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Published on: June 20, 2020
A new tool for assessing the risk of fall in children with severe disability: development of the ALICE scale
S Terzoni1, L C Bianchi2, P Ferrara1
1San Paolo Bachelor School of Nursing, ASST Santi Paolo e Carlo, Milan, Italy.
Insights
A new scale, ALICE, effectively assesses fall risk in children with severe disabilities. This validated tool demonstrates high sensitivity and specificity, aiding in preventing further injury.
Area of Science:
- Pediatrics
- Rehabilitation Medicine
- Disability Studies
Background:
- Falls are a primary cause of physical impairment in children with severe disabilities.
- Existing fall risk assessment scales lack specificity for this vulnerable population.
- There is a critical need for a validated tool to identify and mitigate fall risks in severely disabled children.
Purpose of the Study:
- To develop and validate a novel scale for assessing fall risk in children with severe disabilities.
- To establish the psychometric properties of the new scale, named ALICE.
- To provide clinicians with a reliable tool for fall prevention in this specific pediatric group.
Main Methods:
- An observational prospective study was conducted.
- The ALICE scale was developed and its content validity assessed using the Content Validity Index.
- Internal consistency (Cronbach's alpha) and inter-rater reliability (Spearman's rho) were evaluated.
Main Results:
- The study enrolled 48 children, with 14 experiencing falls (29.2%).
- The ALICE scale demonstrated high performance: 100% sensitivity, 88.2% specificity, 77.8% positive predictive value, and 100% negative predictive value at a cut-off of 16.
- Satisfactory psychometric properties were confirmed, including a Content Validity Index of 0.93, inter-rater reliability (rho=0.91), and Cronbach's alpha of 0.72.
Conclusions:
- The ALICE scale is a reliable and valid instrument for assessing fall risk in children with severe disabilities.
- The scale can be effectively utilized by nurses in clinical practice.
- Further research with larger, multicenter samples is recommended to broaden the scale's applicability.
Introduction:
It is known in the literature that the main cause of physical impairment in children with severe disabilities is falling, which can worsen their already compromised condition. There are no specific scales for this population in the literature, neither in Italian nor in other languages. We created and validated a scale for assessing the risk of falling in children with severe disabilities.
Study Design:
Observational prospective study.
Methods:
We enrolled children (inpatients or day-hospital) admitted to the "Santa Maria Bambina Centre" of the "Fondazione Onlus Sacra Famiglia" in Cesano Boscone, Milan; the Content Validity Index of the Scale was calculated to assess the content validity of a new scale (ALICE). Cronbach's alpha coefficient (α) was used to examine internal consistency, Spearman's rho coefficient to test inter-rater reliability. Sensitivity, specificity, positive and negative predictive values were calculated.
Results:
Out of 48 patients enrolled, 14 fell (29.2%). The ALICE scale, with cut-off set at 16, showed a sensitivity of 100%, a specificity of 88.2%, a positive predictive value of 77.8% and a negative predictive value of 100%. The Content Validity Index of the Scale (=0.93), inter-rater reliability (rho=0.91, p<0.001) and Cronbach's alpha (=0.72) were satisfactory.
Conclusions:
The ALICE scale seems reliable and valid in the disabled population and can be applied by nurses. Further studies with larger samples and a multicentre design are needed.
