Feasibility and predictive performance of the Hendrich Fall Risk Model II in a rehabilitation department: a prospective study
Abstract Background Falls are a common adverse event in both elderly inpatients and patients admitted to rehabilitation units. The Hendrich Fall Risk Model II (HIIFRM) has been already tested in all hospital wards with high fall rates, with the exception of the rehabilitation setting. This study’s a...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2018-01-01
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| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12913-017-2815-x |
| _version_ | 1811226598411599872 |
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| author | Isabella Campanini Stefano Mastrangelo Annalisa Bargellini Agnese Bassoli Gabriele Bosi Francesco Lombardi Stefano Tolomelli Mirco Lusuardi Andrea Merlo |
| author_facet | Isabella Campanini Stefano Mastrangelo Annalisa Bargellini Agnese Bassoli Gabriele Bosi Francesco Lombardi Stefano Tolomelli Mirco Lusuardi Andrea Merlo |
| author_sort | Isabella Campanini |
| collection | DOAJ |
| description | Abstract Background Falls are a common adverse event in both elderly inpatients and patients admitted to rehabilitation units. The Hendrich Fall Risk Model II (HIIFRM) has been already tested in all hospital wards with high fall rates, with the exception of the rehabilitation setting. This study’s aim is to address the feasibility and predictive performances of HIIFRM in a hospital rehabilitation department. Methods A 6 months prospective study in a Italian rehabilitation department with patients from orthopaedic, pulmonary, and neurological rehabilitation wards. All admitted patients were enrolled and assessed within 24 h of admission by means of the HIIFRM. The occurrence of falls was checked and recorded daily. HIIFRM feasibility was assessed as the percentage of successful administrations at admission. HIIFRM predictive performance was determined in terms of area under the Receiver Operating Characteristic (ROC) curve (AUC), best cutoff, sensitivity, specificity, positive and negative predictive values, along with their asymptotic 95% confidence intervals (95% CI). Results One hundred ninety-one patents were admitted. HIIFRM was feasible in 147 cases (77%), 11 of which suffered a fall (7.5%). Failures in administration were mainly due to bedridden patients (e.g. minimally conscious state, vegetative state). AUC was 0.779(0.685–0.873). The original HIIFRM cutoff of 5 led to a sensitivity of 100% with a mere specificity of 49%(40–57%), thus suggesting using higher cutoffs. Moreover, the median score for non-fallers at rehabilitation units was higher than that reported in literature for geriatric non fallers. The best trade-off between sensitivity and specificity was obtained by using a cutoff of 8. This lead to sensitivity = 73%(46-99%), specificity = 72%(65-80%), positive predictive value = 17% and negative predictive value = 97%. These results support the use of the HIIFRM as a predictive tool. Conclusions The HIIFRM showed satisfactory feasibility and predictive performances in rehabilitation wards. Based on both available literature and these results, the prediction of falls among all hospital wards, with high risk of falling, could be achieved by means of a unique tool and two different cutoffs: a standard cutoff of 5 in geriatric wards and an adjusted higher cutoff in rehabilitation units, with predictive performances similar to those of the best-preforming pathology specific tools for fall-risk assessment. |
| first_indexed | 2024-04-12T09:29:06Z |
| format | Article |
| id | doaj.art-4d426c75e14a49ed88797947e2c65811 |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-04-12T09:29:06Z |
| publishDate | 2018-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-4d426c75e14a49ed88797947e2c658112022-12-22T03:38:25ZengBMCBMC Health Services Research1472-69632018-01-011811810.1186/s12913-017-2815-xFeasibility and predictive performance of the Hendrich Fall Risk Model II in a rehabilitation department: a prospective studyIsabella Campanini0Stefano Mastrangelo1Annalisa Bargellini2Agnese Bassoli3Gabriele Bosi4Francesco Lombardi5Stefano Tolomelli6Mirco Lusuardi7Andrea Merlo8Department of Rehabilitation, LAM-Motion Analysis Laboratory, AUSL of Reggio Emilia, S. Sebastiano HospitalClinical Governance Unit, AUSL of Reggio EmiliaDepartment of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio EmiliaDepartment of Rehabilitation, LAM-Motion Analysis Laboratory, AUSL of Reggio Emilia, S. Sebastiano HospitalDepartment of Rehabilitation, LAM-Motion Analysis Laboratory, AUSL of Reggio Emilia, S. Sebastiano HospitalNeurological Rehabilitation Unit, AUSL of Reggio Emilia, S. Sebastiano HospitalNeurological Rehabilitation Unit, AUSL of Reggio Emilia, S. Sebastiano HospitalRespiratory Rehabilitation Unit, AUSL of Reggio Emilia, S. Sebastiano HospitalDepartment of Rehabilitation, LAM-Motion Analysis Laboratory, AUSL of Reggio Emilia, S. Sebastiano HospitalAbstract Background Falls are a common adverse event in both elderly inpatients and patients admitted to rehabilitation units. The Hendrich Fall Risk Model II (HIIFRM) has been already tested in all hospital wards with high fall rates, with the exception of the rehabilitation setting. This study’s aim is to address the feasibility and predictive performances of HIIFRM in a hospital rehabilitation department. Methods A 6 months prospective study in a Italian rehabilitation department with patients from orthopaedic, pulmonary, and neurological rehabilitation wards. All admitted patients were enrolled and assessed within 24 h of admission by means of the HIIFRM. The occurrence of falls was checked and recorded daily. HIIFRM feasibility was assessed as the percentage of successful administrations at admission. HIIFRM predictive performance was determined in terms of area under the Receiver Operating Characteristic (ROC) curve (AUC), best cutoff, sensitivity, specificity, positive and negative predictive values, along with their asymptotic 95% confidence intervals (95% CI). Results One hundred ninety-one patents were admitted. HIIFRM was feasible in 147 cases (77%), 11 of which suffered a fall (7.5%). Failures in administration were mainly due to bedridden patients (e.g. minimally conscious state, vegetative state). AUC was 0.779(0.685–0.873). The original HIIFRM cutoff of 5 led to a sensitivity of 100% with a mere specificity of 49%(40–57%), thus suggesting using higher cutoffs. Moreover, the median score for non-fallers at rehabilitation units was higher than that reported in literature for geriatric non fallers. The best trade-off between sensitivity and specificity was obtained by using a cutoff of 8. This lead to sensitivity = 73%(46-99%), specificity = 72%(65-80%), positive predictive value = 17% and negative predictive value = 97%. These results support the use of the HIIFRM as a predictive tool. Conclusions The HIIFRM showed satisfactory feasibility and predictive performances in rehabilitation wards. Based on both available literature and these results, the prediction of falls among all hospital wards, with high risk of falling, could be achieved by means of a unique tool and two different cutoffs: a standard cutoff of 5 in geriatric wards and an adjusted higher cutoff in rehabilitation units, with predictive performances similar to those of the best-preforming pathology specific tools for fall-risk assessment.http://link.springer.com/article/10.1186/s12913-017-2815-xFall risk assessmentHenrdich II fall risk modelInpatientsRehabilitationSensitivity and specificity |
| spellingShingle | Isabella Campanini Stefano Mastrangelo Annalisa Bargellini Agnese Bassoli Gabriele Bosi Francesco Lombardi Stefano Tolomelli Mirco Lusuardi Andrea Merlo Feasibility and predictive performance of the Hendrich Fall Risk Model II in a rehabilitation department: a prospective study BMC Health Services Research Fall risk assessment Henrdich II fall risk model Inpatients Rehabilitation Sensitivity and specificity |
| title | Feasibility and predictive performance of the Hendrich Fall Risk Model II in a rehabilitation department: a prospective study |
| title_full | Feasibility and predictive performance of the Hendrich Fall Risk Model II in a rehabilitation department: a prospective study |
| title_fullStr | Feasibility and predictive performance of the Hendrich Fall Risk Model II in a rehabilitation department: a prospective study |
| title_full_unstemmed | Feasibility and predictive performance of the Hendrich Fall Risk Model II in a rehabilitation department: a prospective study |
| title_short | Feasibility and predictive performance of the Hendrich Fall Risk Model II in a rehabilitation department: a prospective study |
| title_sort | feasibility and predictive performance of the hendrich fall risk model ii in a rehabilitation department a prospective study |
| topic | Fall risk assessment Henrdich II fall risk model Inpatients Rehabilitation Sensitivity and specificity |
| url | http://link.springer.com/article/10.1186/s12913-017-2815-x |
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