What is the Falls Efficacy Scale International
The Falls Efficacy Scale International (FES-I) and the Short Falls Efficacy Scale International (Short FES-I) are measures of “fear of falling” or, more properly, “concerns about falling”, which are suitable for use in research and clinical practice.
FES-I and Short FES-I have been translated from the original English into many other languages (see below). FES-I and Short FES-I are available free of charge for use by researchers and clinicians providing they are appropriately referenced.
FES-I was developed as part of the Prevention of Falls Network Europe (ProFaNE) project from 2003 to 2006, following an intensive review of fear of falling, self-efficacy and balance confidence questionnaires.
Members of the ProFaNE team led by Chris Todd, Gertrudis Kempen and Lucy Yardley, developed the 16 item FES-I, which has proven to be a useful instrument for researchers and clinicians interested in fear of falling.
The Short FES-I was then developed by the team to allow the tool to be more applicable in clinical practice and to provide a shorter version for research. Short FES-I comprises seven questions.
FES-I & Short FES-I
The FES-I and Short FES-I have been demonstrated to have good reliability and validity, and have been validated for use in older adults with cognitive impairment .
FES-I and Short FES-I are available to download below in a number of language versions along with instructions for use. Also featured are relevant publications to support the use of FES-I and Short FES-I.
How do I use FES-I or Short FES-I?
Scoring FES-I and Short FES-I
- FES-I: minimum 16 (no concern about falling) to maximum 64 (severe concern about falling)
- Short FES-I: minimum 7 (no concern about falling) to maximum 28 (severe concern about falling)
Scoring with missing items
If responses are missing on more than four items on FES-I (i.e.≥5), or more than two items (i.e.≥3) for Short-FES-I then the questionnaire scores cannot be used. If responses are missing on four or less for FES-I, or 2 or less on Short FES-I then it is possible to calculate a FES-I/Short FES-I score. To do this first calculate the total score of the items which have been completed. Divide that score by the number of items completed and then multiply by 16 (FES-I) or 7 (Short FES-I). The new total score should be rounded up to the nearest whole number to give the score for an individual. For example, if scores on Short FES-I were: Item 1=2 Item 2=3 Item 3=missing Item 4=3 Item 5=2 Item 6=4 Item 7=missing Then 2+3+3+2+4=14/5 = 2.8×7= 19.6 which is rounded up to 20.
Are there cut points for scores?
|Low concern||Moderate concern||High concern|
Translated FES-I and Short FES-I
Please see below full list of currently available translations for download and use. If you would like to contact the local translation author please click on contact name for details.
More about FES-I
How do I translate FES-I into my language?
10 step FES-I translation protocol
- The English version of the FES-I is always point of departure. Translate the full 16 item FES-I. Once these 16 items are translated the seven items that make up Short FES-I can simply be selected from this text. However, ensure that the instructions for Short FES-I are also translated as they are slightly different from FES-I instructions.
- Make use of the translator/interviewer notes for interpretations of different items.
- The English version of the FES-I will be translated from English into the local language by at least two translators independently. These translators need to be (a) native speakers of the local language, and (b) familiar with the concept fear of falling.
- A first consensus meeting of the translators is held which has to result in a provisional local version.
- Each of the translators will select two older persons for a try-out of the FES-I in written form. The questionnaire needs to be filled in by each older person separately without any disruption of the translator. Afterwards, the 16 items are discussed between the translator and the older person (Were all items clear? Is it necessary to reformulate items?).
- Each of the translators may adjust the wording of items.
- A second consensus meeting is held to create consensus about a next preliminary local version of the FES-I.
- A back translation from the local language into English is done by a professional translator whose native language is English.
- A third consensus meeting of the translators is held to review the back translation. Important for the reviewing is the intentional meaning of the back translation, not the literal meaning. The objective is a valid translation of the local version of the FES-I, not a new English one. If necessary, the professional back translator will be consulted for additional information.
- We always need to be informed about the final local version. Email firstname.lastname@example.org
For further information about translation and validation see:
- WHO guidelines on translation of instruments
- Acquadro C, Conway K, Giroudet C, Mear I. Linguistic validation manual for health outcome assessments. Lyon: Mapi Institute, 2012.
Further notes for FES-I translators and interviewers
- Item 3: In some languages, ‘simple’ meals are best translated as ‘everyday’ meals, but the intention is to refer to a meal that does not require complex preparation, rather than one that is prepared every day.
- Item 5: This item is intended to refer to shopping that is not extensive or recreational. In some languages, the best translation is ‘shopping for groceries’.
- Item 7: This item refers to any stairs, not necessarily the flight of stairs in one’s own house. (FES-I Item 7 = Short FES-I Item 4)
- Item 8: In some languages, ‘neighbourhood’ may be difficult to translate, and so ‘walking around outside’ can be used instead.
- Item 12: In some languages, it is necessary to add the term ‘acquaintances’ to friends and relatives, since this is a more common and casual category of relationship than friends (see also last comment on items 12, 13 and 16 below).
- Item 13: ‘Crowds’ can be translated as ‘many people’ if necessary (see also last comment on items 12,13 and 16 below).
- Item 14: It was found to be necessary to give examples of what is meant by uneven ground, but no examples could be found that were appropriate for all countries. Consequently, translators should choose any two examples from the following: cobblestones; poorly maintained pavement; rocky ground; unpaved surface.
- Items 12, 13, 16: These items contain a greater element of ambiguity than many of the items assessing functional capabilities, because the physical activities involved in these social events may differ greatly for different respondents. However, it was decided that this ambiguity was acceptable because it is important to assess effects of fear of falling on social activities. (FES-I Item 16 = Short FES-I Item 7)
Core FES-I and Short FES-I publications
- Jørstad EC, Hauer K, Becker C, Lamb SE on behalf of the ProFaNE group. Measuring the psychological outcomes of falling: a systematic review. Journal of the America Geriatrics Society 2004; 5: 501-510.
- Yardley L, Beyer N, Hauer K, Kempen G, Piot-Ziegler C, Todd C. Development and initial validation of the Falls Efficacy Scale-International (FES-I). Age and Ageing 2005; 34(6): 614-619.
- Dias N, Kempen GIJM, Todd CJ, Beyer N, Freiberger E, Piot-Ziegler C, Yardley L, Hauer K. The German version of the Falls Efficacy Scale – International Version (FES-I). Zeitschrift für Geriatrie und Gerontologie 2006; 39: 297-300.
- Kempen GI, Todd CJ, Van Haastregt JC, Zijlstra GA, Beyer N, Freiberger E, Hauer KA, Piot-Ziegler C, Yardley L. Cross-cultural validation of the Falls Efficacy Scale International (FES-I) in older people: results from Germany, the Netherlands and the UK were satisfactory. Disability and Rehabilitation 2007; 29(2): 155-162.
- Kempen GIJM, Yardley L, van Haastregt JCM, Zijlstra GAR, Beyer N, Hauer K, Todd C. The Short FES-I: a shortened version of the falls efficacy scale-international to assess fear of falling. Age and Ageing 2008; 37(1): 45-50.
- Hauer K, Yardley L, Beyer N, Kempen G, Dias N, Campbell M, Becker C, Todd C. Validation of the Falls Efficacy Scale and Falls Efficacy Scale International in geriatric patients with and without cognitive impairment: results of self-report and interview-based questionnaires. Gerontology 2010; 56(2): 190-199.
- Helbostad JL, Taraldsen K, Granbo R, Yardley L, Todd CJ, Sletvold O. Validation of the Falls Efficacy Scale-International in fall-prone older persons. Age and Ageing 2010: 39(2): 256-259.
- Hauer KA, Kempen GIJM, Schwenk M, Yardley L, Beyer N, Todd C, Oster P, Zijlstra GAR. Validity and sensitivity-to-change of the Falls Efficacy Scales International to assess fear of falling in older adults with and without cognitive impairment. Gerontology 2011; 57(5): 462-472
The original FES
- Tinetti ME, Mendes de Leon CF, Doucette JT, Baker DI. Fear of falling and fall-related efficacy in relationship to functioning among community-living elders. Journal of Gerontology 1994; 49(3): M140-147.
FES-I and Short FES-I citations
- Yardley L, Beyer N, Hauer K, Kempen G, Piot-Ziegler C, Todd C. Development and initial validation of the Falls Efficacy Scale International (FES-I). Age and Ageing 2005; 34: 614-619. doi:10.1093/ageing/afi196
- Kempen GIJM, Yardley L, van Haastregt JCM, Zijlstra GAR, Beyer N, Hauer K, Todd C. The Short FES-I: a shortened version of the Falls Efficacy Scale-International to assess fear of falling. Age and Ageing 2008; 37: 45-50. doi:10.1093/ageing/afm157
- Kempen GIJM, Todd CJ, van Haastregt JCM, Zijlstra GAR, Beyer N, Freiberger E, Hauer KA, Piot-Ziegler C, Yardley L. Cross-cultural validation of the Falls Efficacy Scale International (FES-I) in older people: Results from Germany, the Netherlands and the United Kingdom were satisfactory. Disability and Rehabilitation 2007; 29: 155-162. doi:10.1080/09638280600747637
- Hauer K, Yardley L, Beyer, N, Kempen G, Dias N, Campbell M, Becker C, Todd C. Validation of the Falls Efficacy Scale and Falls Efficacy Scale International in geriatric patients with and without cognitive impairment: Results of self-report and interview-based questionnaires. Gerontology 2010; 56: 190-199. doi:0.1159/000236027
- Delbaere K, Close JCT, Mikolaizak AS, Sachdev PS, Brodaty H, Lord SR. The Falls Efficacy Scale International (FES-I). A comprehensive longitudinal validation study. Age and Ageing 2010; 39: 210-216. doi:10.1093/ageing/afp225