Development of a patient-reported outcome to assess concerns about falling in hospital settings

BACKGROUND Concerns-about-falling (previously known as fear-of-falling) are common in older adults with poor physical health – a demographic largely represented by those in the hospital setting.

Such concerns are a key predictor of poor rehabilitation outcomes at discharge and follow-up, as well as an independent predictor of falls post-discharge. Healthcare professionals need to be able to identify older adults who have concerns-about-falling in hospital. Yet, there is currently no validated way to measure this.

Instead, healthcare professionals use questionnaires that were created for use in community settings.

As many of the questions asked are not suitable for the hospital setting, this can be frustrating for patients and healthcare professionals, and leads to inaccurate and incomplete answers.

Through feedback from patients, clinicians and experts in the field, our research team have developed a new, preliminary 8-item patient-reported outcome measure for assessing concerns-about-falling within hospital settings: the Hospital Falls Efficacy Scale International (Hospital FES-I). However, before this can be used clinically, we must determine its validity and reliability.

AIMS AND OBJECTIVES Aim: Evaluate if the Hospital FES-I is a valid and reliable means to assess concerns-about-falling among older adults using inpatient hospital services.

Objectives: Conduct a statistical evaluation of the validity and reliability of the Hospital FES-I in hospital settings (Workstream 1) Conduct a multivariable regression to determine if the Hospital FES-I predicts functional recovery at discharge and 3-months post-discharge (Workstream 2) Identify cut-off points that predict poor functional recovery at and/or post-discharge (Workstream 2) METHODS Population Two-hundred-and-fifty adults aged 65-years and over, who are admitted to inpatient rehabilitation ward (i.e. a population with high prevalence of concerns-about-falling), who are able to communicate in English and able to consent to participate.

Protocol Participants will complete the Hospital FES-I 24-48 hours after admission to inpatient rehabilitation services, and then again 12-24 hours later (for test-retest reliability).

They will then complete follow-up measurements related to physical functioning and overall wellbeing at both discharge and 3 months post-discharge. Analysis We will conduct a thorough psychometric assessment of the Hospital FES-I.

This will consist of confirmatory factor analysis, followed by assessments of internal consistency, test-retest reliability, minimal detectable change, and concurrent validity.

We will then test if Hospital FES-I scores at admission independently predict functional recovery at discharge and/or 3 months post-discharge, and determine cut-off points that predict poor recovery.

EXPECTED OUTPUTS This study will produce a new freely available questionnaire that provides a reliable and valid way to measure concerns-about-falling in hospital.

This tool can then be used by clinicians to identify patients who might need extra support after leaving hospital, and by researchers for future intervention studies.

The research team are members of the World Falls Guidelines recommending committee, and the findings from this project will directly inform these guidelines. Our future studies will then look to translate and validate the questionnaire into other languages.