Exploring the influence of hospital context on acute care physical therapy fall prevention practice: A qualitative study

Background: Falls are a significant concern for hospitals and patients. The risk of falls is particularly heightened around the period of hospitalization. Physical therapy (PT) is commonly consulted for hospitalized patients at-risk for falls, yet it is unknown how the hospital context influences fall prevention practice among physical therapists. Purpose: To explore the perspectives of acute care physical therapists on fall prevention practices within hospital settings and examine how specific contextual factors influence their practice patterns and the effectiveness ofPT interventions. Methods: A prospective qualitative study using collaborative qualitative data analysis was conducted through semi-structured interviews with acute care physical therapists nationwide. Interviews focused on therapists' perceptions of fall prevention practices, PT intervention effectiveness, and the influence of hospital context. Results: We derived three primary themes and ten subthemes. First, mobility promotion was identified as central to fall prevention, requiring a system-wide culture involving multidisciplinary teams, particularly nursing staff. Second, systemic factors, such as time constraints, institutional priorities, high patient volumes, staff availability, equipment availability, and the physical environment, were found to limit optimal PT practice for fall prevention. Third, the effectiveness of PT interventions was context-dependent, with therapists adapting their practices to maximize impact within systemic constraints. Notably, clinical experience seemed to mitigate some practice limitations. Conclusions: Despite the acknowledged benefits of PT, systemic factors often prevent therapists from implementing effective fall prevention interventions. Addressing these contextual barriers and developing standards of practice may enhance patient safety and the overall success of fall prevention efforts in hospitals.