| Empowering individuals to prevent falls better |
About
The Multi-dimensional Falls Efficacy Scale (MdFES) was conceptualised given the need to understand individuals’ perceived ability to prevent and manage falls across four scenarios, including pre-fall, near-fall, fall-landing, and completed fall.
| Scenario | Movement State | Fall-related self-efficacy | Definition |
| Pre-fall | Steady phase | Balance confidence | The perceived self-efficacy to perform various activities without losing balance or falling. |
| Near-fall | Disequilibrium phase | Balance recovery confidence | The perceived self-efficacy to stop a fall upon losing balance from various perturbations, e.g., a slip, a trip or volitional movements. |
| Fall-landing | Descending phase | Safe-falling confidence | The perceived self-efficacy to protect oneself upon falling to the ground. |
| Completed fall | Recovery phase | Post-fall recovery confidence | The perceived self-efficacy to stop a fall upon losing balance is caused by various perturbations, e.g., a slip, a trip or volitional movements. |
There are two known falls efficacy related scales, the Perceived Ability to Manage Fall Scale by Lawrence et al (1998), and the Perceived Ability to Prevent and Manage Fall Risks Scale by Yoshikawa and Smith (2019), that measure falls efficacy as a multidimensional construct. However, these two scales lack the measurement of balance recovery confidence. Recognising the need of having a scale to measure the four forms of falls-related self-efficacy, the MdFES was then constructed. Further studies are needed to give greater insights of the MdFES’s psychometric properties. 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 Multidimensional Falls Efficacy Scale’s development
Several steps were taken to develop the Balance Recovery Confidence scale, ensuring rigour and quality.
Step 1: Constructing the items
Eighteen measurement instruments that were developed to measure falls efficacy were identified from a systematic review conducted using a COSMIN method (link). Items of each measurement instrument were reviewed and discussed by the study team to generate one item for each fall-related self-efficacy (balance confidence, balance recovery confidence, safe-falling confidence, and post-fall recovery confidence), constructing a total of four items. The rationale for constructing one item for each fall-related self-efficacy was to ensure that the scale could be easily administered in busy clinical settings.
Theoretical background
The concept of fall efficacy being a multidimensional construct is underpinned by the self-efficacy theory and the need to build one’s confidence to prevent and manage falls. Bandura’s self-efficacy theory refers to individuals’ perception of their capabilities to act in specific falls-related situations. In this context, the perceived capabilities to prevent a fall include the ability to perform activities steadily and to arrest a fall upon losing balance. The perceived capabilities to manage a fall include the ability to protect oneself upon falling and to be able to get up from the ground.
Published papers:
1. Falls efficacy: Extending the understanding of self-efficacy in older adults towards managing falls – Soh et al., 2021, JFSF.
2. Falls efficacy: The self-efficacy concept for falls prevention and management – Soh S., 2022, Front. Psychol.
3. About Falls Efficacy: A commentary on “World guidelines for falls prevention and management for older adults: a global initiative” – Soh et al., 2024, JFSF.
Step 2: Content validation
A team of medical doctors, physiotherapists, occupational therapists, nurses, and community-dwelling older adults evaluated the content of the constructed scale using the Rand Appropriateness Scale. Content validity (relevance, comprehensiveness, comprehensibility) and face validity were achieved.
Step 3: Rasch analysis
The MdFES was administered to 179 older adults in Singapore. The MdFES demonstrated strong psychometric properties, aligning well with the Rasch model.
Some key highlights include:
For Reliability:
Person reliability: 0.78 (acceptable internal consistency)
Item reliability: 0.98 (high consistency of items)
Person separation index: 1.98
Item separation index: 6.96
For Item Fit and Validity
Infit Mean Square (MNSQ) range: 0.79 – 1.34 (acceptable)
Outfit MNSQ range: 0.71 – 1.24 (acceptable)
Point-measure correlations (PTMEA Corr) were positive for all items, indicating that all items aligned with the overall construct.
Z-standardized scores (ZSTD) revealed misfit for:
Item 3 (“How confident are you to protect yourself if you fall?”) → Overfit (ZSTD = -2.65), meaning responses were too predictable.
Item 1 (“How confident are you to walk steadily?”) → Slight misfit (ZSTD = 2.42), suggesting inconsistency in response patterns.
Step 4: Construct validity
The Multi-FES demonstrated good construct validity when compared to self-reported falls efficacy measures:
Balance Recovery Confidence (BRC) Scale: Moderate positive correlation (r = 0.665)
Activities-specific Balance Confidence (ABC) Scale: Moderate positive correlation (r = 0.506)
Falls Efficacy Scale-International (FES-I): Moderate negative correlation (r = -0.461)
The Multi-FES had lower correlations with objective physical performance measures, indicating that perceived confidence does not always align with actual physical capability:
Mini-BESTest (MBT): Moderately weak positive correlation (r = 0.325)
30s Chair Stand Test (CST): Moderately weak positive correlation (r = 0.21)
Hand Grip Strength (HGS): Moderately weak positive correlation (r = 0.229)
The lower correlation coefficients with PBOMs suggest that the Multi-FES primarily assesses self-perceived confidence in fall prevention and management, rather than physical ability.
At Item-Level Analysis
Each item independently captures only a portion of falls efficacy, but when combined, they provide a more holistic measure.