Annals of Physiotherapy & Occupational Therapy ISSN: 2640-2734 Validation of the Gujarati and Hindi Versions of Modified Falls Efficacy Scale 1 2 Joshi S * and Kumar GP Research Article 1Ashok and Rita Patel Institute of Physiotherapy, Charusat University, India Volume 1 Issue 1 2Sumandeep Vidyapeeth, India Received Date: September 18, 2018 Published Date: October 25, 2018 *Corresponding author: Shuchi Joshi, Assistant Professor, Ashok and Rita Patel DOI: 10.23880/aphot-16000106 Institute of Physiotherapy, Charusat university, India, Tel: 91 9714753839; Email: [email protected] Abstract Background: Frail, old patients with and without cognitive impairment are at high risk of falls and associated medical and psychosocial issues. The Modified Falls Efficacy Scale (MFES) was developed to assess fear of falling and it is shown to be a reliable and valid measure of falls self-efficacy in western countries. The lack of adequate, validated instruments has partly hindered research in this field. Methodology: The ‘forward-backward’ translation procedure was applied to translate the MFES into Hindi and Gujarati. Harmonization was done by expert panel review and pilot testing over 10 subjects. The questionnaires were then finalized.98 participants (70-Gujarati MFES; 28-Hindi MFES), meeting inclusion-exclusion criteria and willing to participate were included in the study. Interview regarding general health and fall history was taken. Gujarati MFES and Hindi MFES data were collected and Berg Balance Scale was performed. Results: The analysis of internal validity of the Gujarati and Hindi MFES revealed that the scale items presented adequate internal consistency (Cronbach’s alpha: Gujarati MFES- 0.993, Hindi MFES-0.992).The Gujarati MFES showed strong positive correlation with BBS (r=0.820, P value=0.000) and a strong negative correlation with age (r= -0.351, P value=0.003). The Hindi MFES showed a moderate positive correlation with BBS (r=0.565, P value=0.002) and a weak negative correlation with age (r= -0.297, P value= 0.125). Conclusion: The Gujarati version of MFES is a valid and measure to estimate fall-related efficacy in older adults who have Gujarati as their first language. The Hindi version of MFES shall have its validity established with a larger sample size. Keywords: Fall-Related Efficacy; Validity; Modified Falls Efficacy Scale; Berg Balance Score Introduction 60 years and older [1]. According to WHO, the size of the elderly population in India increased from 20 million in Over the next several decades, the elderly people will 1951 to 57 million in 1991 and was about 107 million in represent a large segment of the population. In India, a 2010, which is expected to grow upto 198 million in 2030 ‘senior citizen’ or ‘older adult’ is defined as a person aged and 326 million in 2050 [2]. The average remaining Validation of the Gujarati and Hindi Versions of Modified Falls Efficacy Scale Ann Physiother Occup Ther 2 Annals of Physiotherapy & Occupational Therapy length of life is around 18 years (16.7 years for men, 18.9 level and other than as a consequence of sustaining a years for women) at age 60 years and 12 years (10.9 violent blow, loss of consciousness, sudden onset of years for men and 12.4 years for women) at age 70 years paralysis as in stroke or an epileptic seizure [3]. In other [1]. The rapid increase in the number of old people in the words, a “fall” is when a sudden, unintended loss of population also raises various social, economic and health balance leaves the individual in contact with the floor or issues. Elderly people have common problems like another surface such as a step or chair [2]. A near faller is impaired mobility, falls, impaired cognition, urinary defined as a person who tends to fall unintentionally but incontinence, etc. Out of these, falls are common events in not due to extrinsic factor. He /she are supported by the lives of older people and can result in a range of somebody else nearby in the event, otherwise he/she adverse outcomes, from minor bruises to fractures, would suffer from fall. disability, dependence and death [2]. In the US, 30% of individuals aged 65 years and older fall at least once a Falls can result from diverse causes which can be year. In Japan, the prevalence of falls was 13.7%, and in classified into intrinsic and extrinsic factors. Intrinsic China it was 26.4%. In India, the prevalence of falls among factors commonly include postural hypotension, weak older adults aged 60 years and older was 14% to 53% [1]. lower limb strength, impaired balance and slow gait speed. Extrinsic factors include uneven ground, wet floor In 1987, the Kellogg International Working Group on or dark environment. Falls and fear of falling is closely the prevention of falls in the elderly defined the falls as correlated [4]. “unintentionally coming to the ground or some lower Figure 1: Risk Factors for falls. Evidences suggest that fall-related injuries in older Older people who have suffered a fall are at increased adults are age and gender related, leading to high risk of falling again. In a prospective study of 325 healthcare consumption, costs, and long-term reduced community dwelling persons who had fallen in the quality of life. Further implementation of falls prevention previous year, Nevitt, et al. found that 57 experienced at strategies is needed to control the burden of fall-related least one fall in a 12-month follow up period and 31% had injuries in the aging population. They can result in a range 2 or more falls. Falling is also more prevalent in frailer of adverse outcomes, from minor bruises to fractures, older people than vigorous ones, in those who had disability, dependence and death [5]. In 2008, 64% of difficulties undertaking ADLs, and in those with particular adults over 65 years of age reported limitations in at least medical conditions that affect posture, balance and gait. In one domain of physical function-walking, climbing, independent older community dwelling people, about standing, sitting, stooping, reaching, grasping, carrying, 50% of falls occur within their homes and immediate and/or pushing [6]. surroundings. Most falls occur on level surfaces within community used rooms such as bedroom, living room and Joshi S and Kumar GP. Validation of the Gujarati and Hindi Versions of Modified Copyright© Joshi S and Kumar GP. Falls Efficacy Scale. Ann Physiother Occup Ther 2018, 1(1): 000106. 3 Annals of Physiotherapy & Occupational Therapy kitchen. Comparatively few falls occur in the bathroom, Among elderly persons who are afraid of falling, up to on stairs or from ladders and stools. The remaining falls 70% acknowledge avoiding activities because of this fear. occur in public places and other people’s homes. In some cases, individuals become housebound as a result of their fear. Activity restriction is, in itself, a risk factor The location of falls is related to age, sex and frailty. In for falls because it can lead to muscle atrophy, community dwelling elderly women, the number of falls deconditioning and poorer balance. Curtailment of occurring outside the home decreased with age, with a activities can also lead to social isolation. Thus, fear of corresponding increase in the number of falls occurring falling can contribute to both functional decline and inside the home on a level surface. Campbell et al. found impaired quality of life. that fewer men than women fell inside the home (44% versus 65%) and more men fell outside (25% versus The objective of conducting a validity analysis is to 11%). Thus the occurrence of falls is strongly related to ensure that the underlying scale measures what it is exposure, i.e. they occur in situations where older people supposed to measure. Therefore, a scale is valid to the are undertaking their usual daily activities. Most falls extent that it measures what it is intended to measure. occur during periods of maximum activity in the morning The validity of a translated questionnaire can be or afternoon, and only about 20% occur between 9 p.m. examined by content validity, criterion validity and and 7 a.m. construct validity. Content validity is defined as the extension to which a measurement reflects the specific Depending on the population under study, between intended domain of content. Concurrent validity is a 22% and 60% of older people suffer minor injuries from measurement of an agreement in terms of responses falls, 10-15% suffers serious injuries, 2-6% suffers collected from a translated questionnaire versus the fractures and 0.2-1.5% suffers hip fractures. The most questionnaire regarded as the gold standard. Construct commonly self-reported injuries include superficial cuts validity looks into the agreement between a theoretical and abrasions, bruises and sprains. The most common concept and a specific measuring procedure. Construct injuries that require hospitalization comprise femoral validity can further be subdivided into convergent validity neck fractures, other fractures of the leg, radius, ulna and and discriminate validity. Convergent validity is a general other bones in the arm and fractures of the neck and agreement between measures where theoretically they trunk. Elderly people recover slowly from hip fractures should be related. On the other hand, discriminate validity and are vulnerable to post-operative complications. In is a general disagreement between measures where many cases, hip fractures result in death and those who theoretically they should not be related. survive, may never regain complete mobility. The prevalence of fear of falling was various from 12% to 65% of community-dwelling elderly aged of 60 years or above. Falls can result in restriction of activity and fear of falling, reduced quality of life and independence.