Thiem Ulrich, Schlumbohm Ingeborg, Golgert Stefan, Dapp Ulrike, Otte Saskia
Department of Geriatrics, Marienhospital Herne, University Clinic, Ruhr-Universität, Bochum, Germany.
Department of Geriatrics, Medical School OWL, University of Bielefeld, Bielefeld, Germany.
PLoS One. 2025 Sep 3;20(9):e0319726. doi: 10.1371/journal.pone.0319726. eCollection 2025.
Mobility limitations are among the most common functional problems in older people. Repeated falls can lead to injuries and fractures, trigger or intensify concerns of falling, and contribute to subsequent functional decline and loss of independence. Various questionnaires have been developed, both nationally and internationally, to identify older people at increased risk of falling. Data for evaluation against standard tests from the geriatric mobility assessment are scarce.
In a German project evaluating home emergency call systems, the Stay Independent Questionnaire (SIQ) from the American prevention program STEADI (Stopping Elderly Accidents, Deaths, and Injuries) was used for the identification of community-dwelling seniors aged 70 and older at risk of falling. The original questionnaire was translated by professional translators using the typical forward and backward translation process, and a final version was established after discussion involving a bilingual scientist. The diagnostic performance of the questionnaire (diagnostic test) was tested against the mobility assessment Short Physical Performance Battery (SPPB, gold standard). To describe the test performance, typical statistical measures are used, i.e., sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios, each with the corresponding 95% confidence interval (95% CI).
Data from a total of 190 participants (143 women, 75.3%; average age 80.5 years ± 5.5 years standard deviation) were included in the analysis. According to existing comorbidities and functional abilities, between 30% and 40% suffered of advanced comorbidity and/or functional impairment. The questionnaire identified 148 individuals (77.9%) as at risk of falling. According to SPPB, 81 participants had an objectively measurable impairment of standing and walking balance. The test performance measures for SIQ as a diagnostic test are: sensitivity 95.1% 95% CI [88.0%; 98.1%], specificity 34.9% [26.6%; 44.2%], positive and negative predictive value 52.0% [44.0%; 59.9%] and 90.5% [77.9%; 96.2%], respectively, and positive and negative likelihood ratio 1.46 [1.26; 1.69] and 0.14 [0.05; 0.38]. In receiver-operating characteristic (ROC) analysis, the unadjusted area under the curve for SIQ was 65.0% [57.3%; 72.7%], after adjustment for sex and age 71.0% [63.8%; 78.2%].
The German version of the Stay Independent Questionnaire is capable of identifying community-dwelling seniors aged 70 and older without impairment in standing and walking balance. The high sensitivity of the test allows excluding test-negative individuals from further investigation. A limitation of the questionnaire is the high proportion of false positives, resulting from the low specificity of the test. Scientific evaluation will show to what extent the use of the questionnaire may improve the identification and medical care of community-dwelling seniors at risk of falling in terms of fall prevention.
行动能力受限是老年人最常见的功能问题之一。反复跌倒会导致受伤和骨折，引发或加剧对跌倒的担忧，并导致随后的功能衰退和独立性丧失。国内外已开发出各种问卷，以识别跌倒风险增加的老年人。来自老年行动能力评估标准测试的评估数据很少。
在一个评估家庭紧急呼叫系统的德国项目中，美国预防计划STEADI（停止老年人事故、死亡和伤害）的“保持独立问卷”（SIQ）被用于识别70岁及以上有跌倒风险的社区居住老年人。原始问卷由专业翻译人员采用典型的正向和反向翻译流程进行翻译，并在一名双语科学家参与讨论后确定了最终版本。该问卷（诊断测试）的诊断性能与行动能力评估简短身体性能测试（SPPB，金标准）进行了对比测试。为描述测试性能，使用了典型的统计指标，即敏感性、特异性、阳性和阴性预测值以及阳性和阴性似然比，每个指标都有相应的95%置信区间（95%CI）。
共有190名参与者（143名女性，占75.3%；平均年龄80.5岁±5.5岁标准差）的数据纳入分析。根据现有的合并症和功能能力，30%至40%的人患有晚期合并症和/或功能障碍。该问卷识别出148名个体（77.9%）有跌倒风险。根据SPPB，81名参与者存在客观可测量的站立和行走平衡障碍。SIQ作为诊断测试的测试性能指标为：敏感性95.1%，95%CI[88.0%；98.1%]，特异性34.9%[26.6%；44.2%]，阳性和阴性预测值分别为52.0%[44.0%；59.9%]和90.5%[77.9%；96.2%]，阳性和阴性似然比分别为1.
