title: FRAT-up, a Web-based fall-risk assessment tool for elderly people living in the community.
abstract: BACKGROUND
  About 30% of people over 65 are subject to at least one unintentional fall a year. Fall prevention protocols and interventions can decrease the number of falls. To be effective, a prevention strategy requires a prior step to evaluate the fall risk of the subjects. Despite extensive research, existing assessment tools for fall risk have been insufficient for predicting falls.
  
  
  OBJECTIVE
  The goal of this study is to present a novel web-based fall-risk assessment tool (FRAT-up) and to evaluate its accuracy in predicting falls, within a context of community-dwelling persons aged 65 and up.
  
  
  METHODS
  FRAT-up is based on the assumption that a subject's fall risk is given by the contribution of their exposure to each of the known fall-risk factors. Many scientific studies have investigated the relationship between falls and risk factors. The majority of these studies adopted statistical approaches, usually providing quantitative information such as odds ratios. FRAT-up exploits these numerical results to compute how each single factor contributes to the overall fall risk. FRAT-up is based on a formal ontology that enlists a number of known risk factors, together with quantitative findings in terms of odds ratios. From such information, an automatic algorithm generates a rule-based probabilistic logic program, that is, a set of rules for each risk factor. The rule-based program takes the health profile of the subject (in terms of exposure to the risk factors) and computes the fall risk. A Web-based interface allows users to input health profiles and to visualize the risk assessment for the given subject. FRAT-up has been evaluated on the InCHIANTI Study dataset, a representative population-based study of older persons living in the Chianti area (Tuscany, Italy). We compared reported falls with predicted ones and computed performance indicators.
  
  
  RESULTS
  The obtained area under curve of the receiver operating characteristic was 0.642 (95% CI 0.614-0.669), while the Brier score was 0.174. The Hosmer-Lemeshow test indicated statistical significance of miscalibration.
  
  
  CONCLUSIONS
  FRAT-up is a web-based tool for evaluating the fall risk of people aged 65 or up living in the community. Validation results of fall risks computed by FRAT-up show that its performance is comparable to externally validated state-of-the-art tools. A prototype is freely available through a web-based interface.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT01331512 (The InChianti Follow-Up Study); http://clinicaltrials.gov/show/NCT01331512 (Archived by WebCite at http://www.webcitation.org/6UDrrRuaR).
authors.affiliation: Department of Electrical, Electronic, and Information Engineering - DEI, University of Bologna, Bologna, Italy.
authors.forename: Luca
authors.identifier: http://orcid.org/0000-0003-4852-2310
authors.initials: L
authors.lastname: Cattelani
authors.forename: Pierpaolo
authors.identifier: http://orcid.org/0000-0002-4438-1787
authors.initials: P
authors.lastname: Palumbo
authors.forename: Luca
authors.identifier: http://orcid.org/0000-0003-4758-662X
authors.initials: L
authors.lastname: Palmerini
authors.forename: Stefania
authors.identifier: http://orcid.org/0000-0002-6491-0850
authors.initials: S
authors.lastname: Bandinelli
authors.forename: Clemens
authors.identifier: http://orcid.org/0000-0003-1624-8353
authors.initials: C
authors.lastname: Becker
authors.forename: Federico
authors.identifier: http://orcid.org/0000-0003-1664-9632
authors.initials: F
authors.lastname: Chesani
authors.forename: Lorenzo
authors.identifier: http://orcid.org/0000-0002-2318-4370
authors.initials: L
authors.lastname: Chiari
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D020407:Internet; D008297:Male; D012111:Residence Characteristics; D018570:Risk Assessment; D012307:Risk Factors
keywords: ROC curve; accidental falls; aged; odds ratio; risk assessment; risk factors