Development of a self-questionnaire (APP-Chutes®) for pre-screening older persons at moderate or high risk of falling...

Preventing falls in older adults is a public health priority. The 2022 World Falls Guidelines (WGs) provide a validated algorithm to stratify fall risk (low, -intermediate, or high) and guide tailored prevention strategies. However, large-scale implementation of the WGs faces major barriers, including limited healthcare resources. A prescreening self-administered tool could optimize resource use by identifying individuals at potential moderate or high risk who warrant HCP assessment, while empowering older adults in their own care. To describe the development process of a self-administered questionnaire (APP-Chutes®) designed to pre-screen adults aged 65 and over for moderate or high fall risk, as defined by the WGs algorithm, with the aim of subsequent digitalization as a mobile application. A multidisciplinary expert group - including WGs contributors, geriatricians, a physiotherapist, a patient's representative, and methodologists - met over three days across six months. Inspired by the MASK-air® mHealth app model, the group defined the required qualities of the questionnaire, established an item development methodology, and designed a two-stage validation strategy (development and validation studies). For each WGs algorithm parameter, the group selected the most appropriate self-question(s) format - binary or visual analogue scale (VAS) - prioritizing simplicity, caregiver-assisted completion, and future digitalization. The group developed a self-questionnaire comprising binary questions and VAS items replacing WGs physical tests (walking speed, Timed Up and Go, grip strength). Key innovations include splitting ambiguous questions, applying VAS for subjective parameters (unsteadiness, fear of falling, fatigue, physical activity), and defining VAS thresholds to align with WGs binary outcomes. A two-stage prospective validation methodology, using weighted Gwet coefficient and ROC analyses, was defined. APP-Chutes® represents a novel, patient-centered pre-screening tool designed to facilitate the large-scale roll-out of the World Falls Guidelines. Validation studies will determine its accuracy and support its digitalization as a mobile application.