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Establishing content validity for a composite activities-specific risk of falls scale:linkage between fear of falling and physical activity.

ABSTRACT:

Background

Fear of falling (FoF) and physical activity (PA) are important psychological and behavioral factors associated with falls. No instrument quantifies the link between these two factors to evaluate the risk of falls. We aimed to design a scale linking FoF with PA (Composite Activities-specific Risk of Falls Scale, CARFS) for people with various disability levels.

Methods

First, we designed a questionnaire comprising 40 balance-related activities from the International Classification of Functioning, Disability, and Health (ICF) for a pilot survey. Second, participants were interviewed about their activities-specific FoF degree and PA frequency. The participants comprised 30 community-dwelling older adults, hospitalized patients with strokes, and those with spinal cord injuries, each with different disability levels. Third, the content validity of the items was evaluated twice by 12 experienced rehabilitation professionals: one based on experience and the other on the survey responses. Items with a higher than moderate relevance in both evaluations were included in the CARFS. The panel of professionals discussed and voted on the contribution of FoF and PA on the CARF score. Finally, the scale sensitivity in distinguishing disability levels was analyzed to evaluate the population suitability to the CARFS.

Results

The CARFS included 14 activities. A five-point Likert scale was used to quantify degree of FoF (A) and frequency of PA (B). The CARF score (C), which was determined using the eq. C = A+(4-B) + A × B/2, reflected sensitivity to disability levels in most items.

Conclusions

The CARFS has strong content validity for measuring risk of falls in relation to the FoF and PA of people with various disability levels. It has a potential to provide a guide for designing individualized exercise- and behavior-focused fall prevention programs and enable the precise trtrun 0acking of program effectiveness as a multidimensional outcome measure.

SUBMITTER: Wang JX

PROVIDER: S-EPMC8077745 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:INTRODUCTION:Activity restriction due to fear of falling is a common problem after a stroke. It can lead to deteriorated physical condition, restricted social participation and deprived quality of life. The Survey of Activities and Fear of Falling in the Elderly (SAFE) was developed to assess these difficulties, and its utility has been demonstrated among the older adults and older people with Parkinson's disease. This study aimed to expand those demonstrations to community-dwelling chronic stroke survivors using a Chinese translation of the instrument. METHODS:One hundred and eight elderly individuals with a history of stroke completed the Chinese version of the SAFE (SAFE-C). The internal consistency of their responses was assessed using Cronbach's alpha. Twenty of the same subjects were reassessed after a 1-week interval to assess the instrument's test-retest reliability. Structure validity was examined by exploratory factor analysis. Pearson correlation was used to establish the instrument's convergent validity with respect to the results from the Chinese version of the Activities-specific Balance Confidence Scale (ABC-C) and the Chinese version of the Lawton Instrumental Activities of Daily Living scale (IADL-C). RESULTS:The items of the SAFE-C demonstrated excellent internal consistency with a Cronbach's alphas of 0.90. The SAFE-C also had excellent test-retest reliability with an overall intra-class correlaton coefficient of 0.91. A 1-factor structure termed "fear avoidance circumstances" was identified and it was shown to be consistent with the original measure developed among community-living older people. The correlations between the SAFE-C and the ABC-C (r = -0.68) and the IADL-C (r = -0.57) confirmed the convergent validity. CONCLUSIONS:Fear avoidance behavior is a homogeneous construct applicable to people with stroke-specific impairments alike. The SAFE-C is a reliable and valid instrument for measuring the level of fear avoidance behavior among community-dwelling stroke survivors. Stroke survivors with good functional mobility revealed a low level of fear and avoidance as measured by the SAFE-C.