Development of a Screening Tool for Feet/Footwear- Related Influences on Fall Risk

Abstract The effectiveness of multifactorial fall risk assessment and intervention strategies is well documented. Although identifying feet/footwear-related influences on fall risk is a vital fall risk assessment component, few evidence-based resources or screening tools are available. To address this need, we developed the Screening Tool for Feet/Footwear-Related Influences on Fall Risk. Our tool is designed for older adults who are identified as at risk for falling, based on the CDC’s Stopping Elderly Accidents, Deaths, and Injuries (STEADI) Algorithm for Fall Risk Screening, Assessment, and Intervention. Tool development was informed by results of our systematic review of lower-limb factors associated with balance and falls. Our initial tool was evaluated by an external group of 9 interprofessional content experts. Those experts recommended modification of 8 items and rated the tool’s clarity as 81.2/100, appeal as 79.1/100, and clinical feasibility as 76.1/100. After incorporating recommended changes, we completed a modified Delphi study using 8 new interprofessional experts (average years of experience: 19.3). During Phase 1, Delphi participants recommended we combine items with similar treatment recommendations, add a question about orthoses, and increase the specificity of 9 items. This refinement resulted in a 20-item screening tool, which met approval after two rounds of consensus voting. Approval was defined based on the Item Content Validation Index, percentage of agreement > 80% on each item. The high level of agreement illustrates the tool’s content validity. Using our tool, an older adult’s feet/footwear-related risk factors can be identified and incorporated into an effective multifactorial fall prevention intervention.

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Diagnostic test accuracy of an automated device as a screening tool for fall risk assessment in community-residing elderly

Medicine ◽

10.1097/md.0000000000017105 ◽

2019 ◽

Vol 98 (39) ◽

pp. e17105 ◽

Cited By ~ 3

Author(s):

Greta Castellini ◽

Silvia Gianola ◽

Elena Stucovitz ◽

Irene Tramacere ◽

Giuseppe Banfi ◽

...

Keyword(s):

Risk Assessment ◽

Diagnostic Test ◽

Fall Risk ◽

Screening Tool ◽

Diagnostic Test Accuracy ◽

Test Accuracy ◽

Fall Risk Assessment

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Fall Risk Assessment Tools

Italian Journal of Medicine ◽

10.4081/itjm.2019.1196 ◽

2019 ◽

Vol 13 (4) ◽

pp. 200-204

Author(s):

Shyh Poh Teo

Keyword(s):

Risk Assessment ◽

Fall Risk ◽

Hospital Costs ◽

Hospital Setting ◽

Assessment Tools ◽

Screening Tools ◽

Admission Diagnosis ◽

Fall Risk Assessment ◽

Psychological Harm ◽

Fall Rates

Falls in hospital are common and have serious consequences for patients, including physical and psychological harm, increase length of stay and hospital costs. A systematic approach is required to report and identify factors contributing to in-hospital falls and develop interventions to reduce inpatient fall rates. Different hospital settings have different fall rates and characteristics depending on type of hospital service and admission diagnosis. Screening tools were developed to assess fall risk but are usually insensitive to be useful in reducing falls. There is also a need for prospective validation in each hospital setting to ensure accuracy, resulting in a move away from using such scoring tools. A recommended approach for fall risk assessment is given, which integrates the process for outpatient settings and inpatients.

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Correction: A Mobile App (FallSA) to Identify Fall Risk Among Malaysian Community-Dwelling Older Persons: Development and Validation Study (Preprint)

10.2196/preprints.34368 ◽

2021 ◽

Author(s):

Devinder Kaur Ajit Singh ◽

Jing Wen Goh ◽

Muhammad Iqbal Shaharudin ◽

Suzana Shahar

Keyword(s):

Risk Assessment ◽

Predictive Validity ◽

Fall Risk ◽

Concurrent Validity ◽

Older Persons ◽

Screening Tool ◽

Mobile App ◽

Discriminative Ability ◽

Fall Risk Assessment ◽

Validity Test

BACKGROUND Recent falls prevention guidelines recommend early routine fall risk assessment among older persons. OBJECTIVE The purpose of this study was to develop a Falls Screening Mobile App (FallSA), determine its acceptance, concurrent validity, test-retest reliability, discriminative ability, and predictive validity as a self-screening tool to identify fall risk among Malaysian older persons. METHODS FallSA acceptance was tested among 15 participants (mean age 65.93 [SD 7.42] years); its validity and reliability among 91 participants (mean age 67.34 [SD 5.97] years); discriminative ability and predictive validity among 610 participants (mean age 71.78 [SD 4.70] years). Acceptance of FallSA was assessed using a questionnaire, and it was validated against a comprehensive fall risk assessment tool, the Physiological Profile Assessment (PPA). Participants used FallSA to test their fall risk repeatedly twice within an hour. Its discriminative ability and predictive validity were determined by comparing participant fall risk scores between fallers and nonfallers and prospectively through a 6-month follow-up, respectively. RESULTS The findings of our study showed that FallSA had a high acceptance level with 80% (12/15) of older persons agreeing on its suitability as a falls self-screening tool. Concurrent validity test demonstrated a significant moderate correlation (r=.518, P<.001) and agreement (k=.516, P<.001) with acceptable sensitivity (80.4%) and specificity (71.1%). FallSA also had good reliability (intraclass correlation .948; 95% CI .921-.966) and an internal consistency (α=.948, P<.001). FallSA score demonstrated a moderate to strong discriminative ability in classifying fallers and nonfallers. FallSA had a predictive validity of falls with positive likelihood ratio of 2.27, pooled sensitivity of 82% and specificity of 64%, and area under the curve of 0.802. CONCLUSIONS These results suggest that FallSA is a valid and reliable fall risk self-screening tool. Further studies are required to empower and engage older persons or care givers in the use of FallSA to self-screen for falls and thereafter to seek early prevention intervention.

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A Mobile App (FallSA) to Identify Fall Risk Among Malaysian Community-Dwelling Older Persons: Development and Validation Study

JMIR mhealth and uhealth ◽

10.2196/23663 ◽

2021 ◽

Vol 9 (10) ◽

pp. e23663

Author(s):

Devinder Kaur Ajit Singh ◽

Jing Wen Goh ◽

Muhammad Iqbal Shaharudin ◽

Suzana Shahar

Keyword(s):

Risk Assessment ◽

Predictive Validity ◽

Fall Risk ◽

Concurrent Validity ◽

Older Persons ◽

Screening Tool ◽

Mobile App ◽

Discriminative Ability ◽

Fall Risk Assessment ◽

Validity Test

Background Recent falls prevention guidelines recommend early routine fall risk assessment among older persons. Objective The purpose of this study was to develop a Falls Screening Mobile App (FallSA), determine its acceptance, concurrent validity, test-retest reliability, discriminative ability, and predictive validity as a self-screening tool to identify fall risk among Malaysian older persons. Methods FallSA acceptance was tested among 15 participants (mean age 65.93 [SD 7.42] years); its validity and reliability among 91 participants (mean age 67.34 [SD 5.97] years); discriminative ability and predictive validity among 610 participants (mean age 71.78 [SD 4.70] years). Acceptance of FallSA was assessed using a questionnaire, and it was validated against a comprehensive fall risk assessment tool, the Physiological Profile Assessment (PPA). Participants used FallSA to test their fall risk repeatedly twice within an hour. Its discriminative ability and predictive validity were determined by comparing participant fall risk scores between fallers and nonfallers and prospectively through a 6-month follow-up, respectively. Results The findings of our study showed that FallSA had a high acceptance level with 80% (12/15) of older persons agreeing on its suitability as a falls self-screening tool. Concurrent validity test demonstrated a significant moderate correlation (r=.518, P<.001) and agreement (k=.516, P<.001) with acceptable sensitivity (80.4%) and specificity (71.1%). FallSA also had good reliability (intraclass correlation .948; 95% CI .921-.966) and an internal consistency (α=.948, P<.001). FallSA score demonstrated a moderate to strong discriminative ability in classifying fallers and nonfallers. FallSA had a predictive validity of falls with positive likelihood ratio of 2.27, pooled sensitivity of 82% and specificity of 64%, and area under the curve of 0.802. Conclusions These results suggest that FallSA is a valid and reliable fall risk self-screening tool. Further studies are required to empower and engage older persons or care givers in the use of FallSA to self-screen for falls and thereafter to seek early prevention intervention.

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Modified CAGE as a Screening Tool for Mechanical Fall Risk Assessment: A Pilot Survey

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2013.07.122 ◽

2013 ◽

Vol 62 (4) ◽

pp. S107-S108 ◽

Cited By ~ 2

Author(s):

M.R. Greenberg ◽

M.C. Nguyen ◽

B.G. Porter ◽

R.D. Barracco ◽

B. Stello ◽

...

Keyword(s):

Risk Assessment ◽

Fall Risk ◽

Screening Tool ◽

Fall Risk Assessment ◽

Pilot Survey

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A Systematic Review of the Guidelines and Delphi Study for the Multifactorial Fall Risk Assessment of Community-Dwelling Elderly

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17176097 ◽

2020 ◽

Vol 17 (17) ◽

pp. 6097

Author(s):

Jieun Kim ◽

Worlsook Lee ◽

Seon Heui Lee

Keyword(s):

Systematic Review ◽

Risk Assessment ◽

Delphi Study ◽

Fall Risk ◽

Assessment Tool ◽

The Elderly ◽

Community Dwelling ◽

Assessment Tools ◽

Risk Assessment Tool ◽

Fall Risk Assessment

As falls are among the most common causes of injury for the elderly, the prevention and early intervention are necessary. Fall assessment tools that include a variety of factors are recommended for preventing falls, but there is a lack of such tools. This study developed a multifactorial fall risk assessment tool based on current guidelines and validated it from the perspective of professionals. We followed the Meta-Analysis of Observational Studies in Epidemiology’s guidelines in this systematic review. We used eight international and five Korean databases to search for appropriate guidelines. Based on the review results, we conducted the Delphi survey in three rounds; one open round and two scoring rounds. About nine experts in five professional areas participated in the Delphi study. We included nine guidelines. After conducting the Delphi study, the final version of the “Multifactorial Fall Risk Assessment tool for Community-Dwelling Older People” (MFA-C) has 36 items in six factors; general characteristics, behavior factors, disease history, medication history, physical function, and environmental factors. The validity of the MFA-C tool was largely supported by various academic fields. It is expected to be beneficial to the elderly in the community when it comes to tailored interventions to prevent falls.

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Validity of balance and mobility screening tests for assessing fall risk in COPD

Chronic Respiratory Disease ◽

10.1177/1479973120922538 ◽

2020 ◽

Vol 17 ◽

pp. 147997312092253

Author(s):

Rachel McLay ◽

Renata Noce Kirkwood ◽

Ayse Kuspinar ◽

Julie Richardson ◽

Joshua Wald ◽

...

Keyword(s):

Risk Assessment ◽

Fall Risk ◽

Functional Limitation ◽

Forced Expiratory Volume ◽

Screening Tools ◽

Screening Tests ◽

Chronic Obstructive ◽

Timed Up And Go ◽

Fall Risk Assessment ◽

Increased Risk

People with chronic obstructive pulmonary disease (COPD) have balance impairments and an increased risk of falls. The psychometric properties of short balance tests to inform fall risk assessment in COPD are unknown. Our objective was to determine the validity (concurrent, convergent, and known-groups) of short balance and mobility tests for fall risk screening. Participants with COPD aged ≥ 60 years attended a single assessment. Correlation coefficients described the relationships between the Brief Balance Evaluation Systems Test (Brief BESTest), Single-Leg Stance (SLS), Timed Up and Go (TUG), and Timed Up and Go Dual-Task (TUG-DT) tests, with the comprehensive Berg Balance Scale (BBS), chair-stand test, and measures of exercise tolerance, functional limitation, disability, and prognosis. Independent t-tests or Mann–Whitney U tests were used to examine differences between groups with respect to fall risk. Receiver operating characteristic curves examined the ability of the screening tests to identify individuals with previous falls. A total of 86 patients with COPD completed the study (72.9 ± 6.8 years; forced expiratory volume in 1 second: 47.3 ± 20.3% predicted). The Brief BESTest identified individuals who reported a previous fall (area under the curve (AUC) = 0.715, p = 0.001), and the SLS showed borderline acceptable accuracy in identifying individuals with a fall history (AUC = 0.684, p = 0.004). The strongest correlations were found for the Brief BESTest and SLS with the BBS ( r = 0.80 and r = 0.72, respectively) and between the TUG and TUG-DT with the chair-stands test ( r = 0.73 and r = 0.70, respectively). The Brief BESTest and SLS show the most promise as balance screening tools for fall risk assessment in older adults with COPD. These tests should be further evaluated prospectively.

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Technologies for fall risk assessment and conceptual design in personal health record system

Finnish Journal of eHealth and eWelfare ◽

10.23996/fjhw.73258 ◽

2019 ◽

Vol 11 (1-2) ◽

pp. 53-67

Author(s):

Milla Sinikka Immonen ◽

Heidi Similä ◽

Mikko Lindholm ◽

Raija Korpelainen ◽

Timo Jämsä

Keyword(s):

Risk Assessment ◽

Fall Risk ◽

Personal Health Record ◽

Public Health Problem ◽

Falls Prevention ◽

Screening Tools ◽

Sensor Data ◽

Personal Health ◽

Health Record ◽

Fall Risk Assessment

Falls among older people are a major economic and public health problem. Due to the demographic change and aging of populations, there is an urgent need for accurate screening tools to identify those at risk to target effective falls prevention strategies. Clinical fall risk assessments are costly and time-consuming and thus cannot be performed frequently. Technologies provide means for assessing fall risk during daily living, making self-evaluations and fast methods for fall risk assessment for professional use. This study collects and evaluates existing technological solutions for fall risk assessment including various different sensor technologies. The study also presents one easy to use solution for assessing fall risk and suggests a concept-design for integrating sensor-based solutions into the Finnish national Kanta Personal Health Record. The optimal solution for technological fall risk assessment is still unclear. A wide implementation still requires extensive validation studies, adoption to health care processes and novel IoT -solutions for collecting large amounts of sensor data. Thorough methods should be utilised in designing the privacy and security aspects of fall risk assessment solutions, as well as different user profiles, to allow suitable interfaces and visualisations to users. It should always be clear what kind of data are collected from users and how the data are utilised. The consent of the users should also always be collected.

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