title: Validation of two risk-prediction models for recurrent falls in the first year after stroke: a prospective cohort study.
abstract: several multivariable models have been derived to predict post-stroke falls. These require validation before integration into clinical practice. The aim of this study was to externally validate two prediction models for recurrent falls in the first year post-stroke using an Irish prospective cohort study.
  
  
  
  stroke patients with planned home-discharges from five hospitals were recruited. Falls were recorded with monthly diaries and interviews 6 and 12 months post-discharge. Predictors for falls included in two risk-prediction models were assessed at discharge. Participants were classified into risk groups using these models. Model 1, incorporating inpatient falls history and balance, had a 6-month outcome. Model 2, incorporating inpatient near-falls history and upper limb function, had a 12-month outcome. Measures of calibration, discrimination (area under the curve (AUC)) and clinical utility (sensitivity/specificity) were calculated.
  
  
  
  128 participants (mean age = 68.6 years, SD = 13.3) were recruited. The fall status of 117 and 110 participants was available at 6 and 12 months, respectively. Seventeen and 28 participants experienced recurrent falls by these respective time points. Model 1 achieved an AUC = 0.56 (95% CI 0.46-0.67), sensitivity = 18.8% and specificity = 93.6%. Model 2 achieved AUC = 0.55 (95% CI 0.44-0.66), sensitivity = 51.9% and specificity = 58.7%. Model 1 showed no significant difference between predicted and observed events (risk ratio (RR) = 0.87, 95% CI 0.16-4.62). In contrast, model 2 significantly over-predicted fall events in the validation cohort (RR = 1.61, 95% CI 1.04-2.48).
  
  
  
  both models showed poor discrimination for predicting recurrent falls. A further large prospective cohort study would be required to derive a clinically useful falls-risk prediction model for a similar population.
authors.affiliation: School of Physiotherapy, Royal College of Surgeons in Ireland,123 St Stephens Green, Dublin 2, Ireland.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Walsh
authors.affiliation: Department of Clinical Therapies, Faculty of Education and Health Sciences, University of Limerick, Health Research Institute, Limerick, Ireland.
authors.forename: Rose
authors.initials: R
authors.lastname: Galvin
authors.affiliation: Health Research Board (HRB) Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: Fiona
authors.initials: F
authors.lastname: Boland
authors.affiliation: School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.|Department of Geriatric and Stroke Medicine, Beaumont Hospital, Dublin, Ireland.
authors.forename: David
authors.initials: D
authors.lastname: Williams
authors.affiliation: Department of Medicine for the Elderly, St James's Hospital, Dublin, Ireland.|Discipline of Medical Gerontology, School of Medicine, University of Dublin Trinity College, Dublin, Ireland.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Harbison
authors.affiliation: Department of Medicine for the Older Person, Mater Misericordiae University Hospital, Dublin, Ireland.|School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.|School of Medicine, University College Dublin, Dublin, Ireland.
authors.forename: Sean
authors.initials: S
authors.lastname: Murphy
authors.affiliation: Discipline of Medical Gerontology, School of Medicine, University of Dublin Trinity College, Dublin, Ireland.|Department of Age-Related Healthcare, Adelaide and Meath Hospital, Tallaght, Ireland.
authors.forename: Ronan
authors.initials: R
authors.lastname: Collins
authors.affiliation: Department of Medicine for the Elderly, St Vincent's University Hospital, Dublin, Ireland.
authors.forename: Morgan
authors.initials: M
authors.lastname: Crowe
authors.affiliation: Department of Neurology, Adelaide and Meath Hospital, Tallaght, Dublin, Ireland.|Department of Clinical Neuroscience, University College London Institute of Neurology, London, UK.|Academic Unit of Neurology, School of Medicine, University of Dublin Trinity College, Dublin, Ireland.
authors.forename: Dominick J H
authors.initials: DJH
authors.lastname: McCabe
authors.affiliation: School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: Frances
authors.initials: F
authors.lastname: Horgan
mesh_terms: D000058:Accidental Falls; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D003661:Decision Support Techniques; D004185:Disability Evaluation; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007297:Inpatients; D007494:Ireland; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D004856:Postural Balance; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D013997:Time Factors; D034941:Upper Extremity / Q000294:innervation*
keywords: accidental falls; older people; risk prediction; stroke