Falls and confidence related quality of life outcome measures in an older British cohort

Abstract

Falls are common in older subjects and result in loss of confidence and independence. The Falls EYcacy Scale (FES) and the Activities-specific Balance Confidence scale (ABC) were developed in North America to quantify these entities, but contain idiom unfamiliar to an older British population. Neither has been validated in the UK. The FES and the ABC were modified for use within British culture and the internal consistency and test-retest reliability of the modified scales (FES-UK and ABC-UK) assessed. A total of 193 consecutive, ambulant, new, and return patients (n=119; 62%) and their friends and relatives ("visitors", n=74; 38%) were tested on both scales, while the last 60 subjects were retested within one week. Internal reliability was excellent for both scales (Cronbach's alpha 0.97 (FES-UK), and 0.98 (ABC-UK)). Test-retest reliability was good for both scales, though superior for the ABC-UK (intraclass correlation coeYcient 0.58 (FES-UK), 0.89 (ABC-UK)). There was evidence to suggest that the ABC-UK was better than the FES-UK at distinguishing between older patients and younger patients (|t ABC | = 4.4; |t FES | = 2.3); and between fallers and nonfallers (|t ABC | = 8.7; |t FES | = 5.0) where the t statistics are based on the comparison of two independent samples. The ABC-UK and FES-UK are both reliable and valid measures for the assessment of falls and balance related confidence in older adults. However, better test-retest reliability and more robust diVerentiation of subgroups in whom falls related quality of life would be expected to be diVerent make the ABC-UK the current instrument of choice in assessing this entity in older British subjects.

Risk factors for recurrent falls among Brazilian women and men: the Brazilian Osteoporosis Study (BRAZOS)

“…More than 60% of elderly individuals who have fallen develop a fear of falling and nearly 30% report functional limitations in the performance of instrumental activities of daily living and recreation. Furthermore, such individuals exhibit a loss of confidence, a greater degree of dependence 17 and 80% avoid performing activities in which there is a risk of falling 18 . The fear of falling is related to several psychological, social and physical conditions, especially isolation, cognitive impairment, reduced mobility and impairment in quality of life 19 .…”

Validity and Reliability of the Swedish Version of the Activities-specific Balance Confidence Scale in People with Chronic Stroke

“…The ABC scale was first tested in older people, 12,13 and several studies have shown good psychometric properties for this group. 7,8,10,14 Both Botner and colleagues 15 and Salbach and colleagues 9 found the ABC scale to have acceptable measurement properties for people with stroke. Salbach and colleagues used the ABC scale with people living in the community in the first year after stroke and found high internal consistency (a ¼ 0.94) and moderate associations with the TUG, 6-Minute Walk Test (6MWT), and walking speed.…”

“…7 Validated translations include Chinese, 8 French, 9 and British English. 10 A Swedish translation of the ABC scale was validated for persons in the acute and sub-acute phase of stroke 11 in a study that found moderate associations between the ABC scale and the timed up-andgo (TUG) test, the 10-metre timed walk (10TW), and the modified Rivermead Mobility Index (mRMI). 11 Measures of self-rated balance confidence in performing indoor and outdoor tasks provide valuable information for clinicians involved in planning individual rehabilitation efforts.…”

Rasch Analyses of the Activities-specific Balance Confidence Scale With Individuals 50 Years and Older With Lower-Limb Amputations

“…The ABC-scale has been used with various populations and has psychometric evidence supporting its use with older adults, 20 individuals with lower-limb amputations, 21 and stroke. 22 Several adaptations of the scale also exist, including a six item version, 23 two versions utilizing shortened response formats, 24,25 and several international versions (United Kingdom, 26 French Canadian, 22 Icelandic, 24 and Chinese 27 ). In a review of the psychological outcomes of falling, 28 9 studies published between 1966 and 2003 were identified that assessed the measurement properties of the original ABC-scale using methods based on classical test theory (CTT).…”