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Advisory Committee Chair

Rita A Jablonski

Advisory Committee Members

Lori A Loan

Rebecca S Miltner

Xiaofei Qiao

Christianne E Strang

Document Type

Dissertation

Date of Award

2021

Degree Name by School

Doctor of Philosophy (PhD) School of Nursing

Abstract

Background/Significance: Inpatient falls on acute stroke rehabilitation units remains a significant issue that negatively affects healthcare costs and causes physical and psychological injury. Prevelance of falls in the stroke rehabilitation population may be due to the presence of anosognosia for hemiplegia (AHP), which is as an unawareness of physical disability. Though the link between AHP and falls has been suggested in the literature, a formal investigation has not been conducted to address the relationship between the variables. Purpose: To explore the association between the presence of anosognosia for hemiplegia after stroke and patient fall events while admitted to an acute inpatient rehabilitation program. Methods: A prospective, correlational research design was utilized. Logistic regression analysis was then performed between a priori variables after the initial data analysis. Demographic data and data related to fall events were collected for each participant. The Visual Analogue Test for assessing Anosognosia for motor impairment (VATA-m) was utilized to assess for AHP. Findings: There were no statistically significant relationships between the variables presence and severity of AHP and the prevalence and severity of inpatient falls in the sample. Regression analysis also revealed that the presence and severity of AHP was not responsible for any variation in number of falls or severity of falls in the sample. Clinically significant findings include the presence of AHP in 94% of the sample, and evidence suggesting that clinicians at the bedside were unaware of the extent of the participant’s unawareness, which places the participant at a greater risk for fall events. Discussion: Though there were not statistically significant relationships between the key variables of interest, clinically significant findings are apparent. The prevalence of AHP in this sample was much higher than other literature, indicating that previously published studies may be underreporting AHP prevalence. Clinicians at the bedside also erroneously charted that their patient was aware of his or her physical impairment in 100% of the sample. Future research should focus on further understanding how AHP affects global outcomes for stroke survivors, and how clinicians measure or assess for awareness at the bedside.

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