Falls Efficacy Scale International (FES-I)
- Fysiobasen
- Sep 16
- 3 min read
The Falls Efficacy Scale International (FES-I) is a validated questionnaire that measures how worried or fearful a person is about falling during various everyday activities. It was developed through the Prevention of Falls Network Europe (ProFaNE) project between 2003 and 2006, led by Todd and colleagues¹.
FES-I is widely used in both clinical and research settings to assess fear of falling, which can significantly impact activity level, independence, and quality of life among adults and older adults.
It is user-friendly, quick to administer, and can be completed as a self-report or interview. Unlike objective balance tests, FES-I reflects the individual’s perceived fear rather than actual fall risk – but this perception often leads to reduced activity and functional decline¹.
Background and Purpose
Fear of falling is common in older adults and in people with neurological or orthopedic conditions. It may lead to inactivity, reduced balance, and further loss of function, creating a vicious cycle that increases actual fall risk.
FES-I was designed to measure this concern in a standardized way, allowing clinicians and researchers to:
Screen and identify patients with high fall concern
Track changes over time
Evaluate the effect of interventions aimed at reducing fall-related fear¹
Target Population
FES-I is designed for adults and older adults, particularly:
Seniors at risk of falling
Patients with Parkinson’s disease, vestibular disorders, multiple sclerosis
Individuals post-fracture or with joint pathologies²
Structure and Method
The scale includes 16 items, each describing a common daily activity.
Patients rate their level of concern on a 4-point Likert scale:
1 = Not at all concerned
2 = Somewhat concerned
3 = Fairly concerned
4 = Very concerned
Total score range: 16 (no concern) – 64 (extreme concern)¹.
Examples of activities assessed:
Vacuuming or house cleaning
Dressing and undressing
Cooking a simple meal
Bathing or showering
Walking to the store
Rising from or sitting in a chair
Climbing stairs
Walking in the neighborhood
Picking up items from the floor or high shelves
Answering the phone quickly
Walking on slippery or uneven ground
Attending social events³
Interpretation
16–19 points: Little or no concern about falling
20–23 points: Mild concern
≥24 points: Significant concern or fear of falling
There is no universal cut-off; interpretation should always consider the individual’s clinical background, activity level, and fall history. High scores often justify fall prevention interventions such as balance training, strength programs, or cognitive-behavioral strategies³.
Clinical Significance
Studies consistently show that higher FES-I scores are associated with:
Reduced activity participation
Lower quality of life
Increased risk of actual falls⁴
Fear itself may cause avoidance of physical activity, further weakening balance and strength. FES-I is therefore often included in multidisciplinary fall assessments and rehabilitation.
Psychometric Properties
FES-I demonstrates strong psychometric quality across populations:
Internal consistency: Cronbach’s α = 0.94–0.98 (very high reliability)⁵
Test-retest reliability: ICC = 0.91–0.98 (stable over time)
Construct validity: Moderate–high correlations with balance scales such as Berg Balance Scale, Functional Reach Test, and Tinetti⁶
It is validated in many languages, including a Norwegian version, and is freely available for clinical use.
Limitations
Subjective measure: Reflects fear of falling, not actual balance capacity
Influenced by general anxiety or past fall experiences
Does not specify the cause of concern or guide targeted intervention
Therefore, FES-I should be combined with objective functional tests (e.g., Timed Up and Go, 5x Sit-to-Stand, balance assessments) for a complete fall risk profile.
Sources:
Yardley L, Beyer N, Hauer K, Kempen G, Piot-Ziegler C, Todd C. Utvikling og initial validering av Falls Efficacy Scale–International (FES-I). Age and Ageing [Internett]. 2005;34(6):614–9.
Dewan N, MacDermid J. Fall Efficacy Scale–International (FES-I). Journal of Physiotherapy. 2014;60(1):60.
McGarrigle L, Yang Y, Lasrado R, Gittins M, Todd C. Systematisk gjennomgang og meta-analyse av måleegenskaper ved bekymring for fall-instrumenter. Age and Ageing [Internett]. 2023;52(5). [sitert 05.07.2025].
Mehdizadeh M, Martinez-Martin P, Habibi SA, mfl. Reliabilitet og validitet av FES-I hos personer med Parkinsons sykdom i «on» og «off»-faser. Parkinson’s Disease. 2019;2019:1–7.
Morgan MT, Friscia LA, Whitney SL, mfl. Reliabilitet og validitet av FES-I hos personer med svimmelhet og balanseproblemer. Otology & Neurotology. 2013;34(6):1104–8.
van Vliet R, Hoang P, Lord S, mfl. FES-I: Tverrsnittsvalidering hos personer med multippel sklerose. Archives of Physical Medicine and Rehabilitation. 2013;94(5):883–9.
Visschedijk JHM, Terwee CB, Caljouw MAA, mfl. Reliabilitet og validitet av FES-I etter hoftebrudd hos pasienter ≥65 år. Disability and Rehabilitation. 2015;37(23):2225–32.
