基于 COSMIN指南的老年人跌倒风险感知量表的系统评价 [中文引用][英文引用]

目的 系统评价老年人跌倒风险感知评估工具的方法学质量和测量属性质量，为医护人员选择合适的评估工具提供循证依据。方法 计算机检索 Medline，Embase，PubMed，Web of Science，CINAHL，中国知网，万方，维普和中国生物医学文献数据库（China Biology Medicine，CBM）中有关老年人跌倒风险感知评估工具的研究，检索时限为建库至 2024 年 6 月 1 日。由 2 名研究者独立筛选文献及提取数据，采用基于共识的健康测量工具选择标准（consensus-based standards for the selection ofhealth measurement instruments，COSMIN）偏倚风险清单及质量标准对测量工具属性进行系统评价。结果 共纳入 22 项研究，包括 21 种老年人跌倒风险感知量表，均存在一定偏倚风险，且均未报告跨文化效度 / 测量等同性、测量误差；跌倒风险评估量表（fall risk questionnaire，FRQ）因有高质量证据证明其内部一致性和反应度“不足”，为 C 级推荐；其余量表因内容效度均为“不确定”，为 B 级推荐。结论 相较其他量表，老年人跌倒警觉度量表（self-awareness of falls in elderly scale，SAFE）、社区老年人跌倒风险感知量表（fall risk perception scale for the elderly in community，FRPSE）因测量构念全面、测量学属性评价较完善暂被推荐应用（首优 SAFE，次优 FRPSE），但其临床适用性及部分测量学属性需进一步检验。

Objective To systematically evaluate the methodological quality and the measurement attributes of the assessment tools for risk of falls perception in the elderly, therefore to provide evidence-based references for medical staff to select a proper assessment tool. Methods Literature on studies of the assessment tools for risk of falls perception in the elderly was retrieved across databases and websites including Medline, Embase, PubMed, Web of Science, CINAHL, China National Knowledge Infrastructure （CNKI）, Wanfang Data, VIP and China Biology Medicine（CBM）. The retrieval period was from the inception of the databases to 1st June, 2024. Two researchers independently screened the retrieved literature and extracted the data. The bias risk list and quality standards of the consensus-based standards for the selection of health measurement instruments（COSMIN）were used to systematically evaluate the attributes of the assessment tools. Results A total of 22 studies were included, covering 21 scales for the risk of falls perception in the elderly. All the scales had certain risks of bias, and none of them reported cross-cultural validity/measurement equivalence and measurement error. The fall risk questionnaire（FRQ）was rated as Class C recommendation due to the high-quality evidences indicated its“inadequate”internal consistency and responsiveness. The remaining scales were rated as Class B recommendation due to their uncertainty in content validity. Conclusion In comparison with the assessment tools for risk of falls perception in the elderly, the selfawareness of falls in elderly scale（SAFE, a primary choice）and the fall risk perception scale for the elderly in community（FRPSE, the secondary choice）are recommended for their comprehensive structure of measurement and relatively complete evaluation of measurement. However, further studies are required to validate the clinical applicability and measurement attributes of the SAFE and FRPSE.