Transcultural adaptation of the Johns Hopkins Fall Risk Assessment Tool

to perform the transcultural adaptation and content validity analysis of the Johns Hopkins Fall Risk Assessment Tool to assess both fall risk and fall-related injury risk for hospitalized elderly in Brazil.

Method:

the transcultural adaptation consisted of translating the scale to Portuguese (Brazil), back-translating it into its language of origin, establishing a consensus version, and having an expert committee verify its transcultural equivalence. Content assessment was conducted by a committee of judges, ending with the calculation of the items and scales' content validity index. Nurses tested the tool.

Results:

the scale's translated version went through two evaluation rounds by the judges, based on which, the items with unsatisfactory performance were changed. The content validity index for the items was ≥80.0% and the global index 97.1%. The experimental application showed the scale is user-friendly.

Conclusion:

the scale presents valid content for the assessment of fall risk and risk of fall-related injuries and is easy to use, with the potential to contribute to the proper identification of risks and the establishment of care actions.

Descriptors:
Cross-Cultural Comparison; Validation Studies; Nursing Methodology Research; Accidental Falls; Quality of Health Care

Authorship

Maria Carmen Martinez

PhD, RN, WAF Informática, São Paulo, SP, Brazil.WAF InformáticaBrazilSão Paulo, SP, BrazilPhD, RN, WAF Informática, São Paulo, SP, Brazil.

Viviane Ernesto Iwamoto

RN, Specialist in Surgical Center, Unidade de Internação, Hospital Samaritano de São Paulo, São Paulo, SP, Brazil.Hospital Samaritano de São PauloBrazilSão Paulo, SP, BrazilRN, Specialist in Surgical Center, Unidade de Internação, Hospital Samaritano de São Paulo, São Paulo, SP, Brazil.

Maria do Rosário Dias de Oliveira Latorre

PhD, Full Professor, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP, Brazil.Universidade de São PauloBrazilSão Paulo, SP, BrazilPhD, Full Professor, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP, Brazil.

Adriana Moreira Noronha

RN, Unidade de Internação, Hospital Samaritano de São Paulo, São Paulo, SP, Brazil. Hospital Samaritano de São PauloBrazilSão Paulo, SP, BrazilRN, Unidade de Internação, Hospital Samaritano de São Paulo, São Paulo, SP, Brazil.

Ana Paula de Sousa Oliveira

Analist, Núcleo de Epidemiologia, Hospital Samaritano de São Paulo, São Paulo, SP, Brazil.Hospital Samaritano de São PauloBrazilSão Paulo, SP, BrazilAnalist, Núcleo de Epidemiologia, Hospital Samaritano de São Paulo, São Paulo, SP, Brazil.

Carlos Eduardo Alves Cardoso

RN, Specialist in Intensive Care and Cardiology, Unidade de Internação, Hospital Samaritano de São Paulo, São Paulo, SP, Brazil.Hospital Samaritano de São PauloBrazilSão Paulo, SP, BrazilRN, Specialist in Intensive Care and Cardiology, Unidade de Internação, Hospital Samaritano de São Paulo, São Paulo, SP, Brazil.

Ifigenia Augusta Braga Marques

RN, Pronto Socorro Infantil, Hospital Samaritano de São Paulo, São Paulo, SP, Brazil.Hospital Samaritano de São PauloBrazilSão Paulo, SP, BrazilRN, Pronto Socorro Infantil, Hospital Samaritano de São Paulo, São Paulo, SP, Brazil.

Patrícia Vendramim

Doctoral Student, Departamento de Enfermagem, Universidade Federal de São Paulo, São Paulo, SP, Brazil. Assistant Director, Divisão de Pneumologia, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.Universidade de São PauloBrazilSão Paulo, SP, BrazilDoctoral Student, Departamento de Enfermagem, Universidade Federal de São Paulo, São Paulo, SP, Brazil. Assistant Director, Divisão de Pneumologia, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.

Paula Cristina Lopes

Coordinator, Núcleo de Oncologia, Núcleo de Oncologia, Hospital Samaritano de São Paulo, São Paulo, SP, Brazil.Hospital Samaritano de São PauloBrazilSão Paulo, SP, BrazilCoordinator, Núcleo de Oncologia, Núcleo de Oncologia, Hospital Samaritano de São Paulo, São Paulo, SP, Brazil.

Thais Helena Saes de Sant'Ana

RN, Hospital Nove de Julho, São Paulo, SP, Brazil.Hospital Nove de JulhoBrazilSão Paulo, SP, BrazilRN, Hospital Nove de Julho, São Paulo, SP, Brazil.

Corresponding Author: Maria Carmen Martinez Hospital Samaritano de São Paulo. Núcleo de Epidemiologia Rua Conselheiro Brotero, 1505, Cj. 32 Bairro: Higienópolis CEP: 01232-010, São Paulo, SP, Brasil E-mail: mcmarti@uol.com.br

SCIMAGO INSTITUTIONS RANKINGS

PhD, RN, WAF Informática, São Paulo, SP, Brazil.WAF InformáticaBrazilSão Paulo, SP, BrazilPhD, RN, WAF Informática, São Paulo, SP, Brazil.

RN, Hospital Nove de Julho, São Paulo, SP, Brazil.Hospital Nove de JulhoBrazilSão Paulo, SP, BrazilRN, Hospital Nove de Julho, São Paulo, SP, Brazil.

Figures | Tables

Figures (1)
Tables (2)

Thumbnail

Figure 1
Adapted version of Johns Hopkins Fall Risk Assessment Tool to be used in Brazil

Thumbnail

Table 1
Johns Hopkins Fall Risk Assessment Tool - JH-FRAT: results concerning I-CVI* of each item in two rounds of the assessment conducted by the committee of judges, São Paulo - SP - Brazil, 2014

Thumbnail

Table 2
Johns Hopkins Fall Risk Assessment Tool - JH-FRAT: score obtained in the pre-test of the final version adapted to be used in Brazil, São Paulo - SP - Brazil, 2014

Figure 1 Adapted version of Johns Hopkins Fall Risk Assessment Tool to be used in Brazil

Table 1 Johns Hopkins Fall Risk Assessment Tool - JH-FRAT: results concerning I-CVI* of each item in two rounds of the assessment conducted by the committee of judges, São Paulo - SP - Brazil, 2014

Item	Content	Round 1	Round 2
0	The Johns Hopkins Fall Risk Assessment Tool - JH-FRAT	100.0	100.0
1	Fall Risk Factor Category: Scoring not completed for the following reason(s) (check any that apply). Enter risk category (i.e., Low/High) based on box selected.	50.0	100.0
2	·Complete paralysis, or completely immobilized. Implement basic safety (low fall risk) interventions.	66.7	100.0
3	Patient has a history of more than one fall in 6 months prior to admission. Implement high fall risk interventions throughout hospitalization.	83.3	100.0
4	Patient has experienced a fall during current hospitalization. Implement high fall risk interventions throughout.	66.7	100.0
5	Patient is deemed high fall-risk per protocol (e.g., seizure precautions). Implement high fall-risk interventions per protocol.	66.7	100.0
6	Complete the following and calculate fall risk score. If no box is checked, score for category is 0.	100.0	100.0
7	Age (Single-Select).	100.0	100.0
8	60 - 69 years (1 point).	100.0	100.0
9	70 - 79 years (2 points).	100.0	100.0
10	Greater than or equal to 80 years (3 points).	100.0	100.0
11	Fall History (Single-Select).	50.0	100.0
12	One fall within 6 months before admission (5 points).	66.7	100.0
13	Elimination. Bowel and Urine (Single-Select).	100.0	100.0
14	Incontinence (2 points).	83.3	80.0
15	Urgency or frequency (2 points).	66.7	100.0
16	Urgency/frequency and incontinence (4 points).	66.7	100.0
17	Medications: Include PCA/opiates, anti-convulsants, anti-hypertensives, diuretics, hypnotics, laxatives, sedatives, and psychotropics (Single-Select).	66.7	100.0
18	On 1 high fall risk drug (3 points).	66.7	100.0
19	On 2 or more high fall risk drugs (5 points).	66.7	100.0
20	Sedated procedure within past 24 hours (7 points).	50.0	100.0
21	Patient Care Equipment: Any Equipment That Tethers Patient (e.g., IV Infusion, Chest Tube, Indwelling Catheters, SCDs, etc.) (Single-Select).	83.3	80.0
22	One present (1 point).	100.0	80.0
23	Two present (2 points).	100.0	80,0
24	3 or more present (3 points).	100.0	80.0
25	Mobility (Multi-select, Choose all that apply and add points together).	100.0	100.0
26	equires assistance or supervision for mobility, transfer, or ambulation (2 points).	83.3	100.0
27	Unsteady gait (2 points).	83.3	100.0
28	Visual or auditory impairment affecting mobility (2 points).	83.3	100.0
29	Cognition (Multi-select, Choose all that apply and add points together).	100.0	100.0
30	Altered awareness of immediate physical environment (1 point).	83.3	100.0
31	Impulsive (2 points).	50.0	100.0
32	Lack of understanding of one's physical and cognitive limitations (4 points).	100.0	100.0
33	*Moderate risk = 6-13 Total Points, High risk > 13 Total Points	66.7	100.0

*I-CVI - Content validity index for items.

Table 2 Johns Hopkins Fall Risk Assessment Tool - JH-FRAT: score obtained in the pre-test of the final version adapted to be used in Brazil, São Paulo - SP - Brazil, 2014

Item assessed	Mean*(SD)^†
1) First block with instructions and situations that pre-defined risk situations	3.8 (0.5)
2) Risk factor "age"	4.0 (0.0)
3) Risk factor "history of falls"	3.8 (0.9)
4) Risk factor "eliminations"	3.8 (0.6)
5) Risk factor "use of medication with high fall risk"	3.8 (0.6)
6) Risk factor "assistive devices"	4.0 (0.0)
7) Risk factor "mobility"	3.9 (0.3)
8) Risk factor "cognition"	3.6 (0.7)
Set of items	3.8 (0.3)

* Score from 1 to 4 points † SD = standard deviation

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Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo Av. Bandeirantes, 3900, 14040-902 Ribeirão Preto SP Brazil, Tel.: +55 (16) 3315-3451 / 3315-4407 - Ribeirão Preto - SP - Brazil
E-mail: rlae@eerp.usp.br

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Transcultural adaptation of the Johns Hopkins Fall Risk Assessment Tool

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[1] Corresponding Author: Maria Carmen Martinez Hospital Samaritano de São Paulo. Núcleo de Epidemiologia Rua Conselheiro Brotero, 1505, Cj. 32 Bairro: Higienópolis CEP: 01232-010, São Paulo, SP, Brasil E-mail: mcmarti@uol.com.br