Falls Efficacy Scale (FES and FES-I)

The Falls Efficacy Scale (FES)

The FES was developed by Tinetti et al. in 1990 as an instrument to measure fear of falling in mainly community-dwelling older population. The study was based on the operational definition of fear of falling, which is “low perceived self-efficacy at avoiding falls during essential, non-hazardous activities of daily living.”

The scale can be self-administered and consists of 10 items:

1. Take a bath or shower

2. Reach into cabinets or closets

3. Walk around the house

4. Prepare meals not requiring carrying heavy or hot objects

5. Get in and out of bed

6. Answer the door or telephone

7. Get in and out of a chair

8. Getting dressed and undressed

9. Personal grooming (i.e. washing your face)

10. Getting on and off of the toilet

The subject is invited to rate each of the activities on a scale from 1 to 10, with 1 being very confident and 10 being not confident at all, with respect to confidence of performing said activities without falling.

FES results range from 0 to 100, with scores greater than 70 indicating a higher fear of falling (lowers self-efficacy and confidence) that impedes on activities of daily living.

The FES is deemed a reliable and valid measure of fear of falling, with a good test-retest reliability (Pearson’s correlation 0.71) with patients who reported avoiding activities because of fear of falling obtaining higher FES scores.

The Falls Efficacy Scale International version (FES-I)

Yardley et al. set out to develop a modified version of the FES that would measure fear of falling by assessing both easy and difficult physical activities and social activities, a scale that could be suitable for use in international cultural contexts and facile to translate.

The FES-I version was also intended to permit direct comparison between studies and populations in different countries. Yardley et al. were also set to demonstrate not only the new version’s psychometric properties and reliability but as well its concurrent validity with age, falls history and falls risk factors criteria (chronic illness, taking multiple or psychoactive medications, dizziness). The cross-sectional survey was done on a community sample of 704 subjects aged 60 to 95.

The 16 items in the FES-I scale are:

1. Cleaning the house (e.g. sweep, vacuum or dust)

2. Getting dressed or undressed

3. Preparing simple meals

4. Taking a bath or shower

5. Going to the shop

6. Getting in or out of a chair

7. Going up or down stairs

8. Walking around in the neighbourhood

9. Reaching for something above your head or on the ground

10. Going to answer the telephone before it stops ringing

11. Walking on a slippery surface (e.g. wet or icy)

12. Visiting a friend or relative

13. Walking in a place with crowds

14. Walking on an uneven surface (e.g. rocky ground, poorly maintained pavement)

15. Walking up or down a slope

16. Going out to a social event (e.g. religious service, family gathering or club meeting)

Concern about fall risk with regard to the above activities is recorded on:

■ Not at all concerned (+1)

■ Somewhat concerned (+2)

■ Fairly concerned (+3)

■ Very concerned (+4)

The FES-I results range from 16 (no concern about falling) to 64 (severe concern about falling).

The FES-I has shown excellent internal and test-retest reliability (Cronbach's alpha=0.96, ICC=0.96) The FES-I had slightly better discrimination power than the original FES items with respect to differences in concern about falling between groups differentiated by gender, age, falls in the past year, and falls risk criteria.

FES-I validation

In a subsequent validation study, Delbaer et al. established three concern groups with respective cut-off points:

Low concern: 16 - 19;

Moderate concern: 20 - 27

High concern: 28 - 64

The validation study involved a cohort of 500 community-dwelling older people aged between 70 and 90 years that were twice assessed (at baseline and at 12 months). Fall occurrence was monitored monthly and reported fear of falling, quarterly.

Visschedijk et al. assessed the psychometric properties of the FES-I in a sample of 100 patients aged 65 and above, having suffered from a hip fracture. The factor analysis yielded strong evidence that the FES-I is uni-dimensional in patients with a hip fracture; the Cronbach's alpha was 0.94. With regards to reliability, the intra-class correlation coefficient was 0.72.

Halvarsson et al. found the FES-I to have a high reliability (intra-class correlation 0.88) and internal consistency 0.94, for assessing fear of falling in elderly with increased fall risk but with a low relation to/convergent validity with balance performance and HRQL among elderly women with osteoporosis.

References

Original reference FES

Tinetti, M., D. Richman, et al. Falls efficacy as a measure of fear of falling. Journal of gerontology. 1990; 45(6): P239 

Original reference FES-I

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

Validation

Delbaere K, Close JC, Mikolaizak AS, Sachdev PS, Brodaty H, Lord SR. The Falls Efficacy Scale International (FES-I). A comprehensive longitudinal validation study. Age Ageing. 2010 Mar; 39(2):210-6.

Visschedijk JH, Terwee CB, Caljouw MA, Spruit-van Eijk M, van Balen R, Achterberg WP. Reliability and validity of the Falls Efficacy Scale-International after hip fracture in patients aged ≥ 65 years. Disabil Rehabil. 2015;37(23):2225-32.

Halvarsson A, Franzén E, Ståhle A. 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. 2013;24(6):1853-8.

Hauer K, Yardley L, Beyer N, Kempen G, Dias N, Campbell M, Becker C, Todd C. 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. Gerontology. 2010; 56(2):190-9.

Michael T. Morgan, BS, SPT, Lauren A. Friscia, BS, SPT, Susan L. Whitney, PT, PhD, Joseph M. Furman, MD, PhD, and Patrick J. Sparto, PT, PhD Reliability and Validity of the Falls Efficacy Scale-International (FES-I) in Individuals with Dizziness and Imbalance. Otol Neurotol. 2013; 34(6): 1104–1108.