The purpose of this study was to develop a multidimensional falls efficacy scale to be used in practice. The psychometric properties (dimensionality, internal structure, reliability, and construct validity) of the scale were examined using the Classical Test Theory and Rasch Measurement Theory.
The content of the scale was developed through a literature review. It was validated with 11 experts (seven medical and healthcare professionals and four community-dwelling adults aged 65 years and older) using the e-Delphi technique. The constructed scale, the “Multidimensional Falls Efficacy Scale (MdFES)”, was then field-tested with 179 older adults in Singapore. A subgroup of 119 completed four self-reported instruments (Balance Recovery Confidence scale, Activities-specific Balance Confidence scale, short Falls Efficacy Scale-International, and MdFES scale) and three performance-based measures (Handgrip strength dynamometer, 30-second Chair Stand and Mini BESTest). Descriptive and inferential statistics were applied.
The MdFES showed good face validity and content validity based on experts’ consensus. The inter-item correlation ranged between 0.46 and 0.66, indicating that items in the scale were not identical based on their moderate correlation. Factor analysis showed that the first factor explained 68.7%. The second and the last two factors had 14.6% and 16.7% explained variances. The scale’s internal consistency was good (α = .85), with moderate test-retest reliability (ICC3,k=0.65). No flooring or ceiling effects were observed. The four items in the MdFES were well-fitted (Infit Z SD = -0.5; Outfit Z SD = -0.5). The item difficulty estimates ranged between -1.5 and .74, demonstrating its ability to distinguish individuals with high and low confidence to prevent and manage falls. The scale’s construct validity was supported by its relationships with other measures.
MdFES is a novel measurement instrument that assesses individuals’ perceived ability to prevent and manage falls. The scale examines falls efficacy as a multidimensional construct that incorporates balance confidence, balance recovery confidence, safe-falling confidence, and post-fall recovery confidence. The evidence of its psychometric properties encourages clinicians to use the MdFES in clinical practice. Further work will investigate the other psychometric properties of the MdFES and its use on clinical populations.
The MdFES is easy to administer and takes approximately two minutes to complete. The MdFES broadens the conceptual understanding of falls efficacy. It can play an important role towards helping clinicians identify suitable strategies to empower individuals against the threat of falls. Clinicians can use the MdFS as a valuable tool to gain insights into individuals' beliefs about their abilities to deal with falls alongside commonly used performance-based measures.
fear of falling
psychometric properties
