A brief fall-risk screening tool to support early rehabilitation referral in hemodialysis patients: multicenter prospective cohort study.

Abstract

Purpose: To develop a brief screening tool to identify hemodialysis (HD) patients at risk of falls who may benefit from early rehabilitation and prevention strategies.

Methods: A prospective cohort study was conducted across nine centers. Falls were recorded prospectively for 1 year following baseline assessment using the Kihon Checklist (KCL). Participants were categorized into development and validation cohorts. Logistic regression was used to identify KCL items associated with falls, and a short version was constructed by summing odds ratios (OR). Predictive accuracy was evaluated using the area under the receiver operating characteristic curve (AUC) and compared with the standard KCL. The cutoff value was determined using the Youden index.

Results: A total of 403 patients (median age 70.0 years, 42.1% female) were included, of whom 117 (29.0%) experienced a fall during 1 year. Five items were significantly associated with falls, including climbing stairs without a handrail (OR 2.3), history of falls (OR 3.1), fear of falling while walking (OR 2.3), inability to recognize dates (OR 2.1), and feelings of uselessness (OR 2.2). Based on these, a 0-12 point short version was developed. In the validation cohort (n = 100), the AUC was 0.75, comparable to the standard KCL (0.70, p = 0.39). A cutoff of 4.6 yielded a sensitivity of 77.8% and a specificity of 38.4%.

Conclusions: The short KCL showed similar predictive accuracy to the standard version with less burden. Despite modest specificity, it may be a practical tool to identify high-risk HD patients and support early intervention.