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Published on: April 23, 2014
The development and validation of a brief performance-based fall risk assessment tool for use in primary care
Anne Tiedemann1, Stephen R Lord, Catherine Sherrington
1Musculoskeletal Division, The George Institute for International Health, PO Box M201, Missenden Rd, NSW 2050, Australia. atiedemann@george.org.au
Background:
To report the development, external validity, reliability, and feasibility of a falls risk assessment tool for use in primary care.
Methods:
Two prospective cohort studies, a test-retest reliability study, and a feasibility study were included. Seven hundred and sixty four older community-living people (mean age = 75.3 years, SD = 5.8) participated in the tool development study, 362 people (mean age = 80.25 years, SD = 4.5) participated in the external validation study, 30 older people took part in the test-retest reliability study, and 32 clinicians participated in the feasibility study.
Results:
The fall risk assessment score (number of risk factors) displayed a good ability to discriminate between multiple fallers (those who experienced two or more falls) and non-multiple fallers in the external validation study (area under the receiver operating characteristic curve = 0.72, 95% confidence interval = 0.66-0.79). Each of the performance items; low contrast visual acuity, tactile sensitivity, sit to stand, alternate step, and near tandem stand ability; and measures of previous falls and medications could discriminate between prospectively categorized multiple fallers and non-multiple fallers with relative risk values ranging from 1.4 to 2.4 in the development study. The probability of future multiple falls increased from 7% with the identification of zero or one risk factor up to a probability of 49% with the identification of six or more risk factors. The assessment items exhibited moderate to excellent test-retest reliability and a high degree of acceptance by health professionals.
Conclusion:
The assessment tool is an externally validated, reliable, and feasible falls risk assessment that can accurately predict multiple falls and assist with guiding interventions in community living older people.
