A new tool for assessing the risk of fall in children with severe disability: development of the ALICE scale
Keywords:
Fall, tool, disability, childrenAbstract
Introduction. It is known in the literature that the main cause of physical impairment in children with severe disabilities is falling, which can worsen their already compromised condition. There are no specific scales for this population in the literature, neither in Italian nor in other languages. We created and validated a scale for assessing the risk of falling in children with severe disabilities.
Study design. Observational prospective study.
Methods. We enrolled children (inpatients or day-hospital) admitted to the “Santa Maria Bambina Centre” of the “Fondazione Onlus Sacra Famiglia” in Cesano Boscone, Milan; the Content Validity Index of the Scale was calculated to assess the content validity of a new scale (ALICE). Cronbach’s alpha coefficient (α) was used to examine internal consistency, Spearman’s rho coefficient to test inter-rater reliability. Sensitivity, specificity, positive and negative predictive values were calculated.
Results. Out of 48 patients enrolled, 14 fell (29.2%). The ALICE scale, with cut-off set at 16, showed a sensitivity of 100%, a specificity of 88.2%, a positive predictive value of 77.8% and a negative predictive value of 100%. The Content Validity Index of the Scale (=0.93), inter-rater reliability (rho=0.91, p<0.001) and Cronbach’s alpha (=0.72) were satisfactory.
Conclusions. The ALICE scale seems reliable and valid in the disabled population and can be applied by nurses. Further studies with larger samples and a multicentre design are needed.
References
1. Ramirez M, Peek-Asa C, Kraus JF. Disability and risk of school related injury. Inj Prev. 2004; 10(1): 21-6. doi: 10.1136/ip.2003.002865.
2. Zhu H, Xiang H, Xia X, et al. Unintentional injuries among Chinese children with different types and severity of disability. Ann Epidemiol. 2014; 24(1): 23-8. doi: 10.1016/j. annepidem.2013.10.015.
3. Andrews J, Falkmer M, Girdler S. Community participation interventions for children and adolescents with a neurodevelopmental intellectual disability: a systematic review. Disabil Rehabil. 2015; 37(10): 825-33. doi:
10.3109/09638288.2014.944625.
4. Petridou E, Kedikoglou S, Andrie E, et al. Injuries among disabled children: a study from Greece. Inj Prev. 2003; 9(3): 226-30. doi: 10.1136/ip.9.3.226.
5. Cahill S, Stancliffe RJ, Clemson L, Durvasula S. Reconstructing the fall: individual, behavioural and contextual factors associated with falls in individuals with intellectual disability. J Intellect Disabil Res. 2014; 58(4): 321-32. doi: 10.1111/ jir.12015.
6. Benford P, Young B, Coupland C, et al. Risk and protective factors for falls on one level in young children: multicentre case-control study [published correction appears in Inj Prev. 2016 Feb; 22(1):84]. Inj Prev. 2015; 21(6): 381-8. doi: 10.1136/injuryprev-2015-041581.
7. Saccomano SJ, Ferrara LR. Fall prevention in older adults. Nurse Pract. 2015; 40(6): 40-8. doi:
10.1097/01.NPR.0000465117.19783.ee.
8. Cattelani L, Palumbo P, Palmerini L, et al. FRATup, a Web-based fall-risk assessment tool for elderly people living in the community. J Med Internet Res. 2015; 17(2): e41. Published 2015 Feb 18. doi: 10.2196/jmir.4064.
9. Hill AM, McPhail SM, Waldron N, et al. Fall rates in hospital rehabilitation units after individualised patient and staff education programmes: a pragmatic, stepped-wedge, cluster-randomised controlled trial. Lancet. 2015; 385(9987): 2592-9. doi: 10.1016/S0140-6736(14)61945-0.
10. Ho P, Bulsara M, Patman S, Downs J, Bulsara C, Hill AM. Incidence and associated risk factors for falls in adults with intellectual disability. J Intellect Disabil Res. 2019; 63(12): 1441-52.
doi: 10.1111/jir.12686.
11. Morici V, Terzoni S, Ferrara P, Destrebecq A.
Development and Validation of A New Tool for Assessing Risk of Falls in Acute Psychiatric Settings. Int J Emerg Mental Health. 2016; 18(2): 742-7. 10.4172/1522-4821.1000330.
12. Joint Commission. Preventing falls and fallrelated injuries in health care facilities. Sentinel Event Alert 2015 Sep 28; 55(2): 1-5. Available on: http:// www.jointcommission.org/ assets/1/18/SEA_55.pdf [Last accessed: 2021 May 27].
13. Edmonson D, Robinson S, Hughes L. Development of the Edmonson Psychiatric Fall Risk Assessment Tool. J Psychosoc Nurs Ment Health Serv. 2011; 49(2): 29-36. doi: 10.3928/02793695-20101202-03.
14. Polit DF, Beck CT. The content validity index: are you sure you know what’s being reported? Critique and recommendations. Res Nurs Health. 2006; 29(5): 489-97. doi: 10.1002/nur.20147.
15. Limbos MA, Ramirez M, Park LS, Peek-Asa C, Kraus JF. Injuries to the head among children enrolled in special education. Arch Pediatr Adolesc Med. 2004; 158(11): 1057-61. doi: 10.1001/ archpedi.158.11.1057.
16. Zhu HP, Xia X, Xiang HY, Yu CH, Du YK. Disability, home physical environment and non-fatal injuries among young children in China. PLoS One. 2012; 7(5): e37766. doi: 10.1371/journal. pone.0037766.
17. Fraser A, Doan D, Lundy M, Bevill G, Aceros movement related events. Inj Epidemiol. 2019; J. Pediatric safety: review of the susceptibility 6: 12. Published 2019 Apr 8. doi: 10.1186/ of children with disabilities to injuries involving s40621-019-0189-8.
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