THE PREVALENCE OF FALLS IN PATIENTS UNDERGOING MAINTENANCE HEMODIALYSIS, TAKE 2. Megan Witzgall*1; Nikki Pompeo1; Erin Doyle1; Derrick Latos2; Robert Galbreath3 1. Wheeling Jesuit University, Wheeling, WV; 2. Wheeling Dialysis Center, Wheeling, WV; 3. Ohio University Eastern, St. Clairsville, OH PURPOSE: The purpose of this prospective study using retrospective data was to identify the risk factors for falls in patients with renal failure who are receiving maintenance hemodialysis. BACKGROUNDS/SIGNIFICANCE: A fall, as described by patient report, is defined as a sudden, unintentional change in position from an upright posture with/out loss of consciousness causing the victim to land on the ground. One out of three Americans age 65 years and older fall at least once a year with 10% fracturing a bone, dislocating a joint or incurring some other serious injury. Anecdotal experience at a local dialysis center indicated that patients receiving maintenance hemodialysis have a greater than expected number of falls when compared to the general population within the same age ranges. Measures of strength, special tests, and blood values may be useful for determining fall risk in people receiving maintenance hemodialysis. SUBJECTS: A total of 55 hemodialysis patients (31 males, 24 females) with a mean age of 66.0 years (SD=13.8, range= 30-90) volunteered and participated in the study. Participants were excluded under the following conditions: inability to ambulate three meters and return with or without an assistive device, medically unstable, or legal blindness with no vision at all. METHODS AND MATERIALS: The patients were tested using the Functional Reach Test (FRT), the Timed Up and Go (TUG) Test, the Modified Falls Efficacy Scale (MFES), and the Medical Outcomes Study Short-Form-36 (SF 36). Muscle strength of three lower extremity muscle groups was measured using a handheld dynamometer. A chart review was conducted on each patient to collect past medical history, initial date of dialysis, and various laboratory parameters. Data regarding falls were collected over a nine-month period, recording the time, nature, and location of the fall. ANALYSES: Correlations between the number of falls and each demographic variable were determined, and a multivariate analysis, using stepwise linear regression, was used to determine the best combination of variables that predict falls. RESULTS: Eighteen of the 55 patients (33%) reported falling (41 episodes) during the preceding nine-month period. The strongest predictors for the occurrence of falls were the MFES (r = 0.353, p = 0.008), and the presence of peripheral neuropathy (r = 0.325, p = 0.021). Seven other factors were identified as significant: the FRT (r = 0.273, p = 0.044), the TUG Test (r = -0.269, p = 0.047); the use of an assistive device(r = -0.238, p = 0.080), muscle strength of the right quadriceps (r = 0.324, p = 0.016), and right and left dorsiflexors (r = 0.346, p = 0.010; r = 0.363, p = 0.006 respectively), and the MCS score of the SF 36 (r = 0.393, p = 0.037). CONCLUSIONS: The MFES and the presence of a peripheral neuropathy are predictors of falls in maintenance hemodialysis patients; however, it is uncertain if this population is at a higher risk for falls than the typical adult population. FUNDING SOURCE: None KEYWORDS: Falls, Peripheral Neuropathy, Maintenance Hemodialysis, Modified Falls Efficacy Scale, Muscle strength Copyright 2009 by the American Physical Therapy Association. Requests for reprints should be directed to the corresponding author of the article. Educators, students, and other academic customers may receive permission to reprint copyrighted material from Physical Therapy (ISSN 1538-6724) by contacting the Copyright Clearance Center Inc, 222 Rosewood Dr, Danvers, MA 01923. Other types of customers who want permission to reprint should contact the APTA Editorial Office, Attn: Physical Therapy.