemianopsia,
hemiplegia, hemiparesis, postural hypotension, inconti-
nence, and lower extremity sensory neuropathy; then,
rehabilitation nurses lead and design interdisciplinary
approaches to modify and reduce fall risks factors
although protecting rehabilitation patients fall-related
injuries.
Patricia A. Quigley, PhD, MPH, ARNP, CRRN, FAAN,
FAANP, ACNSR
Associate Director
VISN 8 Patient Safety Center of Inquiry, James A. Haley
VAMC (118M) HSR&D/RRD Center of Excellence:
Maximizing Rehabilitation Outcomes 8900 Grand Oak
Circle, Tampa, Florida, USA
References
Morse, J. (1997). Preventing patient falls. Thousand Oaks, CA:
Sage Publications.
Oliver, D., Healy, F. & Haines, T.P. (2010). Preventing falls
and fall-related injuries in hospitals. Clinics in Geriatric
Medicine, 26, 645–692.
© 2013 Association of Rehabilitation Nurses
Rehabilitation Nursing 2013, 38, 163–163 163
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