Table 2

Themes, subthemes and supporting quotes

Overarching theme: Individualised, dynamic and complex fall risk factorsTheme 1: Falls and fall risk caused by multiple interacting factors
1a. Falls and fall risk are multifactorial
(i) ‘There was a box with 12 bottles in it and I had it in my lap… And then the box shifted going over this lip and then that caused the chair to tip… my hand that barely works was securing the box and then my other hand was using the controls on my power chair… I tried to secure the box and I’m shifting my weight forward, and the chair tipped forward’. (P11)
1b. Consider fall risk associated with their actions
(i) ‘I wouldn’t change my chair… it’s up to me to be vigilant in my surroundings… you’re constantly monitoring your environments and your behaviour and your actions’. (P8)
(ii) ‘I removed [the seatbelt] from my wheelchair because what I found is if I am hitting something hard enough to throw me out of my wheelchair, the seatbelt is not going to stop me. What it is going to do is bring my wheelchair with me so if I tip over with the wheelchair strapped to me then I am laying on the ground with my wheelchair on top of me that I can’t get the seatbelt undone, whereas if I hit something and fall out of the wheelchair, it stays upright usually and I can at least get back into it’. (P6)
Theme 2: Dynamic nature of fall risk
(i) ‘There was a change in situation. A change in physical situation. Having a weakened arm, I lost grip stability and strength. It became a real problem. It gives up some times. It just collapses and I just fall mid-transfer’. (P8)
(ii) ‘None of the equipment was new or anything like that. I was used to doing that transfer but it is internal factors. I was disoriented, I hadn’t had enough sleep, I was a new mother and these are the reasons why I had those falls’. (P4)
Theme 3: Single factors perceived to reduce falls and fall-related injuries
3a. Wheelchair features
(i) ‘(Gloves with a rubber sole) are the ultimate, ultimate things that I have that decrease my risk of falling… They are a huge safety net on transfers because of the grip… they help me transfer onto the floor, on equipment, pushing the wheelchair’. (P6) (see figure 2A)
ii) ‘This is just a generic photo of the anti-tippers. They are a huge safety thing and what decreases the likelihood of falling’. (P6) (see figure 2B)
3b. Environmental factors
(i) ’This is the ideal way the pavement gaps should line up… no huge gaping there… this has zero risks for me to fall’. (P4) (see figure 2C)
(ii) ‘This proper sidewalk provides the safety of not having a fall… (It has) proper cut outs, button placement, no dips or uneven ground. Proper grades and…not having to go backwards off a curb’. (P12) (see figure 2D)
3c. Behavioural factors
(i) ‘Trust your feelings. When you feel it is not safe don’t do it; don’t do it because your body, your body will tell you when it’s safe to do it. If you do something dangerous or if you find it’s not safe to do something just stop yourself there’. (P7)
3d. Biological factors
(i) ‘I’ve lost weight and am continuing to lose weight so that’s helping’. (P1)
3e. Social and economic factors
(i) ‘I just don’t walk on my own because if I need a wheelchair I need it fast and anyone that’s assisting me they have been trained to bring my chair for me and to help me to land fairly gently if that’s an option’. (P1)
Theme 4: Fall prevention experiences and priorities
4a. Training inappropriate for dynamic needs
(i) ‘The focus was on getting up and getting mobile and not so much the whole fall prevention’. (P1)
(ii) ‘I never thought of having to go back into the chair in a regression… I was taught fall prevention of how to use a walker and how to use my walking poles but I guess because we were so focused on me walking, myself and everyone included, [fall prevention skills] was sort of missed’. (P12)
4b. Priorities for fall prevention initiatives
(i) ‘You tuck your chin in and you lean forward when you feel yourself going back and that takes practice. So like it was during basketball and we have access to these huge mats. So my friend had me just go up and park my chair without my brakes, and lean back and feel comfortable just falling on it and getting used to it that. So it’s putting me in that situation where I’m going to fall no matter what and where I’m making myself fall so if that happens it’s muscle memory and not just me going oh my gosh I’m falling and you know flailing and hitting my head’. (P12)
(ii) ‘Taking people out in the community and going over sidewalks is a good idea. Teaching them how to do wheelies and navigate steep curves or steep ramps would also prevent them hitting the bottom and flying forward. So making sure people leave the rehab centre with the confidence to perform a wheelie to get down a steep curb. Also, training people on good transfers in the washroom because when you’re wet or slippery or anything like that, you are at a higher risk of falling’. (P5)