Concurrent Validity and Reliability of In-Person and Supervised Remote STEADI Fall Risk Assessment in Community-Dwelling Older Adults

Category of Work

Article

Publication Title

Journal of Geriatric Physical Therapy

Abstract

Background and purpose: Physical therapists play a vital role in preventing and managing falls in older adults. With advancements in digital health and technology, community fall prevention programs need to adopt valid and reliable telehealth-based assessments. The purpose of this study was to evaluate the validity and reliability of the telehealth-based timed up and go (TUG) test, 30-second chair stand test (30s-CST), and four-stage (4-stage) balance test as functional components of the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) fall risk assessment.

Methods: This cross-sectional study was conducted using a convenience sample of community-dwelling older adults. The TUG, 30s-CST, and 4-stage balance test were administered in random order in 1 session in the participant's own environment. Performance was scored concurrently by an in-person and synchronous telehealth rater. The video recordings of the performances were scored by an asynchronous telehealth rater on days 1 and 30 for inter- and intra-rater reliability. Additionally, participants performed the TUG test twice, using the distance measured by the participant and the distance measured by the in-person rater. To establish the validity of telehealth-based STEADI fall risk assessments, the Intraclass Correlation Coefficient (ICC), Pearson correlation coefficient, and 95% limits of agreement were derived. Inter- and intra-rater reliability were established by calculating ICC using a 2-way mixed model. Bland-Altman plots were created for nonsignificant proportional bias tests.

Results and discussion: Thirty community-dwelling older adults participated. Based on the STEADI algorithm, 13 participants were classified as having a moderate fall risk. A comparison of in-person and synchronous telehealth ratings showed excellent ICCs (0.97-0.99) and relationships (r = 0.94-0.98). Bland-Altman plots were created for all tests except for the 30s-CST (t = -2.168, P = .04). All tests had good to excellent inter-rater reliability (ICC = 0.84-1.00) and intra-rater reliability (0.77-1.00). No adverse events were reported.

Conclusion: This study suggests that telehealth-administered functional tests in the STEADI fall risk assessment are valid and reliable when technology, environment, camera view, and angle are optimally managed.

First Page

116

Last Page

124

DOI

doi.org/10.1519/JPT.0000000000000446

Publication Date

9-2025

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