IFRA: a machine learning-based Instrumented Fall Risk Assessment Scale derived from Instrumented Timed Up and Go test in stroke patients

Effective fall risk assessment is critical for post-stroke patients. The present study proposes a novel, data-informed fall risk assessment method based on the instrumented Timed Up and Go (ITUG) test data, bringing in many mobility measures that traditional clinical scales fail to capture. IFRA, which stands for Instrumented Fall Risk Assessment, has been developed using a two-step process: first, features with the highest predictive power among those collected in a ITUG test have been identified using machine learning techniques; then, a strategy is proposed to stratify patients into low, medium, or high-risk strata. The dataset used in our analysis consists of 142 participants, out of which 93 were used for training (15 synthetically generated), 17 for validation and 32 to test the resulting IFRA scale (22 non-fallers and 10 fallers). Features considered in the IFRA scale include gait speed, vertical acceleration during sit-to-walk transition, and turning angular velocity, which align well with established literature on the risk of fall in neurological patients. In a comparison with traditional clinical scales such as the traditional Timed Up & Go and the Mini-BESTest, IFRA demonstrates competitive performance, being the only scale to correctly assign more than half of the fallers to the high-risk stratum (Fischer's Exact test p = 0.004). Despite the dataset's limited size, this is the first proof-of-concept study to pave the way for future evidence regarding the use of IFRA tool for continuous patient monitoring and fall prevention both in clinical stroke rehabilitation and at home post-discharge.