Falls Efficacy Scale International (7 & 16-items)

Abstract

The Falls Efficacy Scale International (FES-I) is a widely recognized self-report questionnaire designed to measure the level of concern or fear of falling an individual experiences while performing various daily and social activities. Developed initially to assess confidence in avoiding falls, the FES-I provides a standardized method for quantifying fall-related anxiety in clinical and research settings. The instrument is available in two primary formats: a comprehensive 16-item version and a shorter, efficient 7-item version. A high cumulative score on either version indicates a greater level of fall-related anxiety and lower self-efficacy.

Keywords

Falls Efficacy Scale International, FES-I, Fear of falling, Fall prevention, Activities of Daily Living, Mobility, Geriatrics, Older Adults.

Authors

Tinetti ME, Richmann D, Powell L (1990), Kempen GIJM, et al. (2007) (Dutch version).

Purpose

The primary purpose of the FES-I is to provide a standardized, cross-culturally validated measure of an individual’s confidence in their ability to maintain balance and avoid falls while engaging in essential life activities. It moves beyond simple fall history to capture the psychological impact of fall risk—specifically, the debilitating effect of the fear of falling.

The scale aims to identify individuals who may restrict their participation in activities due to this fear, even if they have not recently experienced a fall. This identification is crucial for developing targeted interventions, such as physiotherapy or cognitive-behavioral therapy, aimed at improving mobility and quality of life, particularly among older adults.

Construct

The FES-I measures the construct of fall-related self-efficacy, which is defined as the belief in one’s capability to successfully execute necessary actions to prevent a fall. It specifically assesses the emotional and cognitive dimension of fall risk—the concern about falling—across a spectrum of Activities of Daily Living (ADL) and more demanding social and physical tasks.

The scale items cover activities ranging from simple indoor tasks (e.g., walking around the house) to complex outdoor activities (e.g., walking on slippery surfaces or using public transport). By focusing on the degree of concern (rated on a 4-point Likert scale), the FES-I effectively captures the extent to which psychological factors influence functional decline and mobility restriction.

Validity

The FES-I demonstrates strong evidence of construct validity, showing significant correlations with measures of balance, functional mobility, and self-reported activity restriction. It consistently differentiates between individuals with and without a history of falls, and those with high versus low self-reported physical function.

Furthermore, studies investigating its structural properties confirm its alignment with theoretical frameworks of fear and self-efficacy. The scale exhibits high cross-cultural validity, having been successfully translated and validated in numerous languages, confirming its applicability across diverse international populations.

Reliability

Excellent internal consistency has been reported for both the 16-item and 7-item versions of the FES-I, typically yielding Cronbach’s alpha coefficients well above the acceptable threshold of 0.80. This indicates that the items reliably measure the same underlying construct.

Test-retest reliability is also high, suggesting stability of measurement over short time intervals, making the FES-I suitable for tracking changes in fall concern over the course of rehabilitation or intervention programs. These robust psychometric properties ensure its utility as a reliable clinical and research tool.

Factor Analysis

Exploratory and confirmatory factor analyses of the 16-item FES-I generally support a two-factor structure, although it is often used as a unidimensional scale yielding one total score. These two factors typically separate into: 1) basic ADL and household mobility items, and 2) more challenging physical and social activities, which require greater confidence.

The development of the short 7-item version (FES-I Short Form) was based on factor analysis, selecting items that loaded highest on the primary dimension of fall concern, ensuring maximum predictive power while minimizing administration time. This short form retains strong psychometric properties comparable to the full version.

Instrument

Test Type: Questionnaire

Format: Self-report questionnaire using a 4-point Likert scale (1 = Not at all concerned to 4 = Very concerned).

Language Available: Original English, widely translated (including Dutch/Nederlandse versie).

Population Group: Adults, Older Adults, and clinical populations (e.g., Parkinson’s disease, neurological disorders).

Age Group: Typically 60+ years, but validated for use across the adult lifespan where fall risk is relevant.

Population Details: Used to assess functional domains related to Mobility/Movement, Sensory Functions, and Pain, focusing particularly on the Lower Extremity, especially in contexts related to the Nervous System and Senses.

Test Methodology: Respondents rate their level of concern about falling while performing specific activities. Total scores range from 16 to 64 (16 items) or 7 to 28 (7 items). A higher score indicates greater concern about falling.

Keywords

Fall-related self-efficacy, Geriatric assessment, Neurological disorders, Lower extremity function, Valangst, Scale reliability, Clinical outcome measure.

Authors

Author ORCID Identifier: N/A (Information not provided in source.)

Affiliation Email addresses: N/A (Information not provided in source.)

Correspondence Address: N/A (Information not provided in source.)

Permissions & Fee and Test Year

The original version of the FES-I was developed in 1990 by Tinetti, Richmann, and Powell. The widely used international version was standardized subsequently. The Dutch adaptation was published by Kempen GIJM, et al. in 2007.

The FES-I is generally available for non-commercial research and clinical use without a fee, though users should consult the official sources or the relevant collaborating research groups (e.g., Prevention of Falls Network Europe) for specific permissions regarding translations or adaptations.

Supporting documentation for the FES-I is available via the following PDF links:

• The original PDF Explanation Form can be downloaded here: Explanation Form
• A Parkinson-specific Explanation Form PDF can be downloaded here: Explanation Form Parkinson-specific
• The 16-item Instrument PDF can be downloaded here: Instrument 16 items
• The 7-item Instrument PDF can be downloaded here: Instrument 7 items
• A Parkinson-specific Instrument PDF can be downloaded here: Instrument Parkinson-specific

Reference’s

Primary references related to the development and Dutch validation include:

• Tinetti ME, Richmann D, Powell L. (1990). The development and testing of a measure of confidence in performing everyday activities: the Falls Efficacy Scale. J Gerontol. 45(5):P161-7.
• Kempen GIJM, et al. (2007). Development and psychometric evaluation of the Dutch version of the Falls Efficacy Scale-International (FES-I). Age Ageing. 36(6):657-63.

Items of the Falls Efficacy Scale International (7 & 16-items)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way. As the specific items were not provided in the source content (only links to the measuring instruments), we state this limitation.

The original scale items are not explicitly listed in the source text, but the full instruments are available via the PDF links provided in the Permissions section above.

The FES-I requires the patient to indicate their level of concern about falling (1=Not at all concerned, 4=Very concerned) while performing tasks such as:

• Walking around the house.
• Preparing a light meal.
• Walking up or down 7-8 steps.
• Reaching for something above head or on the ground.
• Walking on a slippery surface (e.g., wet floor).
• Walking in a crowded place.
• Going out to a social event.