The Adaption Of Falls Efficacy Scale-International(Chinese) And Its Reliability And Validity Testing

ObjectiveTo modify the Chinese version of the Falls Efficacy Scale-International(FES-I(Ch))based on the bio-psycho-social medical model(increasing the number of dimensions and reducing the excessive internal consistency)and to test its reliability and validity,so that the modified scale can evaluate all aspects of older people’s fear of falling(FoF).The modified scale is further applied to investigate the relationship between FoF and demographic characteristics,in order to provide a scientific basis for clinical staff to efficiently manage FoF in different groups of people.MethodStudy 1:The reliability and validity of FES-I(Ch)were examined using the internal consistency test(Cronbach’s α coefficient)and exploratory factor analysis,respectively.Study 2:Through literature search,collation and entry screening,alternative entries were established based on the FES-I(Ch),and after consultation with experts in related fields,a[Modified FES-I(Chinese),MFES-I(Ch)]entry pool based on the bio-psycho-social medical model was established.Pre-survey,including critical ratio method,internal consistency test and factor analysis was used to determine the dimensions of MFES-I(Ch)entry pool and to eliminate entries that did not fit the scale dimensions and caused excessive consistency in the scale content.Study 3:The internal consistency test(Cronbach’s α coefficient)was used to assess the internal consistency among MFES-I(Ch)entries,intra correlation coefficient reflected its retest reliability,and exploratory factor analysis evaluated its construct validity.Study 4:Mann-Whitney U test analyzed whether there were significant differences in MFES-I(Ch)and FES-I(Ch)scores and age between the faller and non-faller groups.Study 5:Spearman correlation analysis was used to test the correlation between MFES-I(Ch)scores and demographic characteristics(age,height,weight,body mass index,history of falls,history of dizziness,history of chronic illness,history of medication use,exercise habits).Multiple linear regression models were developed to analyze the effect of demographic characteristics on FoF.ResultsStudy 1:134 individuals completed FES-I(Ch).Cronbach’s α coefficient of FES-I(Ch)was 0.95,a result consistent with previous studies,indicating excessive intrinsic consistency.Exploratory factor analysis extracted two common factors,but some entries did not match the dimensions they were in,indicating that there were some problems with the dimensional delineation of the FES-I(Ch)entries.Study 2:A total of 20 alternative entries were established on the basis of FES-I(Ch).After consultation with experts in related fields,a preliminary library of 14 MFES-I(Ch)entries based on the bio-psycho-social medical model was formed.201 individuals participated in the pre-survey,and MFES-I(Ch)dimensions(3 biological,psychological and social dimensions)were determined after the critical ratio method,internal consistency test and factor analysis,and 3 entries that did not match with the dimension they were in were eliminated.A total of 11 entries of MFES-I(Ch)were formed.FES-I(Ch)4-point scale was also changed to a 5-point scale according to the Likert 5-point scale.Study Ⅲ:39 people respectively completed the MFES-I(Ch)before and after 7 days,and the intra correlation coefficient was 0.971.The internal consistency test of MFES-I(Ch)scores of 201 people yielded a Cronbach’s α coefficient of 0.898.Exploratory factor analysis extracted three common factors,and all entries matched their expected dimensions.Study 4:108 completed MFES-I(Ch)and FES-I(Ch).The results of the Mann-Whitney U test showed that both MFES-I(Ch)(p<0.001)and FES-I(Ch)scores(p=0.013)were significantly higher in the faller group(23 individuals)than in the non-faller group(85 individuals),and the p-value for MFES-I(Ch)scores was smaller.However,there was no significant difference in age between the two groups(p>0.05).Study 5:154 participants were surveyed for demographic characteristics.The results showed that MFES-I(Ch)scores weakly correlated with falls history(rho=0.161,p=0.047),history of chronic diseases(rho=-0.221,p=0.006)and history of medication use(rho=-0.228,p=0.004),moderately correlated with history of dizziness(rho=-0.382,p<0.001),but not significantly correlated with age,height,weight,BMI and exercise habits(all p>0.05).A multiple linear regression model was developed and eventually only history of dizziness was included[Y=-3.926X+10.111(Y=MFES-I(Ch),X=history of dizziness),(F=22.928,p<0.001)],indicating that 12.5%of the variation in MFES-I(Ch)scores could be explained by changes in history of dizziness.ConclusionCompared with FES-I(Ch),MFES-I(Ch)can evaluate FoF in elderly people in many aspects based on the bio-psycho-social medical model,has good reliability and validity,and can more accurately assess the differences in FoF between the fallers and non-fallers.Thus,MFES-I(Ch)can be used as a tool to evaluate FoF in the elderly.