Inter-rater Reliability of Modified Morse Fall Scale
A recent study in an acute care hospital in Singapore measured the inter-rater reliability of a modified Morse Falls Scale (mMFS). The original MFS consists of 6 evaluation items. In the modified scale, one additional component, “risk taking behavior,” was included. One researcher and nurses on 7 wards participated in the study. Nurses received one day of training in using the mMFS.
The results demonstrated a high inter-rater agreement overall, with κ values that ranged from 0.63 for “effects of medication” to 1.0 for “risk-taking behavior.” In addition to “effects of medication,” 2 other categories had κ values less than 0.90: use of assistive devices, 0.84, and mental status, 0.88. The categories with lower κ values may represent ambiguity in evaluating the item or a lack of adequate data. In some cases, raters disagreed whether patients needed assistive devices, while there was greater agreement on the item “unsteady gait” (κ = 0.955). The authors note the importance of accurate assessment of mobility and suggest that the use of a more precise measure, such as the “get up and go” test may be beneficial. Difficulties with assessing the impact of medications arose due to the absence of fall risk medication lists in some patient records. The “risk-taking behavior” category had a κ value of 1.00, displaying perfect inter-rater agreement in identifying patients who displayed risk-taking behaviors or failed to comply with fall prevention instructions. The study did not evaluate the impact on patient falls of adding the “risk-taking behavior” category and did not show data regarding inpatient falls. Overall, inter-rater agreement between staff using the mMFS was high.
Tang WS, Chow YL, Lin SKS. The inter-rater reliability test of the modified Morse Fall Scale among patients ≥ 55 years old in an acute care hospital in Singapore. Int J Nursing Pract. 2014;20:32-38.
Posted in Fall Prevention Research