Embracing risk, enhancing autonomy, and accelerating recovery: a mixed-methods evaluation of the Therapeutic Falls pathway.

Abstract

Restricting mobility might keep patients safe in hospital, but leave them unprepared and unsafe after discharge. This work evaluated the impact of "Therapeutic Falls" - a novel approach where patients practice higher-risk activities during inpatient rehabilitation in collaboration with their care team. A mixed-methods evaluation was conducted across five rehabilitation units at Canada's largest hospital. Quantitative outcomes included motor recovery, length of stay and fall rates (with and without harm). Qualitative data were collected through interviews and focus groups with patients, providers, learners and leaders exploring experiences of risk, safety and autonomy. Patients on the Therapeutic Falls pathway (<i>n</i> = 99) had significantly shorter LOS and no significant change in falls with harm. Neurorehabilitation patients specifically showed greater motor recovery without increased fall rates. Qualitative analysis (<i>n</i> = 56) revealed three themes: i) Two distinct profiles of patients who benefit most from the pathway: those progressing toward independent mobility despite a high risk of falls, and those living with permanent risk whose goals prioritize autonomy and quality of life; ii) growing provider confidence in managing risk; and iii) the pivotal role of shared decision-making. Therapeutic Falls challenges traditional falls prevention approaches by recognizing that informed risk-taking can enhance safety, recovery, and transitions in care.