Skip to main content
SpringerLink
Log in

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

  • Original Article
  • Published:
Osteoporosis International Aims and scope Submit manuscript

Abstract

Summary

The Falls Efficacy Scale-International (FES-I) is a highly reliable questionnaire for assessing fear of falling in elderly individuals with increased fall risk and has low or no convergent validity with balance performance tests and health-related quality of life (HRQL) among elderly women with osteoporosis, which indicates that both measurements should be included as they are measuring different components.

Introduction

Fear of falling is increased in elderly individuals with osteoporosis and FES-I is a widely used questionnaire to assess fear of falling. There is limited evidence of the reliability and convergent validity in elderly with increased risk of falling and osteoporosis.

Methods

Reliability and validity study of the FES-I. Community-dwelling elderly with increased fall risk, 59 subjects, were recruited to the reliability assessment, and 81 women with osteoporosis, in the validity assessment. For the reliability assessment, two postal surveys were used. For the validity assessment, we used baseline data from an on-going study in women with osteoporosis. The FES-I was correlated to a single-item question regarding fear of falling, self-reported history of falls, balance performance tests and health-related quality of life.

Results

The FES-I had very good relative reliability (intra-class correlation 0.88) and internal consistency reliability (Cronbach’s alpha 0.94). The value for absolute reliability was a standard error of measure 2.9 (10.6 %), smallest real difference 7.9 (29 %). There was “little if any” to “low” correlation between the FES-I and the single-item question regarding fear of falling and self-reported history of falls, HRQL and balance performance tests.

Conclusion

The FES-I seems to be a highly reliable questionnaire for assessing fear of falling in elderly with increased fall risk but has low relation to/convergent validity with balance performance and HRQL among elderly women with osteoporosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Scheffer AC, Schuurmans MJ, van Dijk N, van der Hooft T, de Rooij SE (2008) Fear of falling: measurement strategy, prevalence, risk factors and consequences among older persons. Age Ageing 37:19–24

    Article  PubMed  Google Scholar 

  2. Zijlstra GA, van Haastregt JC, van Eijk JT, van Rossum E, Stalenhoef PA, Kempen GI (2007) Prevalence and correlates of fear of falling, and associated avoidance of activity in the general population of community-living older people. Age Ageing 36:304–309

    Article  PubMed  CAS  Google Scholar 

  3. Tinetti ME, Richman D, Powell L (1990) Falls efficacy as a measure of fear of falling. J Gerontol 45:P239–P243

    Article  PubMed  CAS  Google Scholar 

  4. Delbaere K, Crombez G, Vanderstraeten G, Willems T, Cambier D (2004) Fear-related avoidance of activities, falls and physical frailty. A prospective community-based cohort study. Age Ageing 33:368–373

    Article  PubMed  Google Scholar 

  5. Sinaki M, Brey RH, Hughes CA, Larson DR, Kaufman KR (2005) Balance disorder and increased risk of falls in osteoporosis and kyphosis: significance of kyphotic posture and muscle strength. Osteoporos Int 16:1004–1010

    Article  PubMed  Google Scholar 

  6. Arnold CM, Busch AJ, Schachter CL, Harrison L, Olszynski W (2005) The relationship of intrinsic fall risk factors to a recent history of falling in older women with osteoporosis. J Orthop Sports Phys Ther 35:452–460

    PubMed  Google Scholar 

  7. Kanis JA (2002) Diagnosis of osteoporosis and assessment of fracture risk. Lancet 359:1929–1936

    Article  PubMed  Google Scholar 

  8. Jorstad EC, Hauer K, Becker C, Lamb SE (2005) Measuring the psychological outcomes of falling: a systematic review. Journal of the American Geriatrics Society 53:501–510

    Article  PubMed  Google Scholar 

  9. 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 34:614–619

    Article  PubMed  Google Scholar 

  10. Kempen GI, Todd CJ, Van Haastregt JC, Zijlstra GA, Beyer N, Freiberger E, Hauer KA, Piot-Ziegler C, Yardley L (2007) Cross-cultural validation of the Falls Efficacy Scale International (FES-I) in older people: results from Germany, the Netherlands and the UK were satisfactory. Disability and Rehabilitation 29:155–162

    Article  PubMed  Google Scholar 

  11. Billis E, Strimpakos N, Kapreli E, Sakellari V, Skelton DA, Dontas I, Ioannou F, Filon G, Gioftsos G (2011) Cross-cultural validation of the Falls Efficacy Scale International (FES-I) in Greek community-dwelling older adults. Disability and Rehabilitation 33:1776–1784

    Article  PubMed  Google Scholar 

  12. Camargos FF, Dias RC, Dias JM, Freire MT (2010) Cross-cultural adaptation and evaluation of the psychometric properties of the Falls Efficacy Scale-International Among Elderly Brazilians (FES-I-BRAZIL). Rev Bras Fisioter 14:237–243

    Article  PubMed  Google Scholar 

  13. Ruggiero C, Mariani T, Gugliotta R et al (2009) Validation of the Italian version of the falls efficacy scale international (FES-I) and the short FES-I in community-dwelling older persons. Archives of Gerontology and Geriatrics 49(Suppl 1):211–219

    Article  PubMed  Google Scholar 

  14. Ulus Y, Durmus D, Akyol Y, Terzi Y, Bilgici A, Kuru O (2012) Reliability and validity of the Turkish version of the Falls Efficacy Scale International (FES-I) in community-dwelling older persons. Archives of Gerontology and Geriatrics 54:429–433

    Article  PubMed  Google Scholar 

  15. Nordell E, Andreasson M, Gall K, Thorngren KG (2009) Evaluating the Swedish version of the Falls Efficacy Scale-International (FES-I). Advances in Physiotherapy 11:81–87

    Article  Google Scholar 

  16. Europe ProFaNE (2011) Falls Efficacy Scale International (FES-I). http://www.profane.eu.org/fesi.html

  17. Lach HW, Reed AT, Arfken CL, Miller JP, Paige GD, Birge SJ, Peck WA (1991) Falls in the elderly: reliability of a classification system. Journal of the American Geriatrics Society 39:197–202

    PubMed  CAS  Google Scholar 

  18. Jarnlo GB, Nordell E (2003) Reliability of the modified figure of eight—a balance performance test for elderly women. Physiotherapy Theory and Practice 19:35–43

    Article  Google Scholar 

  19. Heitmann DK, Gossman MR, Shaddeau SA, Jackson JR (1989) Balance performance and step width in noninstitutionalized, elderly, female fallers and nonfallers. Physical therapy 69:923–931

    PubMed  CAS  Google Scholar 

  20. Frandin K, Sonn U, Svantesson U, Grimby G (1995) Functional balance tests in 76-year-olds in relation to performance, activities of daily living and platform tests. Scand J Rehabil Med 27:231–241

    PubMed  CAS  Google Scholar 

  21. Sullivan M, Karlsson J, Ware JE Jr (1995) The Swedish SF-36 Health Survey—I. Evaluation of data quality, scaling assumptions, reliability and construct validity across general populations in Sweden. Soc Sci Med 41:1349–1358

    Article  PubMed  CAS  Google Scholar 

  22. Sullivan M, Karlsson J, Ware J (1994) Hälsoenkät. Manual och Svensk Tolkningsguide [SF-36 Health Survey. Swedish manual and Interpretation guide] (In Swedish). Göteborg

  23. Weir JP (2005) Quantifying test-retest reliability using the intraclass correlation coefficient and the SEM. J Strength Cond Res 19:231–240

    PubMed  Google Scholar 

  24. Altman DG (1991) Practical statistics for medical research. Chapman & Hall, London

    Google Scholar 

  25. Cronbach LJ (1951) Coefficient alhpa and the internal structure of tests. Psycometrika 16:297–334

    Article  Google Scholar 

  26. Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1:307–310

    Article  PubMed  CAS  Google Scholar 

  27. Bland JM, Altman DG (1990) A note on the use of the intraclass correlation coefficient in the evaluation of agreement between two methods of measurement. Comput Biol Med 20:337–340

    Article  PubMed  CAS  Google Scholar 

  28. Munro BH (2001) Statistical methods for health and care research. Williams & Wilkins, Baltimore

    Google Scholar 

  29. Powell LE, Myers AM (1995) The Activities-specific Balance Confidence (ABC) Scale. J Gerontol A Biol Sci Med Sci 50A:M28–M34

    Article  PubMed  CAS  Google Scholar 

  30. Polit DF, Beck CT (2008) Nursing research: generating and assessing evidence for nursing practice. Williams & Wilkins, Philadelphia

    Google Scholar 

Download references

Acknowledgments

The authors would like to thank all the participants in the study. A special thank goes to Lisbet Broman at Karolinska Institute for guidance and help with data collection. The study was supported by grants through the Regional Agreement on Medical Training and Clinical Research between Stockholm County Council and Karolinska Institute (ALF) and from the Swedish Research Council and the Health Care Sciences Postgraduate School at Karolinska Institute.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, 23100, SE-141 83, Huddinge, Stockholm, Sweden

    A. Halvarsson, E. Franzén & A. Ståhle

  2. Department of Physical Therapy, Karolinska University Hospital, Stockholm, Sweden

    A. Halvarsson, E. Franzén & A. Ståhle

Authors
  1. A. Halvarsson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. E. Franzén
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Ståhle
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. Halvarsson.

Rights and permissions

Reprints and permissions

About this article

Cite this article

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 24, 1853–1858 (2013). https://doi.org/10.1007/s00198-012-2197-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-012-2197-1

Keywords

Search

Navigation