Measuring the Psychological Outcomes of Falling: A Systematic Review

Abstract

The objectives were to identify fall-related psychological outcome measures and to undertake a systematic quality assessment of their key measurement properties. A Cochrane review of fall-prevention interventions in older adults was used to identify fall-related psychological measurements. PubMed, CINAHL, and PsycINFO were systematically searched to identify instruments not used in trials and papers reporting the methodological quality of relevant measures. Reference lists of articles were searched for additional literature, and researchers were contacted. Two reviewers undertook quality extraction relating to content, population, reliability, validity, responsiveness, practicality, and feasibility. Twenty-five relevant papers were identified. Twenty-three measures met the inclusion criteria: six single-item questions, Falls Efficacy Scale (FES), revised FES, modified FES, FES-UK, Activities-specific Balance and Confidence Scale (ABC), ABC-UK, Confidence in maintaining Balance Scale, Mobility Efficacy Scale, adapted FES, amended FES, Survey of Activities and Fear of Falling in the Elderly (SAFFE), University of Illinois at Chicago Fear of Falling Measure, Concern about Falling Scale, Falls Handicap Inventory, modified SAFFE, Consequences of Falling Scale, and Concern about the Consequences of Falling Scale. There is limited evidence about the measurement properties of single-item measures. Several multiitem measures obtained acceptable reliability and validity, but there is less evidence regarding responsiveness, practicality, and feasibility. Researchers should select measures based on the constructs they intend to study. Further research is needed to establish and compare the instruments' measurement properties.

A Falls Concern Scale for people with spinal cord injury (SCI-FCS)

“…9 Several questionnaires have been developed over the years, [10][11][12] but recently the Falls Efficacy Scale International (FES-I) has become the gold standard for assessing concern about falling in older people. 11 The FES-I is principally designed for ambulating elderly people, thus in its current format it is not appropriate for assessing concern about falling in people with SCI.…”

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

“…Results indicated that the ABC-scale had adequate to good reliability and validity. 28 More specifically, the internal consistency reliability (Cronbach ∝) of the ABCscale among individuals with lower-limb amputation was found to be 0.93, and the 4-week test-retest reliability (intraclass correlation coefficient) was 0.91 (95% CI, 0.84-0.95). Further, the evidence supported the scale's construct validity in the form of hypothesized relationships.…”

“…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). Results indicated that the ABC-scale had adequate to good reliability and validity.…”

“…Further, the evidence supported the scale's construct validity in the form of hypothesized relationships. 21 Despite positive psychometric evidence supporting the use of the ABC-scale, further evaluation of the scale's measurement properties is necessary, 19,28 and for several reasons this is especially true among individuals aging with a lower-limb amputation. First, the properties of the ABC-scale have only been established in a sample of individuals with a lower-limb amputation who were 20 years of age and older.…”

Fear of falling and self-perception of health in older participants and non-participants of physical activity programs

“…Consequences of physical inactivity include social isolation, limitations in functional activities, and poor quality of life (Dalbaere, Close, Brodaty, Sachdev, & Lord, 2010;Lopes, Costa, Santos, Castro, & Bastone, 2009). Fear of falling has been reported to occur in 12% to 65% of those with no history of falls, and in 29% to 92% for those with history of falls (Jorstad, Hauer, Becker, & Lamb, 2005). Unfortunately, this psychosomatic phenomenon of fear can be linked to several changes in the physical and mental health conditions in older adults, which, in turn, can lead to chronic diseases, deficits in balance and gait, muscle weakness, cognitive impairment, and anxiety and depression (Dalbaere et al, 2010;Lopes et al, 2009;Legters, 2002;Lord, Menz, & Tiedemann, 2003).…”