Abstract
BackgroundFall risk assessment is a time-consuming and resource-intensive activity. Patient-driven self-assessment as a preventive measure might be a solution to reduce the number of patients undergoing a full clinical fall risk assessment.ObjectiveThe aim of this study was (1) to analyze test accuracy of the Aachen Falls Prevention Scale (AFPS) and (2) to compare these results with established fall risk assessment measures identified by a review of systematic reviews.MethodsSensitivity, specificity, and receiver operating curves (ROC) of the AFPS were calculated based on data retrieved from 2 independent studies using the AFPS. Comparison with established fall risk assessment measures was made by conducting a review of systematic reviews and corresponding meta-analysis. Electronic databases PubMed, Web of Science, and EMBASE were searched for systematic reviews and meta-analyses that reviewed fall risk assessment measures between the years 2000 and 2018. The review of systematic reviews was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. The Revised Assessment of Multiple SysTemAtic Reviews (R-AMSTAR) was used to assess the methodological quality of reviews. Sensitivity, specificity, and ROC were extracted from each review and compared with the calculated values of the AFPS.ResultsSensitivity, specificity, and ROC of the AFPS were evaluated based on 2 studies including a total of 259 older adults. Regarding the primary outcome of the AFPS subjective risk of falling, pooled sensitivity is 57.0% (95% CI 0.467-0.669) and specificity is 76.7% (95% CI 0.694-0.831). If 1 out of the 3 subscales of the AFPS is used to predict a fall risk, pooled sensitivity could be increased up to 90.0% (95% CI 0.824-0.951), whereas mean specificity thereby decreases to 50.0% (95% CI 0.42-0.58). A systematic review for fall risk assessment measures produced 1478 articles during the study period, with 771 coming from PubMed, 530 from Web of Science, and 177 from EMBASE. After eliminating doublets and assessing full text, 8 reviews met the inclusion criteria. All were of sufficient methodological quality (R-AMSTAR score ≥22). A total number of 9 functional or multifactorial fall risk assessment measures were extracted from identified reviews, including Timed Up and Go test, Berg Balance Scale, Performance-Oriented Mobility Assessment, St Thomas’s Risk Assessment Tool in Falling Elderly, and Hendrich II Fall Risk Model. Comparison of these measures with pooled sensitivity and specificity of the AFPS revealed a sufficient quality of the AFPS in terms of a patient-driven self-assessment tool.ConclusionsIt could be shown that the AFPS reaches a test accuracy comparable with that of the established methods in this initial investigation. However, it offers the advantage that the users can perform the self-assessment independently at home without involving trained health care professionals.
Highlights
BackgroundFall incidents are an increasing problem in aging societies [1]
If discrimination between fallers and nonfallers is based on a positive subscale, the pooled sensitivity can be increased to 90.0%, whereas the pooled specificity thereby decreases to 50.0%
This study investigated the test accuracy of the Aachen Falls Prevention Scale (AFPS) as a patient-driven self-assessment tool compared with established tools such as Timed Up and Go, Performance-Oriented Mobility Assessment (POMA), STRATIFY, or Downton Fall Risk Index
Summary
BackgroundFall incidents are an increasing problem in aging societies [1]. Every third adult older than 65 years falls at least once a year [2]. Routinely assessing an individual’s fall risk is recommended within the United States, United Kingdom, and Germany [6,7,8] This assessment is mainly carried out by the family doctor and is based on the question about fall incidents or the subjective fear of falling. The United States Preventive Service Task Force (US PSTF, United States), on the other hand, recommends keeping the assessment as simple as possible and asking patients about their fall history as well as carrying out a functional assessment such as the Timed Up and Go Test [8]. If patients’ fall risk should be monitored over a long term, clinical assessment measures are oversized and unsuitable, in terms of a low-threshold service This leads to the inclusion of a high proportion of low-risk people and waste of resources in terms of clinical setting. Patient-driven self-assessment as a preventive measure might be a solution to reduce the number of patients undergoing a full clinical fall risk assessment
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