The inter-rater and test-retest reliability of the Home Falls and Accidents Screening Tool

Background/aim: The Home Falls and Accidents Screening Tool was developed to assist health professionals to identify falls risk among community-dwelling older people arising from their home environment. The aim of this study was to evaluate the Home Falls and Accidents Screening Tool by examining its inter-rater and test-retest reliability.

Methods: Community-dwelling older people, over the age of 65 (n = 31) were recruited from the caseload of nine occupational therapists across three area health services in Sydney and the Hunter region. A total of 31 home visits were conducted by the researcher and an occupational therapist to independently administer the Home Falls and Accidents Screening Tool. Follow-up visits were then conducted within a two-week period by one of the raters to re-administer the Home Falls and Accidents Screening Tool. Reliability was evaluated using percentage agreement, intra-class correlations and kappa coefficients.

Results: The intra-class correlation coefficient for the Home Falls and Accidents Screening Tool overall score was 0.82 (95% CI, 0.66-0.91) for inter-rater reliability and 0.77 (95% CI, 0.57-0.88) for test-retest reliability, indicating a good level of reliability for the tool. 'Undefined stair edges' was the only item that demonstrated poor inter-rater reliability (kappa = 0.37). All items except 'loose mats' (kappa = 0.19) reached acceptable or excellent levels of test-retest reliability with kappa scores greater than 0.40.

Conclusion: The Home Falls and Accidents Screening Tool demonstrated consistency across raters and across different time periods. Further studies into the reliability of the Home Falls and Accidents Screening Tool would benefit from sampling raters from varying professional backgrounds and older people with higher levels of function.