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Development and Initial Validation of the Iconographical Falls Efficacy Scale

journal contribution
posted on 2023-05-17, 18:39 authored by Delbaere, K, Smith, ST, Lord, SR
Background. Fear of falling scales typically have a strong floor effect in active people and use short phrases to state overall context of fear-related activities. We developed the Iconographical Falls Efficacy Scale (Icon-FES), which includes more demanding activities and uses pictures to provide more complete environmental contexts. Methods. Two-hundred and fifty community-dwelling older people (70–90 years) were assessed on the Icon-FES in conjunction with the Falls Efficacy Scale International (FES-I). Results. Overall structure and measurement properties of the 30-item Icon-FES (evaluated with item-response theory) were good. It measured a single factor with 2 dimensions assessing fear about less and more demanding daily activities. It had high internal consistency (Cronbach's alpha = 0.96) and excellent test–retest reliability. The Icon-FES distribution was considerably closer to normal compared with FES-I, indicating absence of floor and ceiling effects. Construct validity of the Icon-FES was supported by its relation with FES-I and its ability to discriminate between groups relating to demographic characteristics and fall risk factors. A shortened 10-item Icon-FES showed similar psychometric properties to the 30-item Icon-FES. Conclusions. The Icon-FES is an innovative way of assessing fear of falling using pictures to describe a range of activities and situations. This initial validation study showed that the Icon-FES has excellent psychometric properties and showed close continuity with the FES-I. Main advantages of the Icon-FES over the FES-I are its normal distribution and its ability to assess fear of falling in high functioning older people.


Publication title

Journals of Gerontology. Series A: Biological Sciences and Medical Sciences










School of Health Sciences


Gerontological Society Amer

Place of publication

1275 K Street Nw Suite 350, Washington, USA, Dc, 20005-4006

Repository Status

  • Restricted

Socio-economic Objectives

Health related to ageing

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