Introducing a new definition of a near fall: Intra-rater and inter-rater reliability

I. Maidan, T. Freedman, R. Tzemah, N. Giladi, A. Mirelman, J. M. Hausdorff*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Near falls (NFs) are more frequent than falls, and may occur before falls, potentially predicting fall risk. As such, identification of a NF is important. We aimed to assess intra and inter-rater reliability of the traditional definition of a NF and to demonstrate the potential utility of a new definition. To this end, 10 older adults, 10 idiopathic elderly fallers, and 10 patients with Parkinson's disease (PD) walked in an obstacle course while wearing a safety harness. All walks were videotaped. Forty-nine video segments were extracted to create 2 clips each of 8.48. min. Four raters scored each event using the traditional definition and, two weeks later, using the new definition. A fifth rater used only the new definition. Intra-rater reliability was determined using Kappa (K) statistics and inter-rater reliability was determined using ICC. Using the traditional definition, three raters had poor intra-rater reliability (K< 0.054, p> 0.137) and one rater had moderate intra-rater reliability (K= 0.624, p< 0.001). With the traditional definition, inter-rater reliability between the four raters was moderate (ICC = 0.667, p< 0.001). In contrast, the new NF definition showed high intra-rater (K> 0.601, p< 0.001) and excellent inter-rater reliability (ICC = 0.815, p< 0.001). A priori, it is easy to distinguish falls from usual walking and NFs, but it is more challenging to distinguish NFs from obstacle negotiation and usual walking. Therefore, a more precise definition of NF is required. The results of the present study suggest that the proposed new definition increases intra and inter-rater reliability, a critical step for using NFs to quantify fall risk.

Original languageEnglish
Pages (from-to)645-647
Number of pages3
JournalGait and Posture
Issue number1
StatePublished - Jan 2014


FundersFunder number
FP7-ICT-2011-7ICT-2011.5.4, 288878
National Institute on AgingR21AG034227
European Commission
Israel Science Foundation


    • Aging
    • Fall risk
    • Gait
    • Near falls


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