FRAT-up,a web-based fall-risk assessment tool for elderly people living in the community

Background: about 30% of people over 65 are subject to at least one unintentional fall a year. fall prevention protocols and interventions can decrease the number of falls. to be effective,a prevention strategy requires a prior step to evaluate the fall risk of the subjects. despite extensive research,existing assessment tools for fall risk have been insufficient for predicting falls. objective: the goal of this study is to present a novel web-based fall-risk assessment tool (frat-up) and to evaluate its accuracy in predicting falls,within a context of community-dwelling persons aged 65 and up. methods: frat-up is based on the assumption that a subject's fall risk is given by the contribution of their exposure to each of the known fall-risk factors. many scientific studies have investigated the relationship between falls and risk factors. the majority of these studies adopted statistical approaches,usually providing quantitative information such as odds ratios. frat-up exploits these numerical results to compute how each single factor contributes to the overall fall risk. frat-up is based on a formal ontology that enlists a number of known risk factors,together with quantitative findings in terms of odds ratios. from such information,an automatic algorithm generates a rule-based probabilistic logic program,that is,a set of rules for each risk factor. the rule-based program takes the health profile of the subject (in terms of exposure to the risk factors) and computes the fall risk. a web-based interface allows users to input health profiles and to visualize the risk assessment for the given subject. frat-up has been evaluated on the inchianti study dataset,a representative population-based study of older persons living in the chianti area (tuscany,italy). we compared reported falls with predicted ones and computed performance indicators. results: the obtained area under curve of the receiver operating characteristic was 0.642 (95% ci 0.614-0.669),while the brier score was 0.174. the hosmer-lemeshow test indicated statistical significance of miscalibration. conclusions: frat-up is a web-based tool for evaluating the fall risk of people aged 65 or up living in the community. validation results of fall risks computed by frat-up show that its performance is comparable to externally validated state-of-the-art tools. a prototype is freely available through a web-based interface. trial registration: clinicaltrials.gov nct01331512 (the inchianti follow-up study); http://clinicaltrials.gov/show/nct01331512 (archived by webcite at http://www.webcitation.org/6udrrruar). ©luca cattelani,pierpaolo palumbo,luca palmerini,stefania bandinelli,clemens becker,federico chesani,lorenzo chiari.