Psychometric testing of the Fall Risks for Older People in the Community screening tool (FROP-Com screen) for community-dwelling people with stroke

Shamay S M Ng,Terence Y K Fong,Mimi M Y Tse,Ho-Man Choy,Crystal C Y Wong,Gary Y H Tong,Tai-Wa Liu,Cynthia Y Y Lai,Patrick W H Kwong,Yi-Li Tan,Justine Y C Lee,Kei Masani

doi:10.1371/journal.pone.0233045

Abstract

ObjectiveThe Falls Risk for Older People in the Community assessment (FROP-Com) was originally developed using 13 risk factors to identify the fall risks of community-dwelling older people. To suit the practical use in busy clinical settings, a brief version adopting 3 most fall predictive risk factors from the original FROP-Com, including the number of falls in the past 12 months, assistance required to perform domestic activities of daily living and observation of balance, was developed for screening purpose (FROP-Com screen). The objectives of this study were to investigate the inter-rater and test-retest reliability, concurrent and convergent validity, and minimum detectable change of the FROP-Com screen in community-dwelling people with stroke.ParticipantsCommunity-dwelling people with stroke (n = 48) were recruited from a local self-help group, and community-dwelling older people (n = 40) were recruited as control subjects.ResultsThe FROP-Com screen exhibited moderate inter-rater (Intraclass correlation coefficient [ICC]2,1 = 0.79, 95% confidence interval [CI]: 0.65–0.87) and test-retest reliability (ICC3,1 = 0.70, 95% CI: 0.46–0.83) and weak associations with two balance measures, the Berg Balance Scale (BBS) (rho = -0.38, p = 0.008) and the Timed “Up & Go” (TUG) test (rho = 0.35, p = 0.016). The screen also exhibited a moderate association with the Chinese version of the Activities-specific Balance Confidence Scale (ABC-C) (ABC-C; rho = -0.65, p<0.001), a measure of subjective balance confidence.ConclusionsThe FROP-Com screen is a reliable clinical tool with convergent validity paralleled with subjective balance confidence measure that can be used in fall risk screening of community-dwelling people with stroke. However, one individual item, the observation of balance, will require additional refinement to improve the potential measurement error.

Highlights

Falls are a common and serious complication after stroke, among communitydwelling people with stroke [1, 2]
The FROP-Com screen exhibited moderate inter-rater (Intraclass correlation coefficient [ICC]2,1 = 0.79, 95% confidence interval [CI]: 0.65–0.87) and test-retest reliability (ICC3,1 = 0.70, 95% CI: 0.46–0.83) and weak associations with two balance measures, the Berg Balance Scale (BBS) and the Timed “Up & Go” (TUG) test
The screen exhibited a moderate association with the Chinese version of the Activities-specific Balance Confidence Scale (ABC-C) (ABC-C; rho = -0.65, p

Summary

Introduction

Falls are a common and serious complication after stroke, among communitydwelling people with stroke [1, 2]. The original FROP-Com comprises 26 items used to assess 13 fall risk factors, such as cognition, balance ability, functional behavior, and environment. These factors are summed to infer the fall risk in the concurrent presence of multiple cumulative risk factors. To modify the original FROP-Com for screening purposes, Russell et al [10] removed 23 items from the original version to form the 3-item FROP-Com screening tool (FROP-Com screen). This abbreviated tool could accurately predict fallers and nonfallers (sensitivity 67.1%, specificity 66.7%) and discriminate fallers and recurrent fallers (sensitivity 70.0%, specificity 59.0%) [10]

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Conclusion