Development and validation of a questionnaire for analyzing real-life falls in long-term care captured on video

BMC Geriatrics

Stephen N Robinovitch²  Fabio Feldman¹  Rebecca Schonnop³  Yijian Yang² 

[1] Fraser Health Authority, Surrey, BC V3R 7K1, Canada;Injury Prevention and Mobility Laboratory, Department of Biomedical Physiology and Kinesiology, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada;Technology for Injury Prevention in Seniors (TIPS) Program, Injury Prevention and Mobility Laboratory, Department of Biomedical Physiology and Kinesiology, Burnaby BC V5A 1S6, Canada

关键词: Reliability;    Video analysis;    Questionnaire;    Long-term care;    Injuries;    Older adults;    Fall mechanisms;    Falls;   

Others  :  857733
DOI  :  10.1186/1471-2318-13-40

 received in 2012-08-30, accepted in 2013-04-18,  发布年份 2013

【 摘 要 】

Background

Falls are the number one cause of injuries in older adults, and are particularly common in long-term care (LTC). Lack of objective evidence on the mechanisms of falls in this setting is a major barrier to prevention. Video capture of real-life falls can help to address this barrier, if valid tools are available for data analysis. To address this need, we developed a 24-item fall video analysis questionnaire (FVAQ) to probe key biomechanical, behavioural, situational, and environmental aspects of the initiation, descent, and impact stages of falls. We then tested the reliability of this tool using video footage of falls collected in LTC.

Methods

Over three years, we video-captured 221 falls experienced by 130 individuals in common areas (e.g., dining rooms, hallways, and lounges) of two LTC facilities. The FVAQ was developed through literature review and an iterative process to ensure our responses captured the most common behaviours observed in preliminary review of fall videos. Inter-rater reliability was assessed by comparing responses from two teams, each having three members, who reviewed 15 randomly-selected videos. Intra-rater reliability was measured by comparing responses from one team at baseline and 12 months later.

Results

In 17 of the 24 questions, the percentage of inter- and intra-rater agreement was over 80% and the Cohen's Kappa was greater than 0.60, reflecting good reliability. These included questions on the cause of imbalance, activity at the time of the fall, fall direction, stepping responses, and impact to specific body sites. Poorer agreement was observed for footwear, contribution of clutter, reach-to-grasp responses, and perceived site of injury risk.

Conclusions

Our results provide strong evidence of the reliability of the FVAQ for classifying biomechanical, behavioural, situational, and environmental aspects of falls captured on video in common areas in LTC. Application of this tool should reveal new and important strategies for the prevention and treatment of falls and fall-related injuries in this setting.

【 授权许可】

   
2013 Yang et al.; licensee BioMed Central Ltd.

【 图 表 】

【 参考文献 】

• [1]Grisso JA, Kelsey JL, Strom BL, Chiu GY, Maislin G, O'Brien LA, Hoffman S, Kaplan F: Risk factors for falls as a cause of hip fracture in women. The Northeast Hip Fracture Study Group. N Engl J Med 1991, 324(19):1326-1331.
• [2]Head injuries in Canada: a decade of change (1994–1995 to 2003–2004) Can Inst Health Inf 2006. [http://www.cihi.ca/cihi-ext-portal/internet/en/document/types+of+care/specialized+services/trauma+and+injuries/bl_ntr_aug2006 webcite]
• [3]Rubenstein LZ, Josephson KR, Robbins AS: Falls in the nursing home. Ann Intern Med 1994, 121(6):442-451.
• [4]Luukinen H, Koski K, Honkanen R, Kivela SL: Incidence of injury-causing falls among older adults by place of residence: a population-based study. J Am Geriatr Soc 1995, 43(8):871-876.
• [5]Cameron ID, Murray GR, Gillespie LD, Robertson MC, Hill KD, Cumming RG, Kerse N: Interventions for preventing falls in older people in nursing care facilities and hospitals. Cochrane Database Syst Rev (1):CD005465. 2010 Jan 20
• [6]Overstall PW, Exton-Smith AN, Imms FJ, Johnson AL: Falls in the elderly related to postural imbalance. Br Med J 1977, 1(6056):261-264.
• [7]Prudham D, Evans JG: Factors associated with falls in the elderly: a community study. Age Ageing 1981, 10(3):141-146.
• [8]Topper AK, Maki BE, Holliday PJ: Are activity-based assessments of balance and gait in the elderly predictive of risk of falling and/or type of fall? J Am Geriatr Soc 1993, 41(5):479-487.
• [9]Nevitt MC, Cummings SR: Type of fall and risk of hip and wrist fractures: the study of osteoporotic fractures. The Study of Osteoporotic Fractures Research Group. J Am Geriatr Soc 1993, 41(11):1226-1234.
• [10]Feldman F, Robinovitch SN: Recalling the mechanics of falls: young adults cannot accurately describe the sites of impact immediately after a fall occurs. Osteoporos Int 2006, 18:S4.
• [11]Zecevic AA, Salmoni AW, Speechley M, Vandervoort AA: Defining a fall and reasons for falling: comparisons among the views of seniors, health care providers, and the research literature. Gerontologist 2006, 46(3):367-376.
• [12]Zieschang T, Schwenk M, Becker C, Oster P, Hauer K: Feasibility and accuracy of fall reports in persons with dementia: a prospective observational study. Int Psychogeriatr 2012, 24(4):587-598.
• [13]Cummings SR, Nevitt MC, Kidd S: Forgetting falls. The limited accuracy of recall of falls in the elderly. J Am Geriatr Soc 1988, 36(7):613-616.
• [14]Knox CL, Comstock RD: Video analysis of falls experienced by paediatric iceskaters and roller/inline skaters. Br J Sports Med 2006, 40(3):268-271.
• [15]Holliday PJ, Fernie GR, Gryfe CI, Griggs GT: Video Recording of Spontaneous Falls of the Elderly. In Slips, Stumbles, and Falls: Pedestrian Footwear and Surfaces (ASTM STP 1103). Edited by Gray BE. Philadelphia: American Society for Testing and Materials; 1990:7-16.
• [16]Robinovitch SN, Feldman F, Yang Y, Schonnop R, Leung PM, Sarraf T, Sims-Gould J, Loughin M: Video capture of the circumstances of falls in elderly people residing in long-term care: an observational study. Lancet 2013, 381(9860):47-54.
• [17]Hauer K, Lamb SE, Jorstad EC, Todd C, Becker C: Systematic review of definitions and methods of measuring falls in randomised controlled fall prevention trials. Age Ageing 2006, 35(1):5-10.
• [18]Jordan B, Henderson A: Interaction analysis: foundations and practice. J Learning Sci 1995, 4(1):39-103.
• [19]Hayes WC, Myers ER, Robinovitch SN, Van Den Kroonenberg A, Courtney AC, McMahon TA: Etiology and prevention of age-related hip fractures. Bone 1996, 18(1 Suppl):77S-86S.
• [20]Noury N, Rumeau P, Bourke AK, OLaighin G, Lundy JE: A proposal for the classification and evaluation of fall detectors. IRBM 2008, 29:340-349.
• [21]Cummings SR, Nevitt MC: A hypothesis: the causes of hip fractures. J Gerontol 1989, 44(4):M107-M111.
• [22]Berg WP, Alessio HM, Mills EM, Tong C: Circumstances and consequences of falls in independent community-dwelling older adults. Age Ageing 1997, 26(4):261-268.
• [23]Tinetti ME, Doucette J, Claus E, Marottoli R: Risk factors for serious injury during falls by older persons in the community. J Am Geriatr Soc 1995, 43(11):1214-1221.
• [24]Cumming RG, Klineberg RJ: Fall frequency and characteristics and the risk of hip fractures. J Am Geriatr Soc 1994, 42(7):774-778.
• [25]Lach HW, Reed AT, Arfken CL, Miller JP, Paige GD, Birge SJ, Peck WA: Falls in the elderly: reliability of a classification system. J Am Geriatr Soc 1991, 39(2):197-202.
• [26]Wild D, Nayak US, Isaacs B: Description, classification and prevention of falls in old people at home. Rheumatol Rehabil 1981, 20(3):153-159.
• [27]Brocklehurst JC, Exton-Smith AN, Lempert-Barber SM, Hunt LP, Palmer MK: Fracture of the femur in old age: a two-centre study of associated clinical factors and the cause of the fall. Age Ageing 1978, 7(1):2-15.
• [28]Greenspan SL, Myers ER, Maitland LA, Resnick NM, Hayes WC: Fall severity and bone mineral density as risk factors for hip fracture in ambulatory elderly. JAMA 1994, 271(2):128-133.
• [29]Do MC, Breniere Y, Brenguier P: A biomechanical study of balance recovery during the fall forward. J Biomech 1982, 15(12):933-939.
• [30]Maki BE, McIlroy WE: Control of rapid limb movements for balance recovery: age-related changes and implications for fall prevention. Age Ageing 2006, 35(2):ii12-ii18.
• [31]Feldman F, Robinovitch SN: Reducing hip fracture risk during sideways falls: evidence in young adults of the protective effects of impact to the hands and stepping. J Biomech 2007, 40(12):2612-2618.
• [32]Hsiao ET, Robinovitch SN: Common protective movements govern unexpected falls from standing height. J Biomech 1998, 31(1):1-9.
• [33]Taylor PA, Ford CC: Simulation of head impact leading to traumatic brain injury. Natl Tech Inf Serv 2006, ADA481896. [http://www.ntis.gov/search/product.aspx?abbr=ADA481896 webcite]
• [34]Laing AC, Robinovitch SN: The force attenuation provided by hip protectors depends on impact velocity, pelvic size, and soft tissue stiffness. J Biomechanical Eng - ASME 2008, 130(6):061005. 9 pages
• [35]Fleiss JL: Statistical Methods for Rates and Proportions. New York: John Wiley and Sons; 1981.
• [36]Landis JR, Koch GG: The measurement of observer agreement for categorical data. Biometrics 1977, 33(1):159-174.
• [37]Brennan P, Silman A: Statistical methods for assessing observer variability in clinical measures. BMJ 1992, 304(6840):1491-1494.
• [38]Cameron I, Cumming R, Kurrle S, Quine S, Lockwood K, Salkeld G, Finnegan T: A randomised trial of hip protector use by frail older women living in their own homes. Inj Prev 2003, 9(2):138-141.
• [39]Laing AC, Robinovitch SN: Low stiffness floors can attenuate fall-related femoral impact forces by up to 50% without substantially impairing balance in older women. Accid Anal Prev 2009, 41(3):642-650.
• [40]Becker C, Chiari L: What videos can tell us about falling. Lancet 2013, 381(9860):8-9.