Validating the Falls Behavioural (FaB) scale for older people: A Rasch analysis

Purpose. Rasch modelling was used to establish the validity and robustness of the Falls Behavioural (FaB) Scale for Older people. Methods. The sample comprised 678 community-residing elderly people aged 65 – 98 years. Data were analysed by calculating goodness of fit statistics, principal components analysis of residuals and by exploring the effectiveness of the category rating response-scale. Results. A partial-credit rating scale was the best fitting solution and the major change to the original version of the FaB. Analysis supported a 29-item intervention version and a briefer 24-item outcome evaluation (research) version. The latter produced item mean infit statistics of 1.00 (Z = 0.0, SD = 0.33) and mean outfit statistics of 1.03 (Z = 0.0, SD = 0.53), a person separation of 2.36 and internal reliability of 0.85. Conclusion. The 29 item partial rating scale is valid, reliable and would be useful in clinical situations when used as a prompt for discussion and in raising clients' awareness of potential hazards; it also can be used as an outcome measure. The short form is a useful alternate for evaluating the effectiveness of fall reduction interventions that aim to encourage protective strategies when negotiating the environment, mobilizing and doing activities of daily living. Both scales would be improved by adding very difficult and very easy items to increase the range of ability levels of the people to whom it can be applied with precision.

[1]  J. Lai,et al.  The use of Rasch analysis to produce scale-free measurement of functional ability. , 1999, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[2]  S. Gibson,et al.  Fear of falling revisited. , 1996, Archives of physical medicine and rehabilitation.

[3]  L. Yardley,et al.  A prospective study of the relationship between feared consequences of falling and avoidance of activity in community-living older people. , 2002, The Gerontologist.

[4]  Christianna S. Williams,et al.  Falls, injuries due to falls, and the risk of admission to a nursing home. , 1997, The New England journal of medicine.

[5]  R. Cumming,et al.  WITHDRAWN: Interventions for preventing falls in elderly people. , 2009, The Cochrane database of systematic reviews.

[6]  R A Boileau,et al.  The physical activity scale for the elderly (PASE): evidence for validity. , 1999, Journal of clinical epidemiology.

[7]  J. Ware.  SF-36 health survey: Manual and interpretation guide , 2003 .

[8]  G. Masters,et al.  Rating Scale Analysis. Rasch Measurement. , 1983 .

[9]  L. Clemson,et al.  Managing risk and exerting control: determining follow through with falls prevention. , 1999, Disability and rehabilitation.

[10]  A. Campbell,et al.  Randomised controlled trial of prevention of falls in people aged ≥75 with severe visual impairment: the VIP trial , 2005, BMJ : British Medical Journal.

[11]  R. Gonzalez.  Applied Multivariate Statistics for the Social Sciences , 2003 .

[12]  R. Cumming,et al.  Home Visits by an Occupational Therapist for Assessment and Modification of Environmental Hazards: A Randomized Trial of Falls Prevention , 1999, Journal of the American Geriatrics Society.

[13]  Lindy Clemson,et al.  The Effectiveness of a Community‐Based Program for Reducing the Incidence of Falls in the Elderly: A Randomized Trial , 2004, Journal of the American Geriatrics Society.

[14]  Walter Schneider,et al.  Controlled and automatic human information processing: II. Perceptual learning, automatic attending and a general theory. , 1977 .

[15]  John E. Ware,et al.  SF-36 Health Survey. , 1990 .

[16]  A. Jette,et al.  Function and disability in late life: comparison of the Late-Life Function and Disability Instrument to the Short-Form-36 and the London Handicap Scale , 2004, Disability and rehabilitation.

[17]  Cameron Swift,et al.  Prevention of falls in the elderly trial (PROFET): a randomised controlled trial , 1999, The Lancet.

[18]  M. R. Espejo.  Applying the Rasch Model: Fundamental Measurement in the Human Sciences , 2004 .

[19]  S L Wolf,et al.  Environmental and behavioral circumstances associated with falls at home among healthy elderly individuals. Atlanta FICSIT Group. , 1997, Archives of physical medicine and rehabilitation.

[20]  J. Linacre.  Understanding Rasch measurement: estimation methods for Rasch measures. , 1999, Journal of outcome measurement.

[21]  S. Siegel,et al.  Nonparametric Statistics for the Behavioral Sciences , 2022, The SAGE Encyclopedia of Research Design.

[22]  J. Linacre.  Detecting multidimensionality: which residual data-type works best? , 1998, Journal of outcome measurement.

[23]  D. Andrich.  1 – Measurement Criteria for Choosing among Models with Graded Responses , 1996 .

[24]  John M Linacre,et al.  Optimizing rating scale category effectiveness. , 2002, Journal of applied measurement.

[25]  Everett V. Smith,et al.  Introduction to Rasch measurement : theory, models and applications , 2004 .

[26]  Lindy Clemson BAppSc,et al.  The Effectiveness of a Community-Based Program for Reducing the Incidence of Falls in the Elderly: A Randomized Trial , 2004 .

[27]  R. Cumming,et al.  The development of an assessment to evaluate behavioral factors associated with falling. , 2003, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[28]  M M Lusardi,et al.  Development of a scale to assess concern about falling and applications to treatment programs. , 1997, Journal of outcome measurement.