MULTIDIMENSIONAL FALLS EFFICACY
Multidimensional Falls Efficacy Scale
The Multidimensional Falls Efficacy Scale (MdFES) is a brief four-item measure of confidence in preventing and managing falls across different fall-related situations.
Rather than focusing on only one aspect of falls efficacy, the MdFES considers perceived capability before, during and after a potential fall.
THE CONSTRUCT
What Is Multidimensional Falls Efficacy?
Falls efficacy refers to perceived capability to prevent and manage fall-related situations. The MdFES extends assessment beyond confidence in maintaining balance by considering confidence across four different stages of a fall-related event.
Each MdFES item therefore represents a specific falls-efficacy domain, allowing clinicians and researchers to examine where an individual’s confidence may be relatively stronger or weaker.
PRE-FALL
Balance confidence
Perceived capability to maintain stability during movement.
NEAR-FALL
Balance recovery confidence
Perceived capability to regain stability following a perturbation or loss of balance.
FALL-LANDING
Safe-landing confidence
Perceived capability to protect oneself during an unavoidable fall.
COMPLETED FALL
Post-fall recovery confidence
Perceived capability to recover after reaching the ground.
ABOUT THE SCALE
A Brief Four-item Measure
The MdFES was designed to provide a concise assessment of the principal domains of falls efficacy while remaining practical for clinical and research use.
Items
One item represents each falls-efficacy domain.
Response scale
Responses range from no confidence to complete confidence.
Total score
The four item scores may be summed to provide an overall falls-efficacy score.
Initial validation
Initial psychometric evaluation was undertaken in community-dwelling older adults.
SCORING & INTERPRETATION
Interpret the Profile, Not Only the Total
Each item represents a distinct and clinically meaningful domain. Item-level scores can therefore help identify specific areas of lower confidence that may be obscured by a single overall score.
DOMAIN LEVEL
Individual items
Review each of the four items separately to understand the person’s confidence profile across the falls-efficacy continuum.
FALL PREVENTION
Items 1 + 2
Combined interpretation of balance confidence and balance recovery confidence reflects perceived capability to prevent a fall.
Score range: 0–8FALL MANAGEMENT
Items 3 + 4
Combined interpretation of safe-landing and post-fall recovery confidence reflects perceived capability to manage a fall.
Score range: 0–8OVERALL FALLS EFFICACY
Total MdFES score
Sum all four item scores. The total score ranges from 0 to 16, with higher scores representing greater overall confidence in preventing and managing falls.
Use the total score with the domain profile
Two people can have the same total MdFES score while showing different patterns of confidence. For example, one may report relatively lower confidence in preventing a fall, while another may be less confident about managing a fall once it occurs.
DEVELOPMENT
Development and Initial Validation
MdFES development combined conceptual work, review of existing falls-efficacy measures, content evaluation and psychometric testing.
Construct development
Existing falls-efficacy measures and the four-domain conceptual framework informed development of a concise item set.
Content evaluation
Healthcare professionals and older adults evaluated the relevance, clarity and appropriateness of the proposed content.
Psychometric evaluation
Initial validation was conducted in 179 older adults and examined dimensionality, internal consistency, construct validity and discriminative ability.
MEASUREMENT EVIDENCE
Initial Psychometric Properties
The initial validation study provides evidence supporting the MdFES as a brief multidimensional measure, while further evaluation in other populations and settings remains important.
Two-factor structure
Exploratory factor analysis identified a two-factor structure broadly representing fall prevention and fall management.
Internal consistency
Cronbach’s alpha in the initial validation sample.
BRC relationship
Positive association with balance recovery confidence.
ABC relationship
Positive association with activities-specific balance confidence.
Short FES-I relationship
Greater MdFES confidence was associated with lower concern about falling.
Initial sample
Psychometric testing was undertaken in community-dwelling older adults.
CLINICAL INTERPRETATION
Exploratory Thresholds
Receiver operating characteristic analyses in the initial validation sample explored the ability of MdFES scores to distinguish selected fall-related characteristics.
FALL HISTORY
≤13Exploratory threshold for distinguishing participants with a history of falls.
HIGH CONCERN ABOUT FALLING
≤13Exploratory threshold associated with higher concern about falling in the study sample.
POOR BALANCE PERFORMANCE
≤9Exploratory threshold associated with poorer balance performance in the study sample.
These are not universal diagnostic cut-offs
These thresholds were derived from a single initial validation sample and should be interpreted in the context of the population, assessment purpose and accompanying clinical information. They should not replace item-level interpretation or objective assessment of physical function and fall risk.
FROM RESEARCH TO PRACTICE
Implementation in Clinical Practice
A subsequent pilot study examined how the MdFES could be incorporated into routine assessment within a Singapore community hospital.
Early implementation evidence
The study involved patients and nursing staff and examined acceptability, appropriateness, feasibility and fidelity. Patients generally reported favourable experiences, while nursing feedback identified practical issues including language, comprehension and workflow integration.
These findings should be interpreted as implementation and feasibility evidence rather than evidence that use of the MdFES improves clinical outcomes.
GLOBAL COLLABORATION
Translations and Cross-cultural Adaptation
The original English MdFES has been validated. Translation and cross-cultural adaptation projects are underway in multiple languages.
English
Original four-item MdFES.
Download English MdFES →View translation projects in progress
澤龍一 Bahasa Indonesia
Susiana Nugraha Thai
Sirinun Boripuntakul Malay
Devinder Kaur Ajit Singh Chinese (Singapore)
Shawn Soh, Tang Jun Cheng, Bernice Lim Hindi
Shefali Walia, Garima Wadhwa Estonian
Gleb Slyusarchuk Russian
Gleb Slyusarchuk French
Matthieu Gallou-Guyot Turkish
Yasemin Apaydin Filipino
Donald Lipardo
TRANSLATION COLLABORATION
Interested in translating or validating the MdFES?
Please contact the MdFES team before commencing a new translation so that existing projects can be identified and translation work coordinated.
ACCESS
Access the MdFES
The MdFES is available for use by researchers and clinicians with appropriate acknowledgement of the instrument and its development.
MEASUREMENT INSTRUMENT
Download MdFES
Access the English four-item scale and scoring guidance.
Download ScalePRIMARY PUBLICATION
Development & Validation
Read the peer-reviewed report describing development and initial psychometric evaluation.
View PublicationMEASUREMENT LIBRARY
Compare Measures
Review MdFES alongside other falls-efficacy and related measurement instruments.
Measure ListCITATION
How to Cite the MdFES
Soh, S. L. H., Koh, H. F. S., Ng, D. H. Y., Ong, J. R. C., Ong, Y. L., Lim, X. Y., Khizar, M. I. S. B. M., Ho, J. Y., Ting, H. X. T., Yang, W. S., & Tan, C. Y. F. (2025). Development and Initial Validation of a Brief Multidimensional Falls Efficacy Scale. Journal of Frailty, Sarcopenia and Falls, 10(4), 241–251.
View publication →USE & ACKNOWLEDGEMENT
Copyright and Use
The Multidimensional Falls Efficacy Scale is developed and copyrighted by Dr Shawn Soh Leng Hsien, Singapore Institute of Technology.
Researchers and clinicians using the MdFES should appropriately reference the scale and its development. Translation or adaptation projects should be coordinated with the MdFES team.
Advance Multidimensional Falls Efficacy Research
We welcome collaboration involving clinical application, translation, cross-cultural validation and further evaluation of the MdFES.