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