title: Development and initial validation of the Iconographical Falls Efficacy Scale.
abstract: 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.
authors.affiliation: Falls and Balance Research Group, Neuroscience Research Australia, Barker Street, Randwick, Sydney, NSW 2031, Australia. k.delbaere@neura.edu.au
authors.forename: Kim
authors.initials: K
authors.lastname: Delbaere
authors.forename: Stuart T
authors.initials: ST
authors.lastname: Smith
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Lord
mesh_terms: D000058:Accidental Falls; D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D005239:Fear; D005260:Female; D006801:Humans; D008297:Male; D011594:Psychometrics; D012307:Risk Factors; D011795:Surveys and Questionnaires