Fitzgerald SG (James A Haley Tampa VA), Nelson A
(James A Haley Tampa VA), Palacios P
(James A Haley Tampa VA), McGovern S
(James A Haley Tampa VA)
A prospective study was completed to determine the risk factors for wheelchair falls among veterans with spinal cord injury (SCI). Building on this work, a wheelchair falls screening tool was developed. Specific objectives included investigating the stability of the models, develop and refine the tool by using experts in the field, and examine reliability in a local sample of veterans with SCI.
Stability of the regression weights estimated in the models were confirmed using cross-validation techniques. Items were assembled into a draft tool and provided to an expert panel for refinement. Content validity was established by review of the tool by a group of SCI clinicians. Repeated administrations of the screening tool to veterans with SCI assessed test/retest.
Results from the cross-validation indicated that the original predictors were stable and included hours of wheelchair use, pain in previous two months, alcohol abuse (measured by AuditC), higher function (measured by FIM), wheelchair length, having a fall in the previous year, and fewer years of SCI. These predictors explained 83% of the variance. Expert panel recommendations included: eliminating wheelchair length, examining components of the FIM and AuditC independently, and establishing cut points for continuous variables. Final screening tool resulted in five items, all with dichotomous responses. Reliability as measured by Cronbach alpha is greater than 0.7.
Wheelchair falls are a high-risk problem for persons with SCI. Although many standardized fall risk assessment tools exist, they are not specific for wheelchairs. The Wheelchair Falls Screening Tool in SCI is the first fall risk assessment tool that meets the needs of wheelchair populations. Although additional validation is needed, its concise and simplistic format will allow for use by many clinicians.
By assessing the potential for fall risk, interventions can potentially be implemented, thus improving care and decreasing subsequent injury as a result of that fall. The VHA SCI Strategic Health Care Group has strong support for this screening tool and is awaiting its final development and validation for national implementation.