Practicality, validity and sensitivity to change of fear of falling self-report in hospitalised elderly--a comparison of four instruments

SIR—The assessment of fear of falling (FOF) has considerably improved over the last decade [1, 2]. Global single-item measures (‘Are you afraid of falling?’) have been replaced by newer tools that are capable of detecting falls-related self-efficacy, such as the Falls Efficacy Scale (FES) [3] and FES-International (FES-I) [4, 5] or of detecting balance confidence such as the Activities-specific Balance Confidence Scale (ABC-Scale) [6]. The range of activities in these instruments allows for a more detailed view and a better measurement of change [1]. However, some of the items of these tools cannot be easily transferred to an inpatient setting (e.g. ‘going out to social events’ or ‘sweeping the floor’) although hospitals integrated these instruments in their geriatric assessment and researchers included them in clinical studies of hospitalised [7–9] and institutionalised [10, 11] patients. Additionally, as pointed out in a recent review, practicality and feasibility are rarely reported despite the fact that they are critical for the translation of assessments into everyday practice [1]. Therefore, in the present study, psychometric properties are compared alongside with practicality issues for four measures of FOF: a global rating with a dichotomous answer format, a global rating with a polytomous 11-point answer format, the Short FES-I [12] and the full FES-I [4, 5]. The short version of the FES-I has been published only recently and has the potential for improving the feasibility of FOF assessments in a clinical setting.