Empowering individuals to prevent falls better

About

The world’s first Balance Recovery Confidence (BRC) scale was developed by Dr Soh Leng Hsien (Shawn) during his PhD studies at Queen Margaret University, UK under the tutelage of Dr Judith Lane, Dr Chee-Wee Tan, and Professor Nigel Gleeson. The BRC scale distinguishes itself from the other falls efficacy-type scales, such as the Falls Efficacy Scale (Tinetti, 1990) and the Activities-specific Balance Confidence Scale (Powell and Myers, 1995), and other fear of falling measures, such as the Falls Efficacy Scale-International (Yardey et al., 2005) and the Survey of Activities and Fear of Falling in the Elderly (SAFE) (Lachman et al., 1998).

The content of the BRC scale was constructed and validated by an international panel of 28 medical and healthcare professionals (including geriatricians, physiotherapists, occupational therapists, nurses, podiatrists, falls researchers) and 209 adults aged 65 and older. Most of them were from Singapore, but medical and healthcare professionals included those from the UK, US, Malaysia, Australia, and Hong Kong. Research investigating the BRC scale’s psychometric properties is still ongoing.

If you are keen to be part of the team, please write to Dr Shawn Soh at his email address: shawn.soh@singaporetech.edu.sg

Summary of the Balance Recovery Confidence scale’s development

There were several steps taken to develop the Balance Recovery Confidence scale, ensuring rigour and quality.

Step 1: Systematic review (Click to see the published paper)

Eighteen measurement instruments that were developed to measure falls efficacy were identified. There were no measurement instruments designed to measure perceived reactive balance recovery to arrest falls.

Step 2: Feasibility of the concept (Click to see the published paper)

Near-falls are common among community-dwelling older adults. This finding suggests the need for studying balance recovery abilities. Older adults were able to relate to near-falls and balance recovery manoeuvres concepts. They were able to express their balance recovery confidence in various potential fall scenarios.

Step 3: Item generation (Click to see the published paper)

Various stakeholders, including older adults and clinicians, have their perspectives on how the items for the Balance Recovery Confidence scale should be constructed. Common themes, including ‘relevance to the target population’, ‘comprehensibility’ and ‘cultural and contextual sensitivity’, were found in both groups. Unique themes emerged, such as ‘agency of older people in preventing falls’ from the community-dwelling older adults and ‘clinical specificity’ from an international panel of medical and healthcare professionals.

Theoretical background

The concept of balance recovery confidence is underpinned by the self-efficacy theory and the balance control model.

The self-efficacy theory relates to an individual’s perception of their capabilities to act in specific falls-related situations. In this context, the perceived capability to arrest a fall in response to loss of balance scenarios, such as a slip, a trip, or from volitional movements. Falls efficacy refers to a person’s confidence to manage the threat of a fall (Payette et al., 2016). It is a resilience factor that could influence the fear experienced in the face of a threat, such as a fall. Bandura (1977) described four sources of information that can shape personal efficacy: Performance accomplishments or enactive mastery, vicarious experience, social or verbal persuasion, and emotional and physiological states. These sources are influential in developing self-efficacy.

Balance control has two key components: postural control and equilibrium control (Huxham et al., 2001). Postural control involves the reaction of a stationary body to gravity by the active alignment of the trunk and head, adjustment of the body with the support surfaces and interpretation of the environment based on the visual system. In contrast, equilibrium control relates to the coordination of movement strategies to restore the centre of body mass during self-initiated or externally triggered stability disturbances. To determine self-efficacy in postural control and equilibrium control (specifically, performing activities steadily), many clinicians focus on measuring balance confidence (i.e., balance self-efficacy). Balance confidence, which relates to performing activities without losing balance, is an essential psychological construct clinicians consider for rehabilitation success. Measurement instruments commonly used include the Activities-specific Balance Confidence scale and the CONFbal scale of balance confidence to obtain a measure of balance confidence. However, no measurement instruments assess balance recovery confidence (specifically, the ability to arrest a fall using change-in-support strategies in response to a loss of balance).

Conceptual model

Step 4: Content validity and face validity (Click to see the published paper)

The content validity and face validity of the Balance Recovery Confidence (BRC) scale were assessed with an international panel of medical and healthcare professionals and a group of community-dwelling older adults. The BRC scale has high content validity and face validation.