Iconographical Falls Efficacy Scale Research Articles

Prefrontal and Motor Planning Cortical Activity during Stepping Tasks Is Related to Task Complexity but Not Concern about Falling in Older People: A fNIRS Study.

This study investigated the effect of concern about falling on neural efficiency during stepping in older people. Community-dwellers aged >65 years were categorised as having low (n = 71) and high (n = 28) concerns about falling based on the Iconographical Falls Efficacy Scale (IconFES 10-item, scores <19 and ≥19, respectively). Participants performed a choice stepping reaction time test (CSRT), an inhibitory CSRT (iCSRT), and a Stroop stepping test (SST)) on a computerised step mat. Cortical activity was recorded using functional near-infrared spectroscopy. There were no significant differences in stepping response times or cortical activity in the dorsolateral prefrontal cortex (DLPFC), supplementary motor area (SMA), and premotor cortex (PMC) between those with and without concern about falling. However, stepping response times and cortical activity in the PFC, SMA, and PMC were significantly higher in the SST compared with the CSRT in the whole sample. PMC activity was also higher in the SST compared to the iCSRT. These findings demonstrate that cortical activity is higher in cognitively demanding stepping tasks that require selective attention and inhibition in healthy older people. The lack of association between concern about falling and neural efficiency during stepping in this older sample may reflect their only moderate scores on the IconFES.

Cross-cultural adaptation and psychometric property testing of the Taiwan Chinese version of the iconographical falls efficacy scale

The Iconographical Falls Efficacy Scale (Icon-FES) uses short phrases and images to depict activities. This study culturally adapted and validated the Taiwan Chinese version of the 30- and 10-item Icon-FESs (Icon-FESs [TW]) in community-dwelling older individuals. The Icon-FES (TW) was developed using forward-backward translation. A total of 120 community-dwelling older individuals were recruited. They completed the Taiwan Chinese version of the Falls Efficacy Scale-International (FES-I [TC]), the Icon-FES (TW), the Mini-Mental State Examination, and the World Health Organization Quality of Life Questionnaire Brief Version (WHOQOL-BREF) and were assessed using the Berg Balance Scale and the Short Physical Performance Battery (SPPB). The Icon-FES (TW) was recompleted 1 week later. Confirmatory factor analysis was used to evaluate the overall structure and measurement properties. Cronbach's alpha values of 0.97 and 0.91 indicated that the 30- and 10-item Icon-FESs (TW) had high internal consistency. The 30- and 10-item Icon-FESs (TW) exhibited significantly high correlation with the FES-I (r=0.88 and 0.84, respectively). Both versions of the Icon-FES (TW) exhibited mild correlation with the physical domain of the WHOQOL-BREF. The 30- and 10-item Icon-FESs (TW) discriminated by intensity of concern and SPPB score. Their test-retest reliability was high (intraclass correlation coefficient=0.79 and 0.80 for the 30- and 10-item Icon-FESs (TW), respectively). Neither floor nor ceiling effects were observed. The Icon-FES (TW) is a reliable and valid questionnaire useful for assessing the levels of concern regarding falling among older adults in clinical practice and research.

A systematic review and meta-analysis of the measurement properties of concerns-about-falling instruments in older people and people at increased risk of falls.

The 16-item Falls Efficacy Scale International (FES-I) is widely used to assess concerns-about-falling. Variants include 7-item Short FES-I, 30-item Iconographical Falls Efficacy Scale (Icon FES) and 10-item short Icon FES. No comprehensive systematic review and meta-analysis has been conducted to synthesise evidence regarding the measurement properties of these tools. To conduct a systematic review and meta-analysis of the measurement properties of four FES-I variants. MEDLINE, Embase, CINAHL Plus, PsycINFO and Web of Science were searched systematically and articles were assessed for eligibility independently. The methodological quality of eligible studies was assessed using COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) Risk of Bias checklist. The quality of measurement properties was assessed using COSMIN criteria for good measurement properties. Where possible, meta-analysis was conducted; otherwise, narrative synthesis was performed. Overall certainty of evidence was rated using a modified Grading of Recommendations, Assessment, Development and Evaluation system approach. The review included 58 studies investigating measurement properties of the four instruments. There was high-quality evidence to support internal consistency, reliability and construct validity of all instruments. Moderate- to high-certainty evidence suggests one-factor structure of FES-I with two underlying dimensions, one-factor structure of Short FES-I and two-factor structure of Icon FES. There was high-certainty evidence to support the responsiveness of FES-I, with further research needed for the other instruments. There is evidence for excellent measurement properties of all four instruments. We recommend the use of these tools with healthy older people and people at a greater risk of falls due to conditions that might affect mobility and balance.

The Relationship Between Concerns About Falling and Daily Life Activity in Older Men and Women.

Concerns about falling (CAF) affect daily life activities in older people; however, it is unclear whether gender moderates this relationship. The authors investigated the cross-sectional relationship between CAF and objectively measured physical activity (PA) and gait quality in 503 community-dwelling older men and women. About 448 people (age = 76.2 [SD 7.9] years, 296 females) contributed sufficient data on movement intensity, activity duration (bouts of walking, sitting, and standing), number of transitions between activities (sit-to-stand and sit-to-walk), number of steps and gait quality, quantified as walking speed, and sample entropy. Associations with the Iconographical Falls Efficacy Scale were tested. The authors found no significant moderation by gender. However, women participated in less PA than men and showed a more irregular walking pattern. Higher levels of CAF led to lower PA and poorer gait quality. Our findings suggest that prevention of CAF-related PA avoidance may be particularly important for women, who are less active and at higher risk of falls.

The cross-cultural adaptation and factor analysis of the Turkish version of Iconographical Falls Efficacy Scale Long Version.

Iconographical Falls Efficacy Scale (Icon-FES) is the first visual scale for fear of falling. Unlike the others, Icon-FES, including 30 items offers a unique perspective to assess the fear of falling by providing more precise contexts. The study aimed to introduce the 30-item Icon-FES, the first visual content fear of falling scale, into Turkish and to explore its psychometric properties. First, the Turkish language validity of Icon-FES was ensured by following the forward-backward translation protocol. A total of 150 older adults independent in their daily living activities were included in the study. Falls Efficacy Scale International (FES-I) and Activities Specific Balance and Confidence Scale (ABC), which are frequently preferred in the literature for the same purpose, were used to provide the criterion validity of the scale. The exploratory factor analysis method was utilised for the construct validity of the scale. Factor analysis revealed a two-factor structure. 52.22% of the total variance was explained with single-factor analysis. In the criterion validity analysis, while there was a strong positive correlation between Icon-FES and FES-I (r=0.910, p<0.01), a strong negative correlation was found between Icon-FES and ABC (r=-0.887, p<0.01). The Cronbach Alpha value for the internal consistency of the scale was calculated as 0.965. The intraclass correlation coefficient between two measurements performed one-week interval was found to be 0.985 (p<0.001). The study showed that Icon-FES is a valid, reliable and rapid result assessment tool for community-dwelling older adults without cognitive dysfunction.

Feasibility of performance-based and self-reported outcomes in self-managed falls prevention exercise interventions for independent older adults living in the community

BackgroundLittle is known about associations between performance-based measurements and self-reported scales, nor about ceiling effects or sensitivity to change to evaluate effects in the target population for self-managed exercise interventions. This study aimed to explore the feasibility of using performance-based outcomes for gait speed, functional leg strength and balance, and self-reported outcomes of falls-efficacy and functional ability in two self-managed falls prevention exercise interventions for community dwelling older adults.MethodsIndependent living, community-dwelling older adults (n = 67) exercised with one of two self-managed falls prevention exercise programmes, a digital programme (DP) or a paper booklet (PB) in a 4-month participant preference trial. Pre- and post-assessments, by blinded assessors, included Short Physical Performance Battery (SPPB) and 30s Chair stand test (30s CST). Participants completed self-reported questionnaires: Activities-specific and Balance Confidence scale (ABC), Iconographical Falls Efficacy Scale (Icon-FES), Late-Life Function and Disability Instrument Function Component (LLFDI-FC). In addition, improvement in balance and leg strength was also self-rated at post-assessment. Participants’ mean age was 76 ± 4 years and 72% were women.ResultsCeiling effects were evident for the balance sub-component of the SPPB, and also indicated for ABC and Icon-FES in this high functioning population. In SPPB, gait speed, 30s CST, and LLFDI-FC, 21–56% of participants did not change their scores beyond the Minimal Clinically Important Difference (MCID). At pre-assessment all performance-based tests correlated significantly with the self-reported scales, however, no such significant correlations were seen with change-scores. Improvement of performance-based functional leg strength with substantial effect sizes and significant correlations with self-reported exercise time was shown. There were no differences in outcomes between the exercise programmes except that DP users reported improved change of leg strength to a higher degree than PB users.ConclusionThe LLFDI-FC and sit-to-stand tests were feasible and sensitive to change in this specific population. The balance sub-component of SPPB and self-reported measures ABC and Icon-FES indicated ceiling effects and might not be suitable as outcome measures for use in a high functioning older population. Development and evaluation of new outcome measures are needed for self-managed fall-preventive interventions with high functioning community-dwelling older adults.

Validity and Reliability of the Iconographical Falls Efficacy Scale Short Version in Community-Dwelling Older Adults in Turkey

The Iconographical Falls Efficacy Scale (Icon-FES) is the first scale that consists of visual expressions and evaluates the fear of falling. The study aims to adapt the scale to Turkish. The Icon-FES, the Falls Efficacy Scale International, and the Activities-specific Balance Confidence Scale were applied to 150 older adults. The study indicated that Icon-FES has excellent psychometric properties. Presence of chronic diseases was found to be associated factors affecting the fear of falling (P &lt; .05). The short-version Icon-FES-Turkish is a valid and reliable scale and it should be carried out on illiterate older adults.

Relationship between Depressive Symptoms and Cognitive, Psychological, and Physical Performance in Community-Dwelling Older People with Cognitive Impairment

Introduction: Dementia and depression often coexist. Understanding how concomitant comorbidities affect function can improve assessment and management strategies. We examined the relationship between cognitive, psychological, and physical function and depressive symptoms in people with cognitive impairment. Methods: Cross-sectional study using baseline data from the iFOCIS randomized controlled trial involving 309 participants with mild-moderate cognitive impairment. The association between cognitive (Addenbrooke’s Cognitive Examination-III [ACE-III], Frontal Assessment Battery), psychological (Goldberg Anxiety Scale; Iconographical Falls Efficacy Scale), and physical (Physiological Profile Assessment; Short Physical Performance Battery [SPPB]) function, and quality of life (QoL), physical activity levels and activities of daily living, and depressive symptoms (15-item Geriatric Depression Scale [GDS]) were assessed (adjusted for age, sex, education, and ACE-III as appropriate). Results: Participants with depressive symptoms (GDS ≥4) had significantly more falls in the previous year and a higher number of comorbidities than people without depressive symptoms (GDS <4). Each point increase in the GDS was associated with better memory, higher levels of anxiety and concern about falling, poorer balance, slower gait speed, and reduced QoL. The relationship between the GDS and poor balance and QoL withstood additional adjustment for comorbidity tertiles. The relationship between GDS and concern about falls withstood additional adjustment for previous falls (12 months) and SPPB scores. Conclusions: Depressive symptomatology is associated with poorer physical and psychological function and reduced QoL in people with cognitive impairment. These factors should be considered when assessing and intervening in this group. Future research could examine these relationships longitudinally to establish causality and examine intervention efficacy in this group.

Falls efficacy instruments for community-dwelling older adults: a COSMIN-based systematic review

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.

The Iconographical Falls Efficacy Scale (IconFES) in community-dwelling older people-a longitudinal validation study.

This study aimed to develop cut-points for the 30-item and 10-item Iconographical Falls Efficacy Scale (IconFES) in community-dwelling older people and evaluate the psychometric properties, including construct and predictive validity with respect to falls and reduced physical activity over 1year. Eight hundred and one participants completed the IconFES and underwent physical, psychological and cognitive measures at baseline. Physical activity was recorded at baseline and 12months using an activity monitor, and 1-year fall incidence was collected using monthly falls calendars. Using receiver-operating characteristic curves and the Youden's index for history of falls, physiological fall risk and depressive symptoms, cut-points were defined to differentiate between low and high concern about falling (30-item: <53; 10-item: <19). For the 30-item IconFES, we additionally defined cut-points for low (≤40), moderate (41-58) and high (≥59) concern about falling. Groups based on these cut-points differed significantly: low coordinated stability, executive function and amount of daily walking, and high level of disability (30-item version) and female gender (low/high 30-item version). Although there were some inconsistencies across IconFES classifications, high concern about falling predicted having had multiple falls or multiple/injurious falls, low amount of daily walking and low movement intensity at 12months. The developed IconFES cut-points were sensitive to variables associated with concern about falling and predicted fall incidence and physical activity restriction after 12months. Applying these cut-points appears useful to identify older people with high concern about falling, who are at higher risk of falls and activity curtailment.

Evaluating the psychometric properties of the iconographical falls efficacy scale (ICON-FES)

OBJECTIVE:This study aims to analyze the construct and content validity of the Iconographical Falls Efficacy Scale (Icon-FES) in order to measure the fear of falling in community-dwelling older adults.METHODS:The Icon-FES was applied to 333 older adults. An exploratory factor analysis was performed to assess internal consistency. Item response theory (IRT) and confirmatory factor analysis (CFA) were used to evaluate the consistency of the questionnaire and whether it corresponded satisfactorily to the construct “concern about falling.” Concurrent validity with the Falls Efficacy Scale-International (FES-I) and convergent validity with the Senior Fitness Test (SFT) were also assessed. Receiving operator characteristic (ROC) curves were used to determine the sensitivity and specificity.RESULTS:The structural model of the 30-item and 10-item Icon-FES showed some theoretical fragility. The final model of the new short version of the Icon-FES consisted of 13 items, yielding a theoretically satisfactory structural model. Validity analyses indicated that the 13-item Icon-FES had a moderate relationship with the SFT, a strong relationship with the FES-I, and good sensitivity and specificity for a history of falls.CONCLUSION:The 13-item Icon-FES has excellent psychometric properties for measuring fear of falling in community-dwelling older adults. It can be recommended as a screening tool for fear of falling for both research and clinical purposes.

90 Falls Efficacy Related Instruments for Community-Dwellig Older Adults – Development and Content Validity: A Cosmin-Based Systematic Review

Abstract Background Falls efficacy is a widely-studied latent construct in community-dwelling older adults. Various self-reported instruments have been used to measure falls efficacy. Empirical evidence is needed to justify the selection of a specific instrument to measure the intended construct. Objectives To summarize evidence on the development, content validity and structural validity of instruments measuring falls efficacy in community-dwelling older adults using Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist. Study Design and Setting MEDLINE, Web of Science, PsychINFO, SCOPUS, CINAHL were searched (May 2019). Records on development of instruments and studies assessing content validity or structural validity of falls efficacy related scales were included. COSMIN methodology guided the review of eligible studies and methodological quality. Evidence of content validity: relevance, comprehensiveness and comprehensibility and unidimensionality for structural validity were synthesized. A modified GRADE approach was applied to evidence synthesis. Results 35 studies on 18 instruments were included in the review. High quality evidence showed that modified Falls-Efficacy Scale (FES)–13 items (mFES-13) is relevant but not comprehensive for measuring falls efficacy. Moderate quality evidence supported the FES-10 had sufficient relevance and the mFES-14 had sufficient comprehensibility. Only the Activities-specific Balance Confidence (ABC) Scale–Simplified (ABC-15) had sufficient relevance of moderate quality evidence to measure balance confidence. Low to very low quality evidence underpinned 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)). Conclusion Content validity of the 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 the broader continuum of falls efficacy.

Cross-cultural adaptation of the Iconographical falls efficacy scale

Objective To translate the Iconographical Falls Efficacy Scale (Icon-FES)and verify its reliability and validity in community-dwelling older people. Methods After obtaining authorization, the Icon-FES was initially developed according to the guidelines for cross-cultural adaptation. Adopting a convenient sampling method, from December 2017 to March 2018, 450 older adults from 2 communities in Wuhan City were selected to fillgeneral information questionnaire, iconographical falls efficacy scale(Icon-FES)and falls efficacy scale-international (FES-I). Results The Cronbach α coefficient of Icon-FES was 0.972(the shorten Icon-FES was 0.902); split-half reliability was 0.947; retest reliability coefficient was 0.951. Based on the rotation factor component matrix and scree plot, 2 common factors were selected and the cumulative variance contribution rate was 67.33%.The Spearman rank correlation coefficient between Icon-FES and FES-I was 0.663. Conclusion Icon-FES has good reliability and validity in measuring the fear of falls in the community, especially for the elderly with low cultural level and strong activity in China. The shorten Icon-FES is also one of the quick and simple tools. Key words: Fall; Fear of falling; Falls efficacy; Cross-cultural adaptation

Association between the instrumented timed up and go test and cognitive function, fear of falling and quality of life in community dwelling people with dementia.

Objective:To explore relationships between the instrumented timed up and go test (iTUG) and the following risk factors for falls: cognitive functioning, fear of falling (FoF), and quality of life (QoL) in people with dementia.Methods:83 community-dwelling older adults with dementia (mean±sd age 78.00±7.96 years; 60.2% male) completed an interview to capture global cognition (Mini-Addenbrooke’s Cognitive Evaluation), FoF (Iconographical Falls Efficacy Scale) and QoL (ICEpopCAPability measure for Older people). Participants completed an iTUG whilst wearing an inertial sensor on their trunk. Linear accelerations and rotational velocities demarcated sub-phases of the iTUG. Relationships were explored through correlations and regression modelling.Results:Cognition was related to duration of walking sub-phases and total time to complete iTUG (r=0.25-0.28) suggesting gait speed was related to cognition. FoF was most strongly related to turning velocity (r=0.39-0.44), but also to sit-to-stand, gait sub-phases and total time to complete iTUG. Sub-phases explained 27% of the variance in FoF. There were no correlations between iTUG and QoL.Conclusions:Cognition and FoF were related to time to complete walking sub-phases but FoF was more closely related to turning velocity and standing acceleration. iTUG may offer unique insights into motor behaviour in people with dementia.

Effects of an Exergame Software for Older Adults on Fitness, Activities of Daily Living Performance, and Quality of Life.

As people become older, the biological process of aging leads to a decline in functional capabilities, which entails difficulties in the performance of daily tasks. Within the "Active and Assisted Living Joint Programme" a consortium from Spain, Germany, and Switzerland developed an interactive Exergame software for older adults to maintain their physical abilities and independence within the daily tasks. An interventional study was conducted to validate the software. For 3 months, Swiss and Spanish seniors used the system at least three times a week for minimum half an hour in their homes. The physical condition in terms of maintaining or increasing strength, balance, safety, and mobility of the seniors was assessed by using the Berg Balance Scale and the Senior Fitness Test. In addition, the effect on independence within the activities of daily living was assessed by using the Canadian Occupational Performance Measure, the Performance Quality Rating Scale, and the Iconographical Falls Efficacy Scale. We used the EQ 5D to evaluate the "quality of life." Twenty-nine participants (male; n = 14; female; n = 15) completed the study. Scores of endurance (2 minutes step test; P = 0.01, η2 = 0.3) increased significantly. Moderate effect sizes in quality of life (r = 0.3), lower body strength (η2 = 0.08), and large effect sizes in endurance (η2 = 0.3) were detected. A small effect was evaluated within the gait speed (r = 0.2), mobility in the lower body (r = 0.2), and the balance capabilities (r = 0.2). The results of this study lead us to the conclusion that physical training with activity-focused exergames that are related to the everyday tasks of older adults could help to maintain and improve the individual fitness status.

Translation and validation study of the Chinese version Iconographical Falls Efficacy Scale-Short Version (Icon-FES)

BackgroundThe 30-item Iconographical Falls Efficacy Scale (Icon-FES) is the first instrument developed to assess older people’s concern about falling using pictures. The short version of Icon-FES (10-item Icon-FES) was translated and adapted to a local Chinese version, and its psychometric properties was evaluated in Chinese older people. MethodsA forward-backward translation procedure was used, followed by an expert panel review to finalize the 10-item Chinese Icon-FES. One hundred and sixteen Hong Kong Chinese older people (65–95 years) were assessed using the 10-item Chinese Icon-FES in conjunction with the Chinese version 7-item Falls Efficacy Scale-International (FES-I (Ch)). ResultsFive of the 10 items in the Icon-FES were modified to achieve the conceptual and cultural relevance in local context. The final Chinese Icon-FES had excellent internal consistency (Cronbach’s alpha = 0.91) and test-retest reliability (intra-class correlation coefficient ICC = 0.93). High correlation was found between the Chinese Icon-FES and FES-I (Ch) (r = .75, p < .001). Construct validity was supported by its ability to discriminate between groups related to demographic and fall risk factors. ConclusionsThe Chinese Icon-FES is a valid, efficient and easy-to-use instrument for understanding of local Chinese older people’s concerns about falling in Hong Kong.

Cross-cultural adaptation and measurement properties testing of the Iconographical Falls Efficacy Scale (Icon-FES)

BackgroundThe Iconographical Falls Efficacy Scale (Icon-FES) is an innovative tool to assess concern of falling that uses pictures as visual cues to provide more complete environmental contexts. Advantages of Icon-FES over previous scales include the addition of more demanding balance-related activities, ability to assess concern about falling in highly functioning older people, and its normal distribution. ObjectiveTo perform a cross-cultural adaptation and to assess the measurement properties of the 30-item and 10-item Icon-FES in a community-dwelling Brazilian older population. MethodsThe cross-cultural adaptation followed the recommendations of international guidelines. We evaluated the measurement properties (i.e. internal consistency, test–retest reproducibility, standard error of the measurement, minimal detectable change, construct validity, ceiling/floor effect, data distribution and discriminative validity), in 100 community-dwelling people aged ≥60 years. ResultsThe 30-item and 10-item Icon-FES-Brazil showed good internal consistency (alpha and omega >0.70) and excellent intra-rater reproducibility (ICC2,1=0.96 and 0.93, respectively). According to the standard error of the measurement and minimal detectable change, the magnitude of change needed to exceed the measurement error and variability were 7.2 and 3.4 points for the 30-item and 10-item Icon-FES, respectively. We observed an excellent correlation between both versions of the Icon-FES and Falls Efficacy Scale – International (rho=0.83, p<0.001 [30-item version]; 0.76, p<0.001 [10-item version]). Icon-FES versions showed normal distribution, no floor/ceiling effects and were able to discriminate between groups relating to fall risk factors. ConclusionIcon-FES-Brazil is a semantically and linguistically appropriate tool with acceptable measurement properties to evaluate concern about falling among the community-dwelling older population.

Validation of the Iconographical Falls Efficacy Scale in Cognitively Impaired Older People

This study evaluated psychometric properties of the Iconographical Falls Efficacy Scale (Icon-FES) to measure fear of falling in cognitively impaired older people. Icon-FES uses pictures as visual cues to prompt responses. A total of 50 community-dwelling older people with moderate cognitive impairment were assessed on Icon-FES, Falls Efficacy Scale-International, and various physical and cognitive measures. Overall structure and measurement properties of Icon-FES, as evaluated with item response theory, were good. Internal consistency was high (Cronbach's alpha = 0.97). Distribution was near normal, indicating absence of floor and ceiling effects. Icon-FES construct validity was supported by its relation with Falls Efficacy Scale-International (r = .68, p < .001) and its ability to discriminate between groups relating to fall risk factors (gender, balance, falls). Scores were not affected by different levels of cognitive functioning, as assessed with the Mini-Mental State Examination and Trail Making Test. Icon-FES is the first measure of fear of falling that compensates for reduced abstract abilities by using pictures to match the verbal descriptions. This study supports its feasibility, reliability, and validity to assess fear of falling in people with moderate cognitive impairment or dementia living in the community. Compared with Falls Efficacy Scale-International, Icon-FES was better at identifying participants with higher fall risk and did not show a floor effect likely due to a greater range of physically challenging activities.

Development and Initial Validation of the Iconographical Falls Efficacy Scale

Fear of falling scales typically have a strong floor effect in active people and use short phrases to state overall context of fear-related activities. We developed the Iconographical Falls Efficacy Scale (Icon-FES), which includes more demanding activities and uses pictures to provide more complete environmental contexts. Two-hundred and fifty community-dwelling older people (70-90 years) were assessed on the Icon-FES in conjunction with the Falls Efficacy Scale International (FES-I). Overall structure and measurement properties of the 30-item Icon-FES (evaluated with item-response theory) were good. It measured a single factor with 2 dimensions assessing fear about less and more demanding daily activities. It had high internal consistency (Cronbach's alpha = 0.96) and excellent test-retest reliability. The Icon-FES distribution was considerably closer to normal compared with FES-I, indicating absence of floor and ceiling effects. Construct validity of the Icon-FES was supported by its relation with FES-I and its ability to discriminate between groups relating to demographic characteristics and fall risk factors. A shortened 10-item Icon-FES showed similar psychometric properties to the 30-item Icon-FES. The Icon-FES is an innovative way of assessing fear of falling using pictures to describe a range of activities and situations. This initial validation study showed that the Icon-FES has excellent psychometric properties and showed close continuity with the FES-I. Main advantages of the Icon-FES over the FES-I are its normal distribution and its ability to assess fear of falling in high functioning older people.