Using A Continuous Score To Evaluate Changes In Fall Risk After A Walking Intervention

The Centers for Disease Control and Prevention (CDC) developed the STEADI screening tool to facilitate fall risk screening in older adults. A weighted, multi-dimensional fall risk score (FRS) has been proposed for the STEADI protocol to provide a novel method of evaluating fall risk. PURPOSE: The present study examines sensitivity to change of the continuous STEADI score to evaluate utility for intervention research. METHOD: Data were obtained from 39 older adults (average age = 76.5 ± 6.8 years) participating in a pilot study for a clinical trial evaluating fall prevention. Participants were assessed with the STEADI protocol before and after completing the 6 week Walk with Ease intervention. Descriptive statistics were used to evaluate individual and group level FRS changes. RESULTS: 36 participants (90%) exceeded the 10-point threshold identified as elevated risk at baseline. Scores were primarily driven by non-modifiable factors (contributing 43.3% of total FRS), followed by subjective ratings (24.8%), fall history (17.0%) and objective functional scores (14.9%). The nature of FRS changes varied across the 20 participants with pre-post scores. The FRS was unchanged for eight participants, increased for eight other participants (mean 7.1, range 1-12), and decreased for four participants (mean 4.5, range 2-7). Changes were primarily driven by changes in reported fall history, accounting for 53.1% of the change in total score. Objective function and subjective elements made similar contributions to overall changes (24.1% and 22.8% respectively). Small group level changes (overall 1.95-point increase in risk) masked the variability evident in the individual analyses. Closer examination revealed inconsistencies with reported fall history that significantly impacted overall conclusions. Consideration of only the modifiable components revealed a small positive program effect (0.2-point reduction in risk) driven by reductions in fear of falling. DISCUSSION: FRS provides detail on fall risk that is not possible with the traditional STEADI screening, however its longitudinal use reveals some issues with the use of self-reported fall history in estimations of risk change. The use of only the modifiable elements of overall score may provide better detail of intervention effects. CDC U01CE003490-01