Currently accepted at: JMIR Aging
Date Submitted: Sep 5, 2018
Date Accepted: Jan 23, 2019
(closed for review but you can still tweet)
Aachen Falls Prevention Scale: multi-study evaluation and comparison.
Fall incidents are an increasing problem in aging societies. Each individual’s risk of falling is generally difficult to detect and is likely to be underestimated. Different functional and multi-factorial assessments are recommended by national institutions in the United States of America or the United Kingdom. Thus, fall risk assessment is time-consuming and resource-intensive activity which needs trained medical professionals and a clinical setting to be performed successfully. Patient-driven self-assessment as preventive measure might be a solution to reduce the number of patients undergoing full clinical fall risk assessment.
The aim of this article is (1) to analyze test accuracy of the Aachen Falls Prevention Scale (AFPS) and (2) to compare these results to established fall risk assessment measures identified by a review of systematic reviews.
Sensitivity, specificity and Receiver Operating Curves (ROC) of the AFPS were calculated based on data retrieved from two independent studies using the AFPS. Comparison to 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 to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement (PRISMA). The Revised Assessment of Multiple SysTemAtic Reviews (R-AMSTAR) was used to assess methodological quality of reviews. Sensitivity, specificity and ROC were extracted from each review and compared to the calculated values of the AFPS.
Sensitivity, specificity and ROC of the AFPS were evaluated based on two 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 one out of three 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) while mean specificity decreases to 50.0% (95% CI 0.42-0.58). Systematic-review for fall risk assessment measures produced 1478 articles during the time period, with 771 coming from PubMed, 530 from Web of Science and 177 from EMBASE. After eliminating doublets and assessing full text, eight reviews met the inclusion criteria. All were of sufficient methodological quality (R-AMSTAR score ≥22). A total number of nine functional or multi-factorial fall risk assessment measures was extracted from identified reviews including Timed Up and Go test, Berg Balance Scale, POMA, STRATIFY 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.
In the context of this article, the AFPS was presented together with an analysis of its test accuracy. Furthermore, this test was compared with nine established case risk assessment measures. The corresponding test accuracy data were gathered based on a systematic literature review. It could be shown that the AFPS reaches a comparable test accuracy to 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 healthcare professionals. Clinical Trial: not applicable