Background
Methods
Study design
Inclusion/exclusion criteria
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For DV, diagnostic validation studies of falls risk assessment tools.
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For PV, observational studies that compare the validity and reliability of falls risk assessment tools.
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For EFRA, experimental studies, randomised or not, with a control group, including the use of a falls risk assessment tool and including comparison data for sensitivity, specificity, predictive values and/or likelihood ratios with respect to other instruments or professional clinical judgement (nurses, doctors, physiotherapists, etc.).
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Systematic reviews of either of these types of studies, if they meet the inclusion criteria for participants, interventions and outcomes.
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Adults (aged over 16 years) admitted to acute care hospitals.
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Studies focusing on patients admitted to acute psychiatric units or to paediatric units are excluded from this review.
Search methods
Review method
Quality appraisal
Data abstraction
Synthesis
Ethical considerations
Results
Source | Articles located |
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COCHRANE PLUS | 28 |
DARE | 41 |
SCOPUS | 122 |
WEB OF SCIENCE | 227 |
LILACS | 71 |
ENFISPO | 124 |
CUIDEN | 119 |
EMBASE | 107 |
CINAHL | 250 |
PUBMED | 288 |
Google Scholar | 554 |
IME | 97 |
ProFaNe | 9 |
Cochrane bone | 3 |
Cochrane Library | 7 |
Linked searches | 16 |
Dart Europe | 1 |
TDR | 39 |
Open grey | 3 |
Teseo | 75 |
TOTAL
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2181
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Does not meet inclusion criteria | This is not a validation study of an instrument for assessing the risk of falls | Provides no data or insufficient data to reproduce the calculations of diagnostic validity | It’s a comment from another article | The study fails the assessment of methodological quality | Language other than English, Spanish or Portuguese |
Brians 1991 [49]; Browne 2004 [50]; Chow 2007 [51]; Eagle 1999 [52]; El Miedany 2011 [53]; Gerdhem 2005 [54]; Haines 2006 [55]; Haines 2007 [56]; Harrington 2010 [57]; Heinze 2006 [58]; Heinze 2009 [59]; Hendrich 1995 [17]; Hendrich 2003 [18]; Hernández 2008 [60]; Hill 2004 [61]; Jester 2005 [62]; Lee 2011 [63]; Macavoy 1996 [64]; Mertens 2007 [65]; Mertens 2010 [66]; Morse 1988 [14]; Myers 2003 [24]; Myers&Nikoletti 2003 [67]; Nakagawa 2008 [68]; Oliver 2004 [9]; Oliver 2008 [69]; O’Connell 2002 [70]; Perell 2001 [10]; Petitpierre 2010 [71]; Price 1998 [72]; Roqueta 2007 [73]; Tew 2011 [74]; Toyabe 2010 [75]; Webster 2008 [76]; Webster 2010 [77]; Yauk 2005 [78]; |
Study | Participants (n = 13284) * | Study design | Index and comparator test | Age | Men | Women |
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Mean (SD) (years) | n(%) | n(%) | ||||
TOTAL | 69.76 (9.56)
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| 5504 (41.43%)
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| 5358 (40.33%)
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Barker 2011 [42] | Phase I: 263 patients. Phase II 52 patients | Prospective cross-sectional study. Phase I: Assessment of predicitive accuracy; phase II: Assessment on inter-rater agreement. | The Northern Hospital Modified STRATIFY (TNH-STRATIFY) vs STRATIFY. | 61.32 (20.65) | 137 (52.09%) | 126 (47.91%) |
Chapman 2011 [43] | 1540 patients. | Descriptive and comparative cross-sectional study. | The Maine Medical Center fall risk assessment, the New York-Presbiterian Fall and injury risk assessment tool, Morse Fall Scale and Hendrich II fall risk model. | n.a. | n.a. | n.a. |
Ivziku 2011 [44] | 179 patients. | Descriptive prospective study. | Hendrich Fall Risk Model II (HFRM II). | 79.47 (9.5) | 74 (41.34%) | 105 (58.66%) |
Kim EAN 2007 [26] | Validity study: 5489 patients. Reliability study: 144 patients | Prospective descriptive study. | Morse Fall Scale (MFS), St Thomas Risk Assessment Tool in Falling Elderly Inpatients (STRATIFY) and Hendrich II Fall Risk Model (HFRM II). | 55 (19) | 2842 (51.78%) | 2647 (48.22%) |
Kim KS 2011 [27] | 356 patients. | Prospective cohort study. | Morse Fall Scale (MFS), Bobath Memorial Hospital Fall Risk Assessment Scale (BMFRAS), Johns Hopkins Hospital Fall Risk Assessment Tool (JHFRAT). | 62.6 (n.a.) | 201 (56.46%) | 155 (43.54%) |
Lovallo 2010 [45] | 1148 patients. | Prospective observational study. | Conley Scale and Hendrich Fall Risk Model. | 69 (10.33) | 680 (59.23%) | 468 (40.77%) |
Milisen 2007 [23] | Total sample: 2568 patients; surgical wards: 875 patients; medical wards: 1006 patients. | Prospective multicenter study. | St. Thomas’s Risk Assessment Tool in Falling Elderly Inpatients (STRATIFY). | Medical wards: 64.1 (18); Surgical wards: 58.2 (17.1) | Medical wards: 494 (49.10%); Surgical wards: 439 (50.17%) | Medical wards: 512 (50.9%); Surgical wards: 436 (49.83%) |
Oliver 1997 [15] | Phase 1: 116 cases and 116 controls; phase 2 (local validation): 217 patients; phase 3 (remote validation): 331 patients. | Phase 1: a prospective casecontrol study. Phases 2 and 3: prospective cohort study. | Development of STRATIFY. | n.a. | n.a. | n.a. |
Papaioannou 2004 [20] | 620 patients. | Prospective validation cohort study. | Weigthed STRATIFY vs Unweighted STRATIFY. | 78 (7.7) | 282 (45.48%) | 338 (54.52%) |
Schmid 1990 [46] | Phase 1: 204 patients; phase 2: 334 patients. | Phase 1: a retrospective casecontrol study. Phase 2: prospective cohort study. | Development of a new fall risk assessment tool. | n.a. | n.a. | n.a. |
Schwendimann 2006 A [22] | 386 patients. | Prospective cohort study. | Morse Fall Scale (MFS). | 70.3 (18.5) | 156 (40.41%) | 230 (59.59%) |
Schwendimann 2007 [25] | 275 patients. | Prospective cohort study. | Morse Fall Scale (MFS). | 80.3 (12.4) | 99 (36%) | 176 (64%) |
Vassallo 2005 [47] | 135 patients. | Prospective, open, observational study. | STRATIFY, Downton, Tullamore, and Tinetti. | 83.8 (8.01) | 49 (36.3%) | 86 (63.7%) |
Walsh 2010 [48] | 130 inpatients in the predictive accuracy evaluation; 25 and 35 inpatients for the intra-rater and inter-rater reliability analyses. | Prospective cohort study of predictive validity and observational investigation of intra- and inter-rater reliability. | A new instrument (Western Health Falls Risk Assessment, WHeFRA) was compared with ‘gold standard tool’ (STRATIFY). | 75 (29–94)**
| 51 (39.23%) | 79 (60.77%) |
Was there a comparison with an appropriate reference standard? | Was there an appropriate spectrum of patients? | Was there adequate description of the test? | Was there blind outcome assessment? | Decision to perform the gold standard, was independent of the test result? | Can likelihood ratios be calculated? | What was the accuracy of the results? | Can the results be applied to your patients? | Is the test acceptable in this case? | Will the results of the test change your actions? | |
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Barker 2011 [42] |
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Chapman 2011 [43] |
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Ivziku 2011 [44] |
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Kim EAN 2007 [26] |
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Kim KS 2011 [27] |
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Lovallo 2010 [45] |
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Milisen 2007 [23] |
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STRATIFY | MFS | Hendrich | |
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Sensitivity (95% CI)
| 0.800 (0.724 – 0.863) | 0.755 (0.698 – 0.806) | 0.628 (0.549 – 0.702) |
Specificity (95% CI)
| 0.675 (0.658 – 0.692) | 0.677 (0.659 – 0.695) | 0.640 (0.630 – 0.651) |
LH + (95% CI)
| 2.467 (2.047 – 2.973) | 2.014 (1.800 – 2.254) | 1.793 (1.500 – 2.142) |
LH- (95% CI)
| 0.337 (0.224 – 0.507) | 0.401 (0.324 – 0.498) | 0.542 (0.367 – 0.802) |
DOR (95% CI)
| 7.640 (4.862 – 12.007) | 5.068 (3.747 – 6.857) | 3.362 (2.107 – 5.364) |