Identifying fall prevention and management needs of people post-stroke who use wheelchairs and scooters - Background: People post-stroke who use wheelchairs and scooters (WC/S) face unique challenges related to mobility and are at an elevated risk for falls and the development of Concerns about Falling (COF). Despite these challenges, there is a lack of understanding of specific risk factors for falls in this population. This lack of knowledge limits the ability of researchers to develop effective, evidence-based interventions. Rice et al. developed the Individualized Falls Reduction Program (iROLL) using the Health Belief Model (HBM) and Social Cognitive Theory (SCT) with an emphasize on self-management strategies as the theoretical foundation. This fall prevention and management program is designed for people with spinal cord injury (SCI) and multiple sclerosis (MS) who use WC/S. After engaging in the iROLL program, participants reported a significant decrease in COF and an increase in knowledge of fall prevention and management. Currently, the iROLL program does not meet the specific needs of people post-stroke, but the modular structure of the program would allow for the integration of health condition-specific content. However, insufficient literature exists to guide the development of the necessary content to support people post-stroke who use WC/S. Purpose/Study Aims: The purpose of the study is to lay the groundwork necessary to guide the development of iROLL content to meet the needs of people post-stroke who use WC/S. To achieve this goal, we aim to 1) understand the frequency of falls and circumstances associated with falls among people post-stroke who use WC/S, 2) explore the outcomes of falls, 3) examine existing fall prevention and management programs designed for people post-stroke who use WC/S and identify gaps in services, and 4) investigate the key elements needed in a fall prevention and management education program for people post-stroke who use WC/S. Methods: This convergent parallel mixed-methods study will be implemented to obtain both quantitative and qualitative data. A systematic literature review will be performed to collate and analyze existing research on fall incidence, risk factors for falls, consequences of falls, and prevention strategies for people post-stroke who use WC/S. Next, semi-structured interviews and surveys will be conducted with clinicians, people post-stroke who use WC/S, and their care partners. Guided by the findings of the systematic literature review, data will be collected to supplement the existing literature, understand experiences with falls, challenges faced in daily activities, and perceptions of effective strategies/training/education for managing and preventing falls for people post-stroke who use WC/S. Surveys will gather statistical data on fall frequency and contributing factors, while semi-structured interviews will capture personal experiences on falls and fall prevention and management programs/training/education needs. Expected Results: This two-phase study addresses the pressing issue of falls, and it is designed to fill a critical research gap in fall prevention and management for people post-stroke who use WC/S. By evaluating the impact of falls and addressing specific needs and preferences, this study will identify gaps in existing fall prevention programs; and identify the essential components of an effective fall prevention and management program, including risk factor awareness, mobility training, environmental strategies, and increased self-efficacy. Ultimately, the goal is to improve the QOL of people post-stroke who use WC/S, promoting community engagement and reducing the incidence of falls and related complications. This study will provide meaningful input into healthcare practice and improve the overall well-being of this underserved population. Conclusion: Successfully completion of the proposed study will guide the development of evidence-based fall prevention and management programs for people post-stroke who use WC/S.
