Infinger Allison, Dowbiggin Patricia, Seymour Rachel, Wally Meghan, Karunakar Madhav, Caprio Anthony, Patt Joshua, Studnek Jonathan R
Prehosp Emerg Care. 2020 May-Jun;24(3):349-354. doi: 10.1080/10903127.2019.1634777. Epub 2019 Jul 19.
The aging population reintroduces the need to establish early identification of falls risk as a means of primary and secondary prevention of falls. While there are several existing tools to assess environmental risk factors developed for consumers or home health providers, assessment of environmental falls risk by emergency medical services (EMS) providers represents a novel approach to primary and secondary prevention. The purpose of this study was to evaluate a content valid and reliable assessment of environmental fall risk to be performed in the prehospital setting. This was a mixed methods study, conducted from August, 2015 to September, 2017 in Mecklenburg County, NC, utilizing qualitative methodology to develop content valid items for an environmental falls risk assessment and quantitative methodology to assess those items for interrater reliability. Content validity was assessed using 2 expert panels. Expert Panel One was tasked with assessing validity of a construct to indicate an increased risk of an in-home fall for elderly individuals and expert Panel Two was responsible for assessing the likelihood of an EMS professional to identify a construct during their course of patient care. To assess reliability of the identified content valid items, 5 paramedics were recruited for interrater reliability (IRR) testing of the validated falls risk assessment tool. Each paramedic and their partner received education on documentation and deployment of the tool. Crews independently documented presence or absence of each item with pair agreement assessed using Cohen's kappa (κ). A total of 87 items were identified for assessment through review of validated scales and relevant literature, with the content validation process reducing to 9 the number of items tested in the field for reliability. A total of 57 paired assessments were completed and included in analysis. One item returned almost perfect agreement (κ = 0.87), 5 items returned moderate agreement (κ = 0.41-0.54), with the remaining 3 items illustrating fair agreement (κ = 0.33-0.39). We developed a construct valid and reliable assessment of environmental falls risk to be performed in the prehospital setting. Further trials should be conducted using this tool to determine appropriate cut scores and deployment in the prehospital setting to help with primary and secondary fall prevention.
老龄化人口再次凸显了早期识别跌倒风险的必要性，这是预防跌倒的一级和二级预防手段。虽然有几种现有的工具可用于评估为消费者或家庭健康提供者开发的环境风险因素，但紧急医疗服务（EMS）提供者对环境跌倒风险的评估是一级和二级预防的一种新方法。本研究的目的是评估在院前环境中对环境跌倒风险进行的内容有效且可靠的评估。这是一项混合方法研究，于2015年8月至2017年9月在北卡罗来纳州梅克伦堡县进行，利用定性方法为环境跌倒风险评估开发内容有效的项目，并利用定量方法评估这些项目的评分者间信度。使用两个专家小组评估内容效度。专家小组一的任务是评估一个结构的效度，该结构表明老年人在家中跌倒的风险增加，专家小组二则负责评估EMS专业人员在患者护理过程中识别该结构的可能性。为了评估所确定的内容有效项目的信度，招募了5名护理人员对经过验证的跌倒风险评估工具进行评分者间信度（IRR）测试。每位护理人员及其搭档都接受了关于该工具的记录和使用的培训。工作人员独立记录每个项目的存在或不存在情况，并使用科恩kappa系数（κ）评估配对一致性。通过审查经过验证的量表和相关文献，共确定了87个项目进行评估，内容验证过程将在现场测试信度的项目数量减少到9个。总共完成了57对评估并纳入分析。一个项目显示几乎完全一致（κ = 0.87），5个项目显示中等一致（κ = 0.41 - 0.54），其余3个项目显示一般一致（κ = 0.33 - 0.39）。我们开发了一种在院前环境中对环境跌倒风险进行结构有效且可靠的评估。应使用该工具进行进一步试验，以确定适当的截断分数以及在院前环境中的应用，以帮助进行一级和二级跌倒预防。
