3种跌倒风险自评工具在住院老年病人中应用的信效度及预测价值分析

Analysis of reliability,validity and predictive value of three fall risk self-assessment tools in elderly inpatients

目的探讨3种跌倒风险自评工具在住院老年病人中应用的信效度及预测价值。方法采用便利抽样法,选取2023年1—6月中南大学湘雅医院内符合纳排标准的420例住院老年病人为研究对象,分别接受中文版住院病人自我跌倒风险评估量表(CSAFR)、中文版i Engaging跌倒自主评估工具、中文版老年人跌倒风险自评量表(CFRQ)3种工具的评估。采用组内相关系数评价3种工具的调查员信度;采用Cronbach’sα系数评价3种工具的内部一致性;采用因子分析法评价3种工具的结构效度;以中文版Morse跌倒评估量表(CMFS)作为标准,比较3种工具与CMFS测定得分的相关系数,分析标准效度;采用ROC曲线分析比较3种量表对跌倒的预测价值。结果CSAFR、中文版i Engaging跌倒自主评估工具、CFRQ的组内相关系数分别为0.862、0.804和0.926,Cronbach’sα系数分别为0.515、0.726、0.742;效度KMO值分别为0.618、0.662、0.831,Bartlett’s球形度检验值P均<0.01。主成分分析法结果显示,CSAFR提取出2个公因子,累计方差贡献率为47.4%;中文版i Engaging跌倒自主评估工具提取出7个公因子,累计方差贡献率为58.2%;CFRQ提取出3个公因子,累计方差贡献率为43.3%。CSAFR、i Engagring跌倒自主评估工具、CFRQ与CMFS的相关系数分别为0.398、0.376、0.478。ROC分析结果显示:3种工具AUC值分别为0.814、0.689、0.821,当3种工具的截断点分别为3.5、5.5、4.5时,约登指数分别为0.469、0.259、0.503,敏感度分别为64.9%、88.3%、81.8%,特异度分别为82.1%、37.6%、68.5%。结论本研究认为3种跌倒风险自评工具均有一定的信效度,对住院老年病人跌倒风险的评估均有一定的预测价值,其中CFRQ的信效度及预测价值均较高,且评估时间不长,是进行老年人跌倒风险自评的有效工具和重要参考。

Objective To explore the reliability,validity and predictive value of three fall risk self-assessment tools in hospitalized elderly patients.Methods A total of 420 hospitalized elderly patients who met the inclusion and exclusion criteria in Xiangya Hospital of Central South University from January to June 2023 were selected by convenient sampling method.The Chinese version of Self-Assessment of Fall Risk Questionnaire(CSAFR),the Chinese version of the i Engaging fall self-assessment tool and the Chinese version of the Self-rated Fall Risk Questionnaire(CFRQ)were used to evaluate the risk of fall.The intra-group correlation coefficient was used to evaluate the investigator reliability of the three tools.Cronbach’sαcoefficient was used to evaluate the internal consistency of the three tools.Factor analysis was used to evaluate the construct validity of the three tools.With the Chinese version of the Morse Fall Scale(CMFS)as the standard,the correlation coefficient of the measured scores of the three tools with CMFS was analyzed.The receiver operating characteristic(ROC)curve was used to analyze and compare the predictive effects of the three scales on falls.Results The intraclass correlation coefficients of CSAFR,the Chinese version of the i Engaging fall self-assessment tool and CFRQ were 0.862,0.804 and 0.926,respectively.The Cronbach’sαcoefficients were 0.515,0.726 and 0.742,and the validity KMO values were 0.618,0.662,0.831(P<0.01).Orthogonal rotation transformation was performed,and two common factors were extracted from CSAFR,with a cumulative variance contribution rate of 47.4%.Seven common factors were extracted from Chinese version of i Engaging fall self-assessment tool,with a cumulative variance contribution rate of 58.2%.Three common factors were extracted from the CFRQ,with a cumulative variance contribution rate of 43.3%.The correlation coefficients of CSAFR,i Engaging fall self-assessment tool and CFRO with CMFS were 0.398,0.376,and 0.478,respectively.The results of ROC curve analysis showed that the AUC values of three tools were 0.814,0.689 and 0.821,respectively.When the cut-off points of the three tools were 3.5,5.5 and 4.5 respectively,the Youden indexes were 0.469,0.259 and 0.503,respectively.The sensitivity was 64.9%,88.3%and 81.8%respectively,and the specificity was 82.1%,37.6%and 68.5%,respectively.Conclusions This study suggests that the three fall risk self-assessment tools have certain reliability and validity,and have certain predictive value for the falls in hospitalized elderly patients.The reliability,validity and predictive value of CFRQ for the elderly are highest,and the evaluation time is not long.It is an effective tool and can provide important reference for the self-assessment of fall risk in the hospitalized elderly patients in China.