FES-I

Falls Efficacy Scale – International

What is the Falls Efficacy Scale International
(FES-I)?

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.

Background

FES-I

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.

Short FES-I

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 [4].

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?
The FES-I and Short-FES-I translations available on this site are free to download and use. FES-I and Short FES-I can be administered as self-completion questionnaires, or administered verbally as part of a research interview or clinical assessment. When completing the questionnaire, participants should follow the instructions at the top of the FES-I or Short FES-I document, ticking the relevant answer box for each question. It is important to stress that respondents should complete all items. We have created some notes for interviewers (and translators) as to what questions are intended to mean which should be read prior to use. Please let us know you are using FES-I or Short FES-I by emailing us at fes-i@manchester.ac.uk See section Notes for translators and interviewers.
Scoring FES-I and Short FES-I
To calculate the FES-I or Short FES-I score when all items are completed, simply add the scores for each item together to give a total that ranges as follows:

  • 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?
Delbaere and colleagues established cut-points for low, moderate and high concern about falling. We advise that you read the paper before using these cut points.

Low concern Moderate concern High concern
FES-I 16-19 20-27 28-64
Short FES-I 7-8 9-13 14-28

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.

Language FES-I Status Short FES-I Status Contact Name
Arabic Translated Translated Not available currently
Chinese (Cantonese) Simplified Characters Translated Translated Marcella Kwan
Chinese (Cantonese) Traditional Characters Translated Translated Marcella Kwan
Czech Translated Translated Zdenko Reguli
Danish Translated Translated Nina Beyer
Dutch Validated Validated Ruud Kempen
English Validated Translated Chris Todd
Filipino Translated Translated Donald Lipardo
French Translated Translated Chantal Piot Ziegler
German Validated Translated Klaus Hauer
Greek Translated Translated Vicky Billis & Ismene Dontas
Hindi Translated Not Available Chris Todd
Hungarian Translated Translated Eva Kovacs
Italian Translated Translated Antonio Cherubini
Japanese Validated Validated Naoto Kamide
Lithuanian Translated Translated Andrejus Cernovas
Malay Not Available Translated Tan Maw Pin
Maltese Translated Not Available Edwina Pia Zarb
Marathi Translated Translated Atiya Shaikh
Norwegian Translated Translated Jorunn Helbostad
Polish Translated Translated Not available currently
Portuguese – Europe Translated Translated Daniela Figueiredo
Portuguese Brazilian Translated Not Available Daniele Sirineu
Punjabi Translated Not Available Chris Todd
Spanish Translated Translated Not available currently
Swedish Validated Translated Eva Nordell
Thai Translated Translated Sasiporn Ounjaichon
Turkish Translated Not Available Yasemin Ulus
Urdu Translated Not Available Chris Todd

More about FES-I

How do I translate FES-I into my language?
If you would like to translate FES-I into your language please read the original documents on the development of FES-I [references 1-4], the 10 step translation protocol and the translator and interviewer notes below before proceeding. You MUST also first contact fes-i@manchester.ac.uk to confirm whether someone else is already doing a translation into your language. We will then register you as doing the translation as well as answer any questions you may have. One condition of doing the translation is that it is made available through this website.
10 step FES-I translation protocol
10 step FES-I translation protocol prepared by researchers participating in ProFaNE Workpackage 4 2005. The following 10 steps need to be used for the translation of the FES-I into a local language:

  1. 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.
  2. Make use of the translator/interviewer notes for interpretations of different items.
  3. 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.
  4. A first consensus meeting of the translators is held which has to result in a provisional local version.
  5. 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?).
  6. Each of the translators may adjust the wording of items.
  7. A second consensus meeting is held to create consensus about a next preliminary local version of the FES-I.
  8. A back translation from the local language into English is done by a professional translator whose native language is English.
  9. 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.
  10. We always need to be informed about the final local version. Email fes-i@manchester.ac.uk

For further information about translation and validation see:

Further notes for FES-I translators and interviewers
It became clear during the process of translation from English to other European languages that there was no wording of the questionnaire that would translate easily into every European language using exactly the same words and phrases. Consequently, these notes are intended to assist translators of the FES-I to express the same meaning of items, even if they cannot use quite the same words in their language. They may also assist interviewers who are asked for clarification of the meaning of items when the FES-I is administered by interview.
Instructions
Participants should answer items thinking about how they usually do the activity. For example, if they usually walk with an aid they should answer items about walking to show how concerned they would be about falling when using that aid. Some translators may find it helpful to clarify in the instructions (after the sentence on circling an opinion) “The opinions you can choose from are: 1 = not at all concerned 2 = somewhat concerned 3 = fairly concerned 4 = very concerned”. In some languages it is better to translate the word ‘opinion’ as ‘statement’.
Response categories
The word ‘concerned’ expresses a cognitive or rational disquiet about the possibility of falling, but does not express the emotional distress that would be expressed by terms such as ‘worried’, ‘anxious’ or ‘fearful’. It is important to use a similar unemotional term, as respondents may be less willing to admit to emotions, which might be viewed as signs of weakness.
FES-I items
  • 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

The original FES

FES-I and Short FES-I citations
Please find below links to citations for the original FES-I and Short FES-I publications. 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. 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. In addition to the original publications, there are many hundreds of papers reporting on or using the FES-I and Short FES-I in different populations.  We suggest you also search for publications within your local countries and languages. You may also want to get in touch with the local contact listed by the translated versions, as they may be able to inform you of papers and reviews within your local countries.
References
  1. 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
  2. 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
  3. 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
  4. 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
  5. 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
Key Action 6.4:
Ageing Population and Disabilities
EC contract QLK6-CT-2002-02705