Switch Your Focus from Fall Risk Scores to Assessment Skills

Why are your rehabilitation patients at risk for falls?

To properly answer this question, you must go beyond a fall risk screening tool that produces a fall risk score and a category of fall risk (low, moderate, or high). Instead, you must complete a clinical assessment.

When you recognize the purpose and limitations of fall risk screening scores, you can build your clinical assessment skills to conduct a multifactorial fall risk assess.

What’s Missing in Fall Risk Screening?

Say you have a patient who has experienced a right brain stroke. You know that every fall risk screening tool will produce a fall risk score for this patient. But this score fails to portray the many complex clinical factors that could lead to your patient falling.

While deficit severity varies for each patient, the common fall risk factors for a right brain stroke patient, such as denial syndrome, impulsivity, safety deficits, visual neglect or deficit, left hemiparesis, and hemiplegia, are very different than those of a long-term chronic diabetic patient, which could include lower extremity sensory neuropathy, gait and balance deficits, and hypoglycemia. These two patients could receive similar numerical scores, but the reality of their situations and the predictors of fall risk are actually quite different.

To identify the presence, duration, and severity of each of these deficits, you must complete an assessment, which you can then use to recommend precautions to prevent falls.

Transitioning from Screening Tool to Assessment

The fall risk screening tool asks yes or no questions to screen for positive fall risk factors. If positive fall risk factors are ascertained, an assessment must follow. This makes the screening tool a useful first step, but not the whole story.

Fall assessment is an essential part of practice that requires clinical knowledge and skills to identify actual multifactorial fall risk factors.

A proper assessment includes a review of the patient’s:

  • Past medical and surgical history
  • Medications that could contribute to fall risk
  • Laboratory results

An assessment also includes both physical and functional components.

Assessment is the foundation for differential diagnoses, such as the presence of visual neglect, hemiparesis, foot drop, postural hypotension, lower extremity sensory neuropathy, and more.

Two specific fall and injury risk factors you should always be on alert for are postural hypotension and lower extremity sensory neuropathy. These, along with fracture risk, serve as the basis for individualized fall and injury prevention patient care planning.

In my MedBridge course, “Fall and Injury Risk Assessment Is More Than a Score,” we discuss specific techniques that will better position you to modify your practice and implement patient-centered individualized care plans to reduce falls and fall-related injuries. You can also build your clinical knowledge and gain expertise in all facets of fall and injury prevention by taking my MedBridge Certificate Program, “Fall & Injury Prevention: How to Manage, Engage, and Evaluate.”

As a rehabilitation practitioner, your goal is to improve each patient’s function, independence, confidence, and safety. Expanding your clinical assessment and individualized care planning skills is the key to achieving that goal. While a fall risk screening tool can be a good place to start, your clinical assessment should not end there. A comprehensive assessment of multifactorial fall and injury risk factors will better protect your patients from injury so you can achieve better long-term outcomes.