The predictive validity of the Hessisch Oldendorf Risk of Falling Scale (HOSS) decreases during the course of rehabilitation

Abstract

BACKGROUND: Falls are highly frequent among neurological patients during rehabilitation and subsequent risk assessments are crucial to prevent falls. OBJECTIVE: This study aims to determine the predictive values of the Hessisch Oldendorf Risk of Falling Scale (HOSS, “Hessisch Oldendorfer Sturzrisiko Skala”) for two timeframes: the first month of rehabilitation and from the second month to the end of rehabilitation. METHODS: Scale performances were assessed for 512 patients during inpatient neurological rehabilitation by calculating the sensitivity and the specificity. HOSS items were entered into a binary logistic regression model. Fall rates were calculated and used for correlation analyses and group comparisons. RESULTS: Initial HOSS assessment showed a sensitivity of 80.4% and a specificity of 60.7%. The HOSS re-assessment resulted in a sensitivity of 67.3% and a specificity of 69.5%. Only a non-somnolent state was identified to increase the risk of falling in both timeframes. Patients with a moderate impaired functional status (Barthel-Index between 20 and 50 points) showed the highest fall rates. CONCLUSION: The predictive validity of the HOSS decreases during the rehabilitation course. This might be caused by an altered relevance of the HOSS items during the re-assessment compared to the initial assessment for which the HOSS was developed for.