Development and validation of a falls-grading scale.
OBJECTIVE
The recording of fall events is usually subjective and imprecise, which limits clinical practice and falls-related research. We sought to develop and validate a scale to grade near-fall and fall events on the basis of their severity represented by the use of health care resources, with the goal of standardizing fall reporting in the clinical and research settings.


METHODS
Qualitative instrument development was based on a literature review and semistructured interviews to assess face and content validity. We queried older individuals and health care professionals with expertise in the care of patients at risk of falling about clinically important differences to detect and how to optimize the scale's ease of use. To assess the scale's interrater reliability, we created 30 video-vignettes of falls and compared how health care professionals and volunteers rated each of the falls according to our grading scale.


RESULTS
We developed the illustrated 4-point Hopkins Falls Grading Scale (HFGS). The grades distinguish a near-fall (grade 1) from a fall for which an individual did not receive medical attention (grade 2), a fall associated with medical attention but not hospital admission (grade 3), and a fall associated with hospital admission (grade 4). Overall, the HFGS exhibited good face and content validity and had an intraclass correlation coefficient of 0.998.


CONCLUSIONS
The 4-point HFGS demonstrates good face and content validity and high interrater reliability. We predict that this tool will facilitate the standardization of falls reporting in both the clinical and research settings.
Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
Marcela
M
Davalos-Bichara
Frank R
FR
Lin
John P
JP
Carey
Jeremy D
JD
Walston
Jennifer E
JE
Fairman
Michael C
MC
Schubert
Jeremy S
JS
Barron
Jennifer
J
Hughes
Jennifer L
JL
Millar
Anne
A
Spar
Kristy L
KL
Weber
Howard S
HS
Ying
Kathleen M
KM
Zackowski
David S
DS
Zee
Yuri
Y
Agrawal
D000058:Accidental Falls / Q000706:statistics & numerical data*; D006801:Humans; D026741:Physical Therapy Modalities; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires