Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO; Department of Neurology, Washington University School of Medicine, St. Louis, MO.
Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT.
Arch Phys Med Rehabil. 2021 Dec;102(12):2309-2315. doi: 10.1016/j.apmr.2021.07.800. Epub 2021 Aug 15.
To determine the effect of adding the Activity Measure for Post-Acute Care (AM-PAC) Inpatient '6-Clicks' Short Forms to the Morse Fall Scale (MFS) to assess fall risk. Falls that occur in a rehabilitation hospital result in increased morbidity and mortality, increased cost, and negatively affect reimbursement. Identifying individuals at high risk for falls would enable targeted fall prevention strategies and facilitate appropriate resource allocation to address this critical patient safety issue.
We used a retrospective observational design and repeated k-fold cross-validation (10 repeats and 10 folds) of logistic regression models with falls regressed onto: MFS alone, AM-PAC basic mobility and applied cognitive scales alone, and MFS and AM-PAC combined.
Inpatient rehabilitation hospital.
After exclusions, 2007 patients from an inpatient setting (N=2007; 131 experienced a fall). Primary diagnoses included 602 individuals with stroke (30%), 502 with brain injury (25%), 321 with spinal cord injury (16%), and 582 with other diagnoses (29%).
Not applicable.
Experience of a fall during inpatient stay.
The MFS at admission was associated with falls (area under the curve [AUC], 0.64). Above and beyond the MFS, AM-PAC applied cognitive and basic mobility at admission were also significantly associated with falls (combined model AUC, 0.70). Although MFS and applied cognition showed linear associations, there was evidence for a nonlinear association with AM-PAC basic mobility.
The AM-PAC basic mobility and AM-PAC applied cognitive scales showed associations with falls above and beyond the MFS. More work is needed to validate model predictions in an independent sample with truly longitudinal data; prediction accuracy would also need to be substantially improved. However, the current data do suggest that the AM-PAC has the potential to reduce the burden of fall management by focusing resources on a smaller cohort of patients identified as having a high fall risk.
确定在 Morse 跌倒量表（MFS）中添加活动后护理（AM-PAC）住院患者“6 次点击”短表，以评估跌倒风险，对评估跌倒风险的效果。康复医院发生的跌倒会导致发病率和死亡率增加、成本增加，并对报销产生负面影响。识别出有跌倒高风险的个体，将能够实施有针对性的跌倒预防策略，并有助于适当分配资源来解决这一关键的患者安全问题。
我们使用回顾性观察设计和逻辑回归模型的重复 k 折交叉验证（10 次重复和 10 次折叠），将跌倒回归到：单独的 MFS、单独的 AM-PAC 基本活动能力和应用认知量表、以及 MFS 和 AM-PAC 结合。
住院康复医院。
排除后，2007 名住院患者（N=2007；131 人发生跌倒）。主要诊断包括 602 名卒中患者（30%）、502 名脑损伤患者（25%）、321 名脊髓损伤患者（16%）和 582 名其他诊断患者（29%）。
不适用。
住院期间发生跌倒的情况。
入院时的 MFS 与跌倒相关（曲线下面积[AUC]，0.64）。除了 MFS 之外，入院时的 AM-PAC 应用认知和基本活动能力也与跌倒显著相关（综合模型 AUC，0.70）。尽管 MFS 和应用认知呈线性关联，但 AM-PAC 基本活动能力存在非线性关联的证据。
AM-PAC 基本活动能力和 AM-PAC 应用认知量表与 MFS 相比，与跌倒的关联更显著。需要更多的工作来验证独立样本中真正的纵向数据的模型预测；还需要显著提高预测准确性。然而，目前的数据确实表明，AM-PAC 有可能通过将资源集中在被确定为有高跌倒风险的较小患者群体上，从而减轻跌倒管理的负担。
