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Development and Validation of a Falls-Grading Scale

Davalos-Bichara, Marcela MD1,8; Lin, Frank R. MD, PhD1; Carey, John P. MD1; Walston, Jeremy D. MD2; Fairman, Jennifer E. CMI, FAMI3; Schubert, Michael C. PT, PhD1; Barron, Jeremy S. MD2; Hughes, Jennifer PhD2; Millar, Jennifer L. PT4; Spar, Anne PT4; Weber, Kristy L. MD5; Ying, Howard S. MD6; Zackowski, Kathleen M. PhD, OT4,9; Zee, David S. MD7; Agrawal, Yuri MD1

Journal of Geriatric Physical Therapy: April/June 2013 - Volume 36 - Issue 2 - p 63–67
doi: 10.1519/JPT.0b013e31825f6777
Research Reports

Background and Purpose: The recording of fall events is usually subjective and imprecise, which limits clinical practice and falls-related research. We sought to develop and validate a scale to grade near-fall and fall events on the basis of their severity represented by the use of health care resources, with the goal of standardizing fall reporting in the clinical and research settings.

Methods: Qualitative instrument development was based on a literature review and semistructured interviews to assess face and content validity. We queried older individuals and health care professionals with expertise in the care of patients at risk of falling about clinically important differences to detect and how to optimize the scale's ease of use. To assess the scale's interrater reliability, we created 30 video-vignettes of falls and compared how health care professionals and volunteers rated each of the falls according to our grading scale.

Results: We developed the illustrated 4-point Hopkins Falls Grading Scale (HFGS). The grades distinguish a near-fall (grade 1) from a fall for which an individual did not receive medical attention (grade 2), a fall associated with medical attention but not hospital admission (grade 3), and a fall associated with hospital admission (grade 4). Overall, the HFGS exhibited good face and content validity and had an intraclass correlation coefficient of 0.998.

Conclusion: The 4-point HFGS demonstrates good face and content validity and high interrater reliability. We predict that this tool will facilitate the standardization of falls reporting in both the clinical and research settings.

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1Department of Otolaryngology-Head and Neck Surgery

2Division of Geriatrics and Gerontology

3Department of Arts as Applied to Medicine

4Department of Physical Medicine and Rehabilitation

5Department of Orthopaedic Surgery

6Department of Ophthalmology

7Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, USA.

8Escuela de Medicina Ignacio A. Santos del Tecnológico de Monterrey, Monterrey, México.

9Kennedy Krieger Institute, The Johns Hopkins Medical Institutions, Baltimore, USA.

Address correspondence to: Yuri Agrawal, MD, Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD 21205 (

Scientific meeting presentations: 4th Pan-American Congress, International Association of Gerontology and Geriatrics, Falls Session, October 22, 2011, Ottawa, Ontario, Canada.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site.

Copyright © 2013 the Section on Geriatrics of the American Physical Therapy Association
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