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RehabMeasures Instrument

Falls Efficacy Scale – International

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Purpose

A 16-item self-administered questionnaire designed to assess fear of falling in mainly community-dwelling older population.

Link to Instrument

Instrument Details

Acronym FES-I

Administration Mode

Paper & Pencil

Cost

Not Free

Diagnosis/Conditions

  • Arthritis + Joint Conditions
  • Multiple Sclerosis
  • Vestibular Disorders

Key Descriptions

  • 16 Items, including a range of functional activities
  • Individuals are instructed to rate each activity on a four-point Likert scale, depending on how concerned they are that they might fall if they did this activity, regardless of whether they actually perform it. (Dewan & MacDermid, 2014).
  • Items are scored a 1 if they are not at all concerned about falling going up to 4 if they are very concerned during each activity:
    1 = Not at all concerned
    2 = Somewhat concerned
    3 = Fairly concerned
    4 = Very concerned
  • Item scores are summed to calculate a range of total score from minimum 16 to maximum 64 (Dewan & MacDermid, 2014).
  • Higher the score, greater the fear of falling (FOF). The downloadable original and translated versions of FES-I are available on the Prevention of Falls Network Europe (ProFaNE) website: http://www.profane.eu.org

Number of Items

16

Equipment Required

  • Pen/Pencil
  • Questionnaire

Time to Administer

10 minutes

5-10 minutes

Required Training

No Training

Instrument Reviewers

Nupur Prasad Rajadhyaksha, PT

ICF Domain

Activity
Participation

Considerations

  • A 7-item version of FES-I (short FES-I) has also been developed, validated and recommended for the community-dwelling older population in order to minimize the assessment burden and increase the acceptability (Kempen et al., 2008).
  •  If data is missing on more than four items then that questionnaire cannot be used. If data is missing on no more than four of the 16 items then calculate the sumscore of the items that have been completed (i.e. add together the responses to each item on the scale), divide by the number of items completed, and multiply by 16. The new sumscore should be rounded up to the nearest whole number to give the score for an individual.
  • Several studies published using versions of FES – I in different languages such as Swedish, Serbian, Spanish, Greek and Arabic are available but not included in this summary (Alghadir et al., 2015; Billis et al., 2011; Gazibara et al., 2013; Halvarsson, A., Franzén, E., & Ståhle, A., 2013; Lomas-Vega et al., 2012). The FES-I was developed through a series of meetings between members of the Prevention of Falls Network Europe (ProFaNE), an EC funded collaboration coordinating research into fall prevention. The downloadable original and translated versions of FES-I are available on the Prevention of Falls Network Europe (ProFaNE) website: http://www.profane.eu.org

Vestibular Disorders

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Standard Error of Measurement (SEM)

People with vestibular disorders: (Morgan et al.,2013, n = 53; mean age = 54 (15) years)

  • SEM = 3.0 points

Minimal Detectable Change (MDC)

People with vestibular disorders: (Morgan et al.,2013)

  • 8.2 points

Test/Retest Reliability

People with vestibular disorders: (Morgan et al.,2013)

  • Excellent test-retest reliability (ICC = .94)

Criterion Validity (Predictive/Concurrent)

Concurrent validity:

People with vestibular disorders: (Morgan et al.,2013)

  • Excellent correlations with Activity Balance Confidence (ABC) scores (r = -0.84)
  • Excellent correlations with Dizziness Handicap Inventory (DHI) (r = 0.75)
  • Excellent correlations with Vestibular Activities and Participation (VAP) (r = 0.78)
  • Adequate correlations with gait speed (r = -0.55)
  • Adequate correlations with 4 item- Dynamic Gait Index (DGI-4) (r = -0.55)

Older Adults and Geriatric Care

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Cut-Off Scores

Community-dwelling older adults: (Delbaere et al., 2010; n = 500; mean age = 77.4 (6.08))

  • Scores between 16 – 19 indicate low concern about falls
  • Scores between 20 – 27 indicate moderate concern about falls
  • Scores between 28 – 64 indicate high concern about falls

Normative Data

Older adults with and without cognitive impairments: (Hauer et al., 2011; n = 284; mean age in cognitively impaired = 82.5 (6.2); mean in cognitively intact = 81.6 (6.8) )

  • Mean (SD) FES - I score of cognitively impaired group; 29.2 (10.3), range = 16 - 63
  • Mean (SD) FES - I score of cognitively intact group; 29.6 (10.7), range = 16 - 59

Community-dwelling older adults: (Delbaere et al., 2010)

  • Mean (SD) FES - I score at baseline; 22.6 (6.4), range = 16 – 57
  • Mean (SD) FES - I score at 3 months; 21.7 (6.6), range = 16 – 55
  • Mean (SD) FES - I score at 6 months; 22.8 (7.8), range = 16 – 64
  • Mean (SD) FES - I score at 9 months; 23.6 (8.2), range = 16 – 62
  • Mean (SD) FES - I score at 12 months; 23.6 (8.1), range = 16 – 64

Test/Retest Reliability

Community-dwelling older adults: (Dewan and MacDermid, 2014)

  • Excellent test-retest reliability (ICC = .96)

Geriatric rehabilitation patients with or without cognitive impairments: (Hauer et al., 2010)

  • Adequate to Excellent test-retest reliability (ICC = .58 to 0.92)

Internal Consistency

Community-dwelling older adults:

  • Excellent internal consistency (Cronbach’s alpha = 0.96*) (Dewan and MacDermid, 2014)
  • Adequate internal consistency (Cronbach’s alpha = 0.79) (Delbaere et al., 2010)

Geriatric rehabilitation patients with or without cognitive impairments:

  • Excellent internal consistency (Cronbach’s alpha = 0.925* to 0.957*) (Hauer et al., 2010)

Older adults with and without cognitive impairments:

  • Excellent internal consistency (Cronbach's alpha = 0.92*), both community-dwelling older adults and geriatric rehabilitation patients with or without cognitive impairments (Hauer et al., 2011)

*Scores > 0.9 may indicate redundancy

Floor/Ceiling Effects

Older adults with and without cognitive impairments:

  • Adequate floor effects = 3.9% (Hauer et al., 2011, n = 11)

Responsiveness

Older adults with and without cognitive impairments: (Hauer et al., 2011; n = 130)

  • Moderately sensitive (Effect Size (ES) = 0.36)

Multiple Sclerosis

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Standard Error of Measurement (SEM)

Multiple sclerosis: (Vliet et al., 2013, n = 169, mean age = 50.6 (10.9) years)

  • SEM = 0.19 points

Minimal Detectable Change (MDC)

Multiple sclerosis: (Vliet et al., 2013)

  • 0.52 points

Internal Consistency

Multiple sclerosis:

  • Excellent internal consistency (Cronbach’s alpha = 0.94*) (Vliet et al.,2013)

*Scores > 0.9 may indicate redundancy

Criterion Validity (Predictive/Concurrent)

Predictive validity:

Multiple sclerosis: (Vliet et al., 2013)

  • Good predictive validity was established through its ability to discriminate between multiple fallers and non-multiple fallers assessed during a 12-month follow-up period, suggesting that the FES-I is likely to have an acceptable sensitivity to change in people with MS.

 

n

16 item FES-I

Previous falls

 

Mean ± SD

P

< 3

85

30.0 ± 10.4

< 0.001

≥ 3

84

40.0 ± 9.6

Future falls

 

 

 

< 3

96

32.3 ± 11.4

< 0.001

≥ 2

73

38.5 ± 9.8

Construct Validity

Convergent Validity

Multiple sclerosis: (Vliet et al., 2013)

Convergent validity evidence : Relations between FES – I, previous falls, fatigue, Trail Making Test (Part B), muscle strength and balance measures

 

Previous falls

Fatigue

 

Trail Making Test (Part B)

Muscle strength

Balance measures

  1. FES - I

0.460*

0.417*

0.278*

-0.265*

0.301*

  1. Previous falls

 

0.172

0.211*

-0.144

0.190

  1. Fatigue

 

 

 

 

 

 

  1. Trail Making Test (Part B)

 

0.147

 

-0.384*

0.324*

  1. Muscle strength

 

 

-0.100

 

-.314*

  1. Balance measures

 

 

0.111

 

 

Coefficients are Spearman’s r

* Significant at p<0.01

 

Discriminant validity

Multiple sclerosis: (Vliet et al., 2013, n = 169, mean age = 50.6 (10.9) years )

  • Poor correlations between FES-I and the duration of the disease (P = 0.138) is indicative of good discriminant validity, suggesting that high FES-I scores are not merely a reflection of disease duration.

Joint Pain and Fractures

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Standard Error of Measurement (SEM)

Elderly with hip fracture: (Visschedijk et al., 2015, Group 1, n = 100, mean age = 83.1 (8.3) years, Group 2, n = 23, mean age  = 83.2 (7.2) years)

  • SEM = 6.4 points

Minimal Detectable Change (MDC)

Elderly with hip fracture: (Visschedijk et al., 2015)

  • 17.7 points

Interrater/Intrarater Reliability

Elderly with hip fracture:(Visschedijk et al., 2015)

  • Adequate inter-rater reliability (ICC = 0.72)

Internal Consistency

Elderly with hip fracture:

  • Excellent internal consistency (Cronbach’s alpha = 0.94*), 3th or 4th week after admission to SNF (Visschedijk et al., 2015)

*Scores > 0.9 may indicate redundancy

Non-Specific Patient Population

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Content Validity

  • The FES-I was developed through a series of meetings between members of the Prevention of Falls Network Europe (ProFaNE), an EC funded collaboration coordinating research into fall prevention.
  • Members examined the existing items of the FES to identify any potential difficulties they might pose either for accurate translation or for applicability to their cultural context.
  • The wording of items that posed potential problems was then revised through discussion. For example, the item ‘Reaching into cabinets or closets’ appeared ambiguous because of cross-cultural differences in the use of storage space and the terms employed to describe it; consequently, the activity this item assessed was standardised as ‘Reaching up or bending down’ (Yardley, Beyer, Hauer, Kempen, Piot-Zieglers & Todd, 2005).

Face Validity

  • Not assessed statistically, however, the authors selected additional items with cross-cultural face validity to assess more difficult and social activities based on the literature and the professional experience of members.
  • The resulting questionnaire comprised 16 items, including the 10 original items from the FES (with some rewording where necessary) and six new items assessing walking on slippery, uneven or sloping surfaces, and visiting friends or relatives, going to a social event or going to a place with crowds.
  • The authors employed the revised FES instructions and response categories that assess level of concern about falling when carrying out each activity on a four point scale (1=not at all concerned, 4=very concerned) (Yardley et al., 2005).

Bibliography

Alghadir, A. H., Al-Momani, M., Marchetti, G. F., & Whitney, S. L. (2015). “Cross-cultural adaptation and measurement properties of the Arabic version of the Fall Efficacy Scale International.” Neurosciences, 20(3), 230-235. Find it on MEDLINE EBSCOhost

Billis, E., Strimpakos, N., Kapreli, E., Sakellari, V., Skelton, D. A., Dontas, I., & ... Gioftsos, G. (2011). ”Cross-cultural validation of the Falls Efficacy Scale International (FES-I) in Greek community-dwelling older adults.” Disabil Rehabil, 33(19-20), 1776-1784. Find it on MEDLINE EBSCOhost

Delbaere, K., Close, J. T., Mikolaizak, A. S., Sachdev, P. S., Brodaty, H., & Lord, S. R. (2010). “The Falls Efficacy Scale International (FES-I). A comprehensive longitudinal validation study.” Age Ageing, 39(2), 210-216. Find it on MEDLINE EBSCOhost

Dewan, N., & MacDermid, J. C. (2014). “Fall Efficacy Scale-International (FES-I).” J Physiother, 60(1), 60. Find it on MEDLINE EBSCOhost

Gazibara, T., Stankovic, I., Tomic, A., Svetel, M., Tepavcevic, D. K., Kostic, V. S., & Pekmezovic, T. (2013). “Validation and cross-cultural adaptation of the Falls Efficacy Scale in patients with Parkinson's disease in Serbia.” Geriatr Gerontol Int, 13(4), 936-941. Find it on MEDLINE EBSCOhost

Halvarsson, A., Franzén, E., & Ståhle, A. (2013). “Assessing the relative and absolute reliability of the Falls Efficacy Scale-International questionnaire in elderly individuals with increased fall risk and the questionnaire's convergent validity in elderly women with osteoporosis.” Osteoporos Int, 24(6), 1853-1858. Find it on MEDLINE EBSCOhost

Hauer, K., Yardley, L., Beyer, N., Kempen, G., Dias, N., Campbell, M., & ... Todd, C. (2010). “Validation of the Falls Efficacy Scale and Falls Efficacy Scale International in geriatric patients with and without cognitive impairment: results of self-report and interview-based questionnaires.” Gerontol, 56(2), 190-199. Find it on MEDLINE EBSCOhost

Hauer, K. A., Kempen, G. M., Schwenk, M., Yardley, L., Beyer, N., Todd, C., & ... Zijlstra, G. R. (2011). “Validity and sensitivity to change of the falls efficacy scales international to assess fear of falling in older adults with and without cognitive impairment.” Gerontol, 57(5), 462-472. Find it on MEDLINE EBSCOhost

Kempen, G. M., Yardley, L., van Haastregt, J. M., Zijlstra, G. R., Beyer, N., Hauer, K., & Todd, C. (2008). “The Short FES-I: a shortened version of the falls efficacy scale-international to assess fear of falling.” Age Ageing, 37(1), 45-50. Find it on MEDLINE EBSCOhost

Lomas-Vega, R., Hita-Contreras, F., Mendoza, N., & Martínez-Amat, A. (2012). “Cross-cultural adaptation and validation of the Falls Efficacy Scale International in Spanish postmenopausal women.” Menopause, 19(8), 904-908. Find it on MEDLINE EBSCOhost

Morgan, M. T., Friscia, L. A., Whitney, S. L., Furman, J. M., & Sparto, P. J. (2013). “Reliability and validity of the Falls Efficacy Scale-International (FES-I) in individuals with dizziness and imbalance.” Otol Neurotol, 34(6), 1104-1108. Find it on MEDLINE EBSCOhost

van Vliet, R., Hoang, P., Lord, S., Gandevia, S., & Delbaere, K. (2013). “Falls efficacy scale-international: a cross-sectional validation in people with multiple sclerosis.” Arch Phys Med Rehabil, 94(5), 883-889. Find it on MEDLINE EBSCOhost

Visschedijk, J. M., Terwee, C. B., Caljouw, M. A., Spruit-van Eijk, M., van Balen, R., & Achterberg, W. P. (2015). “Reliability and validity of the Falls Efficacy Scale-International after hip fracture in patients aged ≥ 65 years.” Disabil Rehabil, 37(23), 2225-2232. Find it on PubMed

Yardley, L., Beyer, N., Hauer, K., Kempen, G., Piot-Ziegler, C., & Todd, C. (2005). “Development and initial validation of the Falls Efficacy Scale-International (FES-I).” Age Ageing, 34(6), 614-619. Find it on MEDLINE EBSCOhost

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