Background Patients with communication disability following stroke are at increased risk for adverse events including falls. However, they are often excluded from falls research, and little is known about the circumstances and outcomes of their falls. Understanding more about falls among this population will help inform policy and practice aiming to improve their safety in hospital.

Method This cohort study analysed matched medical records and patient incident reports for patients with communication disability after stroke who had at least one fall during inpatient rehabilitation.

Results The study included 109 patients with 308 falls. Prior to the first fall, 48% of participants had falls prevention strategies in place. Documents examined suggested that patient factors (e.g., balance) contributed to half of all falls, but no contributing factors were identified in a third of the falls. The most common type of fall was ‘unwitnessed rolls from bed’ (44%). Falls occurred across the day and night, and injuries occurred in 15% of falls. Financial and resource impacts on the hospital system included additional staffing and patient investigations.

Conclusion This study presents the circumstances, outcomes, and potential contributing factors for falls in patients with communication disability following stroke. Patient factors were the most often identified contributing factor. Where patients were unable to describe the fall, the circumstances were unclear. Understanding the reasons why patients are attempting to get out of bed may identify ways to reduce the risk and incidence of falls in this population. Observational studies of this group may identify the circumstances leading up to their falls.