Fall History Questionnaire

Abstract

The Vragenlijst valgeschiedenis (Fall History Questionnaire) is a specialized screening instrument designed for use by physiotherapists to systematically document a patient’s history of falls and near-falls. This questionnaire helps to identify the frequency of these events and the specific circumstances under which they occurred. Comprising thirteen core questions, the instrument is divided into two major sections: eight questions dedicated to actual falls and five questions dedicated to near-falls. For patients who report having neither fallen nor experienced a near-fall in the past year, a streamlined version utilizing only three questions is administered. It serves as a vital tool in assessing mobility risks, particularly in populations susceptible to balance impairments, such as individuals with Parkinson’s disease.

Keywords

Fall History, Near-Falls, Parkinson’s Disease, Geriatrics, Physiotherapy, Risk Assessment, Balance, Mobility.

Authors

Stack E, Ashburn A (1999), KNGF-richtlijn Ziekte van Parkinson (2016) (Dutch Version Adaptation).

Purpose

The primary purpose of the Vragenlijst valgeschiedenis is to provide clinicians, especially physiotherapists, with a standardized method for gathering detailed, retrospective information regarding a patient’s fall history. By quantifying the number of falls and near-falls, and documenting the associated environmental or physical conditions, the instrument facilitates the identification of high-risk patients who require targeted intervention.

This information is essential for developing personalized intervention strategies aimed at preventing future falls, which are a major source of morbidity and mortality, particularly among the elderly and those suffering from neurodegenerative conditions like Parkinson’s disease. The structured format ensures that critical details about the context of the falls (e.g., location, activity, time of day) are consistently captured.

Construct

The scale measures the clinical construct of Fall Risk Exposure and Fall Circumstance Documentation. It functions not as a measure of underlying psychological traits but rather as a focused assessment of observable, historical behavioral events—falls and near-falls—that are highly predictive of future mobility challenges and potential injury risk.

The instrument operationalizes this construct by clearly differentiating between actual falls (loss of balance resulting in contact with the ground or lower surface) and near-falls (loss of balance recovered without contact). This distinction is important as both types of events provide critical insight into the patient’s current balance capabilities, compensatory strategies, and the environmental hazards encountered in their daily life.

Validity

Specific detailed information regarding the content, criterion, and construct validity of the original 1999 iteration or the 2016 Dutch adaptation is not explicitly provided in the core source documentation. However, as a history questionnaire utilized in clinical practice, its face and content validity are derived from its direct relevance to established clinical best practices in geriatrics and neurological rehabilitation, where a comprehensive fall history is recognized globally as a fundamental predictor of future fall risk.

Reliability

Data concerning the internal consistency (e.g., Cronbach’s alpha) or test-retest reliability of the Vragenlijst valgeschiedenis is not available in the provided source material. Given its structure as a clinical history tool that captures discrete, historical events rather than a complex psychometric scale measuring a latent trait, reliability concerns would typically center on the consistency of the patient’s self-report over short assessment intervals and, if administered verbally, inter-rater reliability among clinicians.

Factor Analysis

No formal factor analysis has been reported in the available documentation for this instrument. Since the questionnaire is structured into two simple, distinct, and clinically relevant components—falls and near-falls—it is primarily utilized as a descriptive assessment tool. It does not typically require dimensional reduction techniques necessary for scales that aim to uncover latent underlying factors.

Instrument

Test Type: Clinical Screening Questionnaire / Self-Report History Tool

Format: Paper-and-pencil or interview-administered questionnaire

Language Available: Original version (1999), Dutch adaptation (2016)

Population Group: Clinical Populations, Adults, and Elderly

Age Group: 18 years and older (Adults and Geriatric population)

Population Details: Specifically recommended for patients with Parkinson’s disease and other conditions affecting the nervous system and senses, which increase the risk of falls.

Test Methodology: The questionnaire consists of thirteen items divided into two parts: 8 questions dedicated to actual falls and 5 questions dedicated to near-falls. If a patient reports no falls or near-falls in the preceding year, a brief screening using only three core questions is utilized to confirm this history.

Keywords

Fall Prevention, Balance Assessment, Neurological Disorders, KNGF guideline, Nervous system, Clinical Assessment.

Authors

Author ORCID Identifier: Information not available.

Affiliation Email addresses: Information not available.

Correspondence Address: Information not available.

Permissions & Fee and Test Year

The original conceptualization of the scale was published in 1999 by Stack E and Ashburn A. The official Dutch adaptation, utilized within the context of the KNGF guidelines (Royal Dutch Society for Physiotherapy) for Parkinson’s disease, was formally established in 2016. Information regarding specific licensing fees or commercial permissions for the KNGF adapted version is not provided in the source material, but its use is implied within standard clinical physiotherapy practice guided by the KNGF standards.

Reference’s

The primary references associated with this instrument are:

• Stack E, Ashburn A (1999). Title of original article (Specific title not provided in source).
• KNGF (Koninklijk Nederlands Genootschap voor Fysiotherapie) Richtlijn Ziekte van Parkinson (2016).

The official measurement instrument (PDF) can be downloaded here: Meetinstrument.

The explanatory manual (PDF) can be downloaded here: Toelichtingsformulier.

Items of the Vragenlijst valgeschiedenis

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

The original source content provided the descriptive text and document links, but did not include the actual list of the thirteen specific questions comprising the Vragenlijst valgeschiedenis. The structure is known to contain two parts:

• Part 1: 8 questions focusing on actual falls.
• Part 2: 5 questions focusing on near-falls.