Validation of Fall Risk Assessment Specific to the Inpatient Rehabilitation Facility Setting

Abstract

Purpose: To evaluate and compare the Morse Fall Scale (MFS) and the Casa Colina Fall Risk Assessment Scale (CCFRA) for identification of patients at risk for falling in an acute inpatient rehabilitation facility. The primary objective of this study was to perform a retrospective validation study of the CCFRAS, specifically for use in the inpatient rehabilitation facility (IRF) setting. Design: Retrospective validation study. Method: The study was approved under expedited review by the local Institutional Review Board. Data were collected on all patients admitted to Cottage Rehabiliation Hospital (CRH), a 38-bed acute inpatient rehabilitation hospital, from March 2012 to August 2013. Patients were excluded from the study if they had a length of stay less than 3 days or age less than 18. The area under the receiver operating characteristic curve (AUC) and the diagnostic odds ratio were used to examine the differences between the MFS and CCFRAS. AUC between fall scales was compared using the DeLong Test. Findings: There were 931 patients included in the study with 62 (6.7%) patient falls. The average age of the population was 68.8 with 503 males (51.2%). The AUC was 0.595 and 0.713 for the MFS and CCFRAS, respectively (0.006). The diagnostic odds ratio of the MFS was 2.0 and 3.6 for the CCFRAS using the recommended cutoffs of 45 for the MFS and 80 for the CCFRAS. Conclusion: The CCFRAS appears to be a better tool in detecting fallers vs. nonfallers specific to the IRF setting. Clinical Relevance: The assessment and identification of patients at high risk for falling is important to implement specific precautions and care for these patients to reduce their risk of falling. The CCFRAS is more clinically relevant in identifying patients at high risk for falling in the IRF setting compared to other fall risk assessments. Implementation of this scale may lead to a reduction in fall rate and injuries from falls as it more appropriately identifies patients at high risk for falling.

The predictive value of fall assessment tools for patients admitted to hospice care

“…Fall assessment tools, which are commonly used to predict which patients are likely to fall or not, are designed for use in specific healthcare settings1–18 for a specific disease,7 13 19–22 for patients of a similar age3–6 10 14 16 20 23–25 or for general use 26–28. Previous reports compare the predictive values of one tool with another8 9 15 17 20 26 or evaluate the predictive value of a single tool,6 7 14 29 30 then fault the tool's predictive ability when it appears that the tool grossly overestimated or underestimated the likelihood of fall. Predictive ability is further confounded because risk is not recalculated and adjusted after implementation of fall prevention interventions.…”

Current state of fall prevention and management policies and procedures in Canadian spinal cord injury rehabilitation

“…However, these assessments were previously found to poorly predict fall risk in rehabilitation settings [29,31,32]. As well, some SCI rehabilitation hospitals in the current study used customized fall risk assessments, but some of these tools lack psychometric standardization [14]. Further, it has been suggested that the use of risk assessment scores to determine fall risk in rehabilitation is an ineffective use of staff time due to the lack of useful information produced [31].…”

“…For instance, all sites used different risk assessments. The purpose of a risk assessment tool is to assist clinicians in identifying sub-groups of individual patients at high risk of falling [14]. Fall risk assessment is a required practice for healthcare organizations to achieve accreditation [1].…”

“…Administrators perceived that the acute care fall prevention/management policies and procedures applied in Canadian tertiary hospitals that provide SCI rehabilitation failed to account for the specialized fall prevention/management needs of patients with SCI [12]. Fall prevention/management tools are often applied to patients with SCI with limited context-specific or population-specific validation [12,14]. In this study, we aimed to generate a comprehensive understanding of the fall prevention/management policies and procedures that are applied to patients with SCI in Canadian rehabilitation hospitals.…”

Development of the Sydney Falls Risk Screening Tool in brain injury rehabilitation: A multisite prospective cohort study

“…A variety of FRSTs have been developed in different patient settings, but few have been developed specifically for inpatient rehabilitation (Sherrington et al., ; Thomas, Pavic, Bisaccia, & Grotts, ). Consequently, FRSTs developed in acute care settings are often used in rehabilitation (Lee, Geller, & Strasser, ).…”