Abstract
BackgroundFalls efficacy is a widely-studied latent construct in community-dwelling older adults. Various self-reported instruments have been used to measure falls efficacy. In order to be informed of the choice of the best measurement instrument for a specific purpose, empirical evidence of the development and measurement properties of falls efficacy related instruments is needed.MethodsThe Consensus-based Standards for the Selection of Health Measurement Intruments (COSMIN) checklist was used to summarise evidence on the development, content validity, and structural validity of instruments measuring falls efficacy in community-dwelling older adults. Databases including MEDLINE, Web of Science, PsychINFO, SCOPUS, CINAHL were searched (May 2019). Records on the development of instruments and studies assessing content validity or structural validity of falls efficacy related scales were included. COSMIN methodology was used to guide the review of eligible studies and in the assessment of their methodological quality. Evidence of content validity: relevance, comprehensiveness and comprehensibility and unidimensionality for structural validity were synthesised. A modified GRADE approach was applied to evidence synthesis.ResultsThirty-five studies, of which 18 instruments had been identified, were included in the review. High-quality evidence showed that the Modified Falls Efficacy Scale (FES)-13 items (MFES-13) has sufficient relevance, yet insufficient comprehensiveness for measuring falls efficacy. Moderate quality evidence supported that the FES-10 has sufficient relevance, and MFES-14 has sufficient comprehensibility. Activities-specific Balance Confidence (ABC) Scale–Simplified (ABC-15) has sufficient relevance in measuring balance confidence supported by moderate-quality evidence. Low to very low-quality evidence underpinned the content validity of other instruments. High-quality evidence supported sufficient unidimensionality for eight instruments (FES-10, MFES-14, ABC-6, ABC-15, ABC-16, Iconographical FES (Icon-FES), FES–International (FES-I) and Perceived Ability to Prevent and Manage Fall Risks (PAPMFR)).ConclusionContent validity of instruments to measure falls efficacy is understudied. Structural validity is sufficient for a number of widely-used instruments. Measuring balance confidence is a subset of falls efficacy. Further work is needed to investigate a broader construct for falls efficacy.
Highlights
Falls efficacy is a widely-studied latent construct in community-dwelling older adults
The purpose of this paper is to systematically review content and structural validity of falls efficacy-related scales for communitydwelling older adults, using COSMIN guidelines
Seventy-one records were excluded: 44 did not include constructs relating to falls-related self-efficacy or balance confidence, 11 assessed other measurement properties, six did not assess measurement properties, two were conducted on different populations, two were abstracts, one was a thesis, one was in citation and four were written in other languages (i.e. Persian, German, Dutch)
Summary
Falls efficacy is a widely-studied latent construct in community-dwelling older adults. Various selfreported instruments have been used to measure falls efficacy. Falls efficacy can be better addressed among older adults to maximise their independence, promote maintenance of an active lifestyle and counter burdensome associations [4]. Falls efficacy as a latent construct in community-dwelling older adults has been widely studied in research and clinical practice [5]. Over the last three decades, falls efficacy has been studied alongside other falls-related psychological constructs, i.e. fear of falling and balance confidence [8]. Selecting appropriate instruments to measure falls efficacy is obscured by operational heterogeneity amongst relevant psychological constructs such as fear of falling and balance confidence [8]. High-quality psychometric evidence should underpin the selection of specific instruments
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