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BACKGROUND Patients with high fall risk tend to spend substantial time in bed due to reduced physical activity. Thus, accidental falls frequently occur during body position changes, including when a person rises from the bed to stand. This study examined the existing literature on a person’s activity while lying on the bed and accidental falls or fall risk estimation. OBJECTIVE To conduct a systematic review of the current literature to examine the relationship between a person’s in-bed physical activity/movements and accidental falls or fall risk estimation. METHODS We searched Pubmed, Scopus, and Web of Science for articles that mentioned in-bed movements and falls, published in English from January 2010 to June 2022. We included eligible articles for full review by a two-step screening process. The initial screening included the articles whose abstracts mentioned falls or fall risk and physical activity/movement on the bed, and then full article reviews were conducted to confirm the eligibility. Articles that did not meet these criteria were not considered in the review. During the full review, we extracted the information on the citations, research designs, participant descriptions, in-bed movements, and fall risk assessment. We also extracted the information on sensing technologies and measurement characteristics, if they were considered in the article. Finally, we synthesized the extracted information to report our findings. RESULTS A total of 40 studies were eligible for our review. Various methods were considered to assess fall risk, including scoring the fall risk, testing physical functions (e.g., functional ambulation profiles), a patient reporting a history of falls or describing the fear of falling, and detecting patient-related events increasing the fall risk. Examples of in-bed movements were unattended bed exit, difficulty (e.g., rocking motions) rising from the bed to sit or stand, and body position on the edge of the bed. Out of 9 interventional studies found, only three interventional studies reported an association between in-bed movements and fall risk. These studies aimed to evaluate sensor-based fall risk monitoring systems on the hospital floors and found that detecting unattended bed exits was associated with reduced fall rate, i.e., falls per patient-days, especially for those with increased fall probability. CONCLUSIONS The definitions of fall risk and in-bed movement varied widely across reviewed articles. Studies should report clear definitions of fall risk and in-bed movement. We found insufficient evidence of the relationships between in-bed movements and fall risk in the literature. Thus, we encourage future studies to identify and validate the types of in-bed movements specific to increased or increasing fall risks. |
