The psychometric properties of the modified fear of falling avoidance behavior questionnaire in Parkinson’s disease and older adults

Merrill Landers; Ash M. Haller; Arturo Aldaco; Billy La; Adetayo A. Babarinde; John V. Rider; Jason K. Longhurst

doi:10.33393/aop.2024.2702

Authors

Merrill Landers Department of Physical Therapy, School of Integrated Health Sciences, University of Nevada, Las Vegas, Nevada - USA https://orcid.org/0000-0002-4234-910X
Ash M. Haller Sequoia Hospital, Dignity Health, Redwood City, California - USA https://orcid.org/0009-0000-6950-1178
Arturo Aldaco Sunrise Hospital and Medical Center, Las Vegas, Nevada - USA
Billy La FYZICAL Balance and Therapy Centers – Buffalo, Las Vegas, Nevada - USA https://orcid.org/0009-0006-1377-7603
Adetayo A. Babarinde School of Integrated Health Sciences, University of Nevada, Las Vegas, Nevada - USA https://orcid.org/0000-0002-9545-4341
John V. Rider School of Occupational Therapy, Touro University Nevada, Henderson, Nevada - USA https://orcid.org/0000-0002-8277-6990
Jason K. Longhurst Department of Physical Therapy and Athletic Training, Doisy College of Health Sciences, Saint Louis University, St. Louis, Missouri - USA https://orcid.org/0000-0003-1853-6949

DOI:

https://doi.org/10.33393/aop.2024.2702

Keywords:

Balance, Balance confidence, Falls, Gait, Postural instability, Reliability

Abstract

Introduction: The Fear of Falling Avoidance Behavior Questionnaire (FFABQ) has good psychometric properties. However, a recently modified version (mFFABQ) was theorized to be easier to understand because the updated Likert responses are more consistent with the item stem. This study aimed to examine the reliability and validity of the mFFABQ in older adults and in people with Parkinson’s disease (PD).

Methods: A total of 88 participants, 39 with PD (age = 72.2 ± 9.5; 29 males, 10 females) and 49 older adults (age = 72.8 ± 5.0; 13 males, 36 females) answered the mFFABQ twice, separated by one week, for test-retest reliability. Construct validity was evaluated through correlational analyses with fall history, Activities-Specific Balance Confidence Scale (ABC), Berg Balance Scale (BBS), Timed Up and Go, 30 Second Sit to Stand, Sensory Organization Test, Zung Anxiety Scale, Beck Depression Inventory; Consequences of Falling Questionnaire (CoFQ), and average daily activity levels using an activity monitor.

Results: The mFFABQ had good overall test-retest reliability (ICC = 0.822 (older adult ICC = 0.781, PD ICC = .806). The mFFABQ correlated with fall history (r=-0.430) and exhibited high correlation with the ABC (rho=-.804) and moderate correlations with CoFQ (rho=.582) and BBS (rho=-.595). The mFFABQ also correlated with time stepping (rho=-.298), and number of steps (rho=-.358).

Discussion: These results provide supportive evidence for the reliability and validity of the mFFABQ in older adults and people with PD, which supports its suitability as a clinical and research tool for the assessment of fear of falling avoidance behavior.

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References

Salari N, Darvishi N, Ahmadipanah M, Shohaimi S, Mohammadi M. Global prevalence of falls in the older adults: a comprehensive systematic review and meta-analysis. J Orthop Surg Res. 2022;17(1):334. https://doi.org/10.1186/s13018-022-03222-1 PMID:35765037 DOI: https://doi.org/10.1186/s13018-022-03222-1

Allen NE, Schwarzel AK, Canning CG. Recurrent falls in Parkinson’s disease: a systematic review. Parkinsons Dis. 2013;2013:906274. https://doi.org/10.1155/2013/906274 PMID:23533953 DOI: https://doi.org/10.1155/2013/906274

Lee S, Oh E, Hong GS. Comparison of factors associated with fear of falling between older adults with and without a fall history. Int J Environ Res Public Health. 2018;15(5):982. https://doi.org/10.3390/ijerph15050982 PMID:29757960 DOI: https://doi.org/10.3390/ijerph15050982

Landers MR, Nilsson MH. A theoretical framework for addressing fear of falling avoidance behavior in Parkinson's disease. Physiother Theory Pract. 2023;39(5):895-911. https://doi.org/10.1080/09593985.2022.2029655 PMID:35180834 DOI: https://doi.org/10.1080/09593985.2022.2029655

Landers MR, Lopker M, Newman M, Gourlie R, Sorensen S, Vong R. A cross-sectional analysis of the characteristics of individuals with Parkinson disease who avoid activities and participation due to fear of falling. J Neurol Phys Ther. 2017;41(1):31-42. https://doi.org/10.1097/NPT.0000000000000162 PMID:27977519 DOI: https://doi.org/10.1097/NPT.0000000000000162

Landers MR, Jacobson KM, Matsunami NE, McCarl HE, Regis MT, Longhurst JK. A vicious cycle of fear of falling avoidance behavior in Parkinson’s disease: a path analysis. Clin Park Relat Disord. 2021;4:100089. https://doi.org/10.1016/j.prdoa.2021.100089 PMID:34316667 DOI: https://doi.org/10.1016/j.prdoa.2021.100089

Landers MR, Durand C, Powell DS, Dibble LE, Young DL. Development of a scale to assess avoidance behavior due to a fear of falling: the Fear of Falling Avoidance Behavior Questionnaire. Phys Ther. 2011;91(8):1253-1265. https://doi.org/10.2522/ptj.20100304 PMID:21700763 DOI: https://doi.org/10.2522/ptj.20100304

Landers MR, Oscar S, Sasaoka J, Vaughn K. Balance confidence and fear of falling avoidance behavior are most predictive of falling in older adults: prospective analysis. Phys Ther. 2016;96(4):433-442. https://doi.org/10.2522/ptj.20150184 PMID:26294679 DOI: https://doi.org/10.2522/ptj.20150184

Scarlett L, Baikie E, Chan SWY. Fear of falling and emotional regulation in older adults. Aging Ment Health. 2019;23(12):1684-1690. https://doi.org/10.1080/13607863.2018.1506749 PMID:30430850 DOI: https://doi.org/10.1080/13607863.2018.1506749

Lee SP, Hsu YW, Andrew L, Davis T, Johnson C. Fear of falling avoidance behavior affects the inter-relationship between vision impairment and diminished mobility in community-dwelling older adults. Physiother Theory Pract. 2022;38(5):686-694. https://doi.org/10.1080/09593985.2020.1780656 PMID:32543314 DOI: https://doi.org/10.1080/09593985.2020.1780656

Soh SL, Tan CW, Thomas JI, et al. Falls efficacy: extending the understanding of self-efficacy in older adults towards managing falls. J Frailty Sarcopenia Falls. 2021;6(3):131-138. https://doi.org/10.22540/JFSF-06-131 PMID:34557612 DOI: https://doi.org/10.22540/JFSF-06-131

Hoehn MM, Yahr MD. Parkinsonism: onset, progression and mortality. Neurology. 1967;17(5):427-442. https://doi.org/10.1212/WNL.17.5.427 PMID:6067254 DOI: https://doi.org/10.1212/WNL.17.5.427

Hoops S, Nazem S, Siderowf AD, et al. Validity of the MoCA and MMSE in the detection of MCI and dementia in Parkinson disease. Neurology. 2009;73(21):1738-1745. https://doi.org/10.1212/WNL.0b013e3181c34b47 PMID:19933974 DOI: https://doi.org/10.1212/WNL.0b013e3181c34b47

Powell LE, Myers AM. The Activities-specific Balance Confidence (ABC) scale. J Gerontol A Biol Sci Med Sci. 1995;50A(1):M28-M34. https://doi.org/10.1093/gerona/50A.1.M28 PMID:7814786 DOI: https://doi.org/10.1093/gerona/50A.1.M28

Berg K, Wood-Dauphinee S, Willliams JI, Gayton D. Measuring balance in the elderly: preliminary development of an instrument. Physiother Can. 1989;41(6):304-311. https://doi.org/10.3138/ptc.41.6.304 DOI: https://doi.org/10.3138/ptc.41.6.304

Rikli RE, Jones CJ. Development and validation of a functional fitness test for community-residing older adults. J Aging Phys Act. 1999;7(2):127-129. https://doi.org/10.1123/japa.7.2.129 DOI: https://doi.org/10.1123/japa.7.2.129

Podsiadlo D, Richardson S. The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39(2):142-148. https://doi.org/10.1111/j.1532-5415.1991.tb01616.x PMID:1991946 DOI: https://doi.org/10.1111/j.1532-5415.1991.tb01616.x

Rikli RE, Jones CJ. Development and validation of criterion-referenced clinically relevant fitness standards for maintaining physical independence in later years. Gerontologist. 2013;53(2):255-267. https://doi.org/10.1093/geront/gns071 PMID:22613940 DOI: https://doi.org/10.1093/geront/gns071

Ford-Smith CD, Wyman JF, Elswick RK Jr, Fernandez T, Newton RA. Test-retest reliability of the sensory organization test in noninstitutionalized older adults. Arch Phys Med Rehabil. 1995;76(1):77-81. https://doi.org/10.1016/S0003-9993(95)80047-6 PMID:7811180 DOI: https://doi.org/10.1016/S0003-9993(95)80047-6

Zung WW. A rating instrument for anxiety disorders. Psychosomatics. 1971;12(6):371-379. https://doi.org/10.1016/S0033-3182(71)71479-0 PMID:5172928 DOI: https://doi.org/10.1016/S0033-3182(71)71479-0

Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry. 1961;4(6):561-571. https://doi.org/10.1001/archpsyc.1961.01710120031004 PMID:13688369 DOI: https://doi.org/10.1001/archpsyc.1961.01710120031004

Yardley L, Smith H. A prospective study of the relationship between feared consequences of falling and avoidance of activity in community-living older people. Gerontologist. 2002;42(1):17-23. https://doi.org/10.1093/geront/42.1.17 PMID:11815695 DOI: https://doi.org/10.1093/geront/42.1.17

Talley KM, Wyman JF, Gross CR. Psychometric properties of the activities-specific balance confidence scale and the survey of activities and fear of falling in older women. J Am Geriatr Soc. 2008;56(2):328-333. https://doi.org/10.1111/j.1532-5415.2007.01550.x PMID:18179492 DOI: https://doi.org/10.1111/j.1532-5415.2007.01550.x

Jonasson SB, Nilsson MH, Lexell J. Psychometric properties of four fear of falling rating scales in people with Parkinson’s disease. BMC Geriatr. 2014;14(1):66. https://doi.org/10.1186/1471-2318-14-66 PMID:24884466 DOI: https://doi.org/10.1186/1471-2318-14-66

Donoghue D, Stokes EK; Physiotherapy Research and Older People (PROP) group. How much change is true change? The minimum detectable change of the Berg Balance Scale in elderly people. J Rehabil Med. 2009;41(5):343-346. https://doi.org/10.2340/16501977-0337 PMID:19363567 DOI: https://doi.org/10.2340/16501977-0337

Meseguer-Henarejos AB, Rubio-Aparicio M, López-Pina JA, Carles-Hernández R, Gómez-Conesa A. Characteristics that affect score reliability in the Berg Balance Scale: a meta-analytic reliability generalization study. Eur J Phys Rehabil Med. 2019;55(5):570-584. https://doi.org/10.23736/S1973-9087.19.05363-2 PMID:30955319 DOI: https://doi.org/10.23736/S1973-9087.19.05363-2

Park SH, Lee YS. The diagnostic accuracy of the Berg Balance Scale in predicting falls. West J Nurs Res. 2017;39(11):1502-1525. https://doi.org/10.1177/0193945916670894 PMID:27784833 DOI: https://doi.org/10.1177/0193945916670894

Muir SW, Berg K, Chesworth B, Speechley M. Use of the Berg Balance Scale for predicting multiple falls in community-dwelling elderly people: a prospective study. Phys Ther. 2008;88(4):449-459. https://doi.org/10.2522/ptj.20070251 PMID:18218822 DOI: https://doi.org/10.2522/ptj.20070251

Qutubuddin AA, Pegg PO, Cifu DX, Brown R, McNamee S, Carne W. Validating the Berg Balance Scale for patients with Parkinson’s disease: a key to rehabilitation evaluation. Arch Phys Med Rehabil. 2005;86(4):789-792. https://doi.org/10.1016/j.apmr.2004.11.005 PMID:15827933 DOI: https://doi.org/10.1016/j.apmr.2004.11.005

Petersen C, Steffen T, Paly E, Dvorak L, Nelson R. Reliability and minimal detectable change for Sit-to-Stand Tests and the Functional Gait Assessment for individuals with Parkinson disease. J Geriatr Phys Ther. 2017;40(4):223-226. https://doi.org/10.1519/JPT.0000000000000102 PMID:27805924 DOI: https://doi.org/10.1519/JPT.0000000000000102

Christopher A, Kraft E, Olenick H, Kiesling R, Doty A. The reliability and validity of the Timed Up and Go as a clinical tool in individuals with and without disabilities across a lifespan: a systematic review. Disabil Rehabil. 2021;43(13):1799-1813. https://doi.org/10.1080/09638288.2019.1682066 PMID:31656104 DOI: https://doi.org/10.1080/09638288.2019.1682066

Berlanga LA, Matos-Duarte M, Abdalla P, Alves E, Mota J, Bohn L. Validity of the two-minute step test for healthy older adults. Geriatr Nurs. 2023;51:415-421. https://doi.org/10.1016/j.gerinurse.2023.04.009 PMID:37146558 DOI: https://doi.org/10.1016/j.gerinurse.2023.04.009

Grove CR, Whitney SL, Hetzel SJ, Heiderscheit BC, Pyle GM. Validation of a next-generation sensory organization test in adults with and without vestibular dysfunction. J Vestib Res. 2021;31(1):33-45. https://doi.org/10.3233/VES-200040 PMID:33325418 DOI: https://doi.org/10.3233/VES-200040

Freeman L, Gera G, Horak FB, Blackinton MT, Besch M, King L. Instrumented test of sensory integration for balance: a validation study. J Geriatr Phys Ther. 2018;41(2):77-84. https://doi.org/10.1519/JPT.0000000000000110 PMID:27893564 DOI: https://doi.org/10.1519/JPT.0000000000000110

Rossi-Izquierdo M, Basta D, Rubio-Rodríguez JP, et al. Is posturography able to identify fallers in patients with Parkinson’s disease? Gait Posture. 2014;40(1):53-57. https://doi.org/10.1016/j.gaitpost.2014.02.003 PMID:24629311 DOI: https://doi.org/10.1016/j.gaitpost.2014.02.003

Beck AT, Steer RA, Carbin MG. Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation. Clin Psychol Rev. 1988;8(1):77-100. https://doi.org/10.1016/0272-7358(88)90050-5 DOI: https://doi.org/10.1016/0272-7358(88)90050-5

Wang YP, Gorenstein C. Psychometric properties of the Beck Depression Inventory-II: a comprehensive review. Br J Psychiatry. 2013;35(4):416-431. https://doi.org/10.1590/1516-4446-2012-1048 PMID:24402217 DOI: https://doi.org/10.1590/1516-4446-2012-1048

Beaton DE, Bombardier C, Katz JN, Wright JG. A taxonomy for responsiveness. J Clin Epidemiol. 2001;54(12):1204-1217. https://doi.org/10.1016/S0895-4356(01)00407-3 PMID:11750189 DOI: https://doi.org/10.1016/S0895-4356(01)00407-3

Tudor-Locke C, Craig CL, Thyfault JP, Spence JC. A step-defined sedentary lifestyle index: <5000 steps/day. Appl Physiol Nutr Metab. 2013;38(2):100-114. https://doi.org/10.1139/apnm-2012-0235 PMID:23438219 DOI: https://doi.org/10.1139/apnm-2012-0235

Koo TK, Li MY. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med. 2016;15(2):155-163. https://doi.org/10.1016/j.jcm.2016.02.012 PMID:27330520 DOI: https://doi.org/10.1016/j.jcm.2016.02.012

Nunes ACL, Jesus-Moraleida FR, Lima POP, Landers MR. Translation, cross-cultural adaptation, and measurement properties of the Brazilian-Portuguese version of the fear of falling avoidance behavior questionnaire in older adults. J Aging Phys Act. 2022;30(6):1014-1023. https://doi.org/10.1123/japa.2021-0425 PMID:35354670 DOI: https://doi.org/10.1123/japa.2021-0425

Acaröz Candan S, Demircioğlu A, Şahin ÜK. Cross-cultural adaptation and psychometric properties of the Fear of Falling Avoidance Behavior Questionnaire in Turkish community-dwelling older adults. Disabil Rehabil. 2021;43(23):3387-3394. https://doi.org/10.1080/09638288.2020.1734674 PMID:32135067 DOI: https://doi.org/10.1080/09638288.2020.1734674

Longhurst JK, Rider JV, Eckard K, et al. Factors predicting fear of falling avoidance behavior in parkinsonisms. NeuroRehabilitation. 2022;50(1):65-73. https://doi.org/10.3233/NRE-210267 PMID:34957961 DOI: https://doi.org/10.3233/NRE-210267

Rider JV, Longhurst JK, Lekhak N, Navalta JW, Young DL, Landers MR. Psychological factors associated with fear of falling avoidance behavior in Parkinson's disease: the role of depression, anxiety, and catastrophizing. J Geriatr Psychiatry Neurol. 2023 May;36(3):215-224. https://doi.org/10.1177/08919887221119974 PMID:35977708 DOI: https://doi.org/10.1177/08919887221119974

Nilsson MH, Drake AM, Hagell P. Assessment of fall-related self-efficacy and activity avoidance in people with Parkinson’s disease. BMC Geriatr. 2010;10(1):78. https://doi.org/10.1186/1471-2318-10-78 PMID:20973974 DOI: https://doi.org/10.1186/1471-2318-10-78

Landers MR, Navalta JW, Murtishaw AS, Kinney JW, Pirio Richardson S. A high-intensity exercise boot camp for persons with Parkinson disease: a phase II, pragmatic, randomized clinical trial of feasibility, safety, signal of efficacy, and disease mechanisms. J Neurol Phys Ther. 2019;43(1):12-25. https://doi.org/10.1097/NPT.0000000000000249 PMID:30531382 DOI: https://doi.org/10.1097/NPT.0000000000000249

Tennstedt S, Howland J, Lachman M, Peterson E, Kasten L, Jette A. A randomized, controlled trial of a group intervention to reduce fear of falling and associated activity restriction in older adults. J Gerontol B Psychol Sci Soc Sci. 1998;53(6):384-392. https://doi.org/10.1093/geronb/53B.6.P384 PMID:9826971 DOI: https://doi.org/10.1093/geronb/53B.6.P384

Dorresteijn TA, Zijlstra GA, Ambergen AW, Delbaere K, Vlaeyen JW, Kempen GI. Effectiveness of a home-based cognitive behavioral program to manage concerns about falls in community-dwelling, frail older people: results of a randomized controlled trial. BMC Geriatr. 2016;16(1):2. https://doi.org/10.1186/s12877-015-0177-y PMID:26739339 DOI: https://doi.org/10.1186/s12877-015-0177-y

Yardley L, Beyer N, Hauer K, Kempen G, Piot-Ziegler C, Todd C. Development and initial validation of the Falls Efficacy Scale-International (FES-I). Age Ageing. 2005;34(6):614-619. https://doi.org/10.1093/ageing/afi196 PMID:16267188 DOI: https://doi.org/10.1093/ageing/afi196

Lachman ME, Howland J, Tennstedt S, Jette A, Assmann S, Peterson EW. Fear of falling and activity restriction: the survey of activities and fear of falling in the elderly (SAFE). J Gerontol B Psychol Sci Soc Sci. 1998;53(1):43-50. https://doi.org/10.1093/geronb/53B.1.P43 PMID:9469171 DOI: https://doi.org/10.1093/geronb/53B.1.P43