The Falls Efficacy Scale (FES) is a crucial tool in geriatric and rehabilitative medicine used to assess an individual's confidence in performing daily activities without falling. Calculating the score correctly depends entirely on which specific version of the questionnaire has been administered. The most common versions are the FES-International (FES-I), the Short FES-I, and the Modified FES (MFES). Each has a unique scoring protocol that determines the level of concern or confidence regarding falls.
How to calculate the Falls Efficacy Scale-International (FES-I) score
The FES-I is a 16-item questionnaire used to measure concern about falling during a variety of social and physical activities, both inside and outside the home. It is widely used and available in multiple languages.
Scoring for complete FES-I questionnaires
To calculate the score for a completed FES-I questionnaire, follow these simple steps:
- Assign points: Each of the 16 items is rated on a 4-point Likert scale. The point values are assigned as follows:
- 1 = Not at all concerned
- 2 = Somewhat concerned
- 3 = Fairly concerned
- 4 = Very concerned
- Sum the scores: Add the score from each of the 16 items together to get a total score. The final score will range from 16 to 64.
Handling missing FES-I data
If a respondent leaves some items blank, the scoring method must be adjusted.
- Invalidate if too many missing: If more than four items are left blank, the questionnaire is considered invalid and a score cannot be calculated.
- Calculate score with remaining data: If four or fewer items are missing, follow these steps:
- Add the scores for the items that were completed.
- Divide this sum by the number of items completed.
- Multiply the result by 16 (the total number of items on the scale).
- Round the final figure up to the nearest whole number to get the total score.
Interpreting FES-I scores
High scores on the FES-I indicate a greater concern or fear of falling. The cutoff scores for different levels of concern are generally categorized as follows:
- Low concern: 16–19
- Moderate concern: 20–27
- High concern: 28–64
Calculating the Short Falls Efficacy Scale-International (Short FES-I)
The Short FES-I is a more concise, 7-item version of the FES-I designed for practical, quicker assessment.
Scoring for complete Short FES-I questionnaires
- Assign points: Similar to the full version, each of the seven items uses a 4-point Likert scale:
- 1 = Not at all concerned
- 2 = Somewhat concerned
- 3 = Fairly concerned
- 4 = Very concerned
- Sum the scores: Add the scores from all seven items. The total will range from 7 to 28.
Handling missing Short FES-I data
- Invalidate if too many missing: If more than two items are missing, the questionnaire is invalid.
- Calculate score with remaining data: If two or fewer items are missing:
- Add the scores of the items that were completed.
- Divide this sum by the number of items completed.
- Multiply the result by 7 (the total number of items).
- Round the final figure up to the nearest whole number to get the total score.
Interpreting Short FES-I scores
- Low concern: 7–8
- Moderate concern: 9–13
- High concern: 14–28
Calculating the Modified Falls Efficacy Scale (MFES) score
The MFES is a 14-item scale that expands upon the original 10-item FES by adding outdoor activities. It uses a different scoring system to the FES-I versions.
Scoring the MFES
- Assign points: Each item is rated on a 10-point visual analogue scale:
- 0 = Not confident/not sure at all
- 10 = Completely confident/completely sure
- Average the scores: The final score is the average of all 14 item scores, with the total score ranging from 0 to 10. Higher scores on the MFES reflect greater confidence and less fear of falling.
Interpreting MFES scores
- An average score below 8.0 may indicate reduced fall-related self-efficacy.
- An average score below 5.0 may be a predictor of in-hospital falls and longer hospital stays.
Comparison of FES versions and scoring
| Aspect | FES-International (FES-I) | Short Falls Efficacy Scale-International (Short FES-I) | Modified Falls Efficacy Scale (MFES) |
|---|---|---|---|
| Number of Items | 16 | 7 | 14 |
| Rating Scale | 4-point Likert scale (1-4) | 4-point Likert scale (1-4) | 10-point visual analog scale (0-10) |
| Total Score Range | 16–64 | 7–28 | 0–10 (average score) |
| Scoring Method | Sum of all item scores | Sum of all item scores | Average of all item scores |
| Missing Data Rule | Invalid if >4 items missing. Can impute if ≤4. | Invalid if >2 items missing. Can impute if ≤2. | Scoring is based on average, so can accommodate some missing data by averaging the completed items. |
| Interpretation | Higher scores mean greater concern. | Higher scores mean greater concern. | Higher scores mean greater confidence. |
Conclusion
Calculating a Falls Efficacy Scale score is a straightforward process of adding up item ratings, but it is critical to use the correct method for the specific scale administered. The FES-I and Short FES-I scales measure concern about falling and are scored by summing points on a 4-point scale, with higher totals indicating greater concern. The MFES measures confidence and requires averaging ratings from a 10-point scale, with lower scores reflecting reduced confidence. Understanding the nuances of each version's scoring and interpretation is key to accurately assessing a person's falls-related self-efficacy and informing clinical decisions for fall prevention.
