Tinetti Falls Efficacy Scale

Original Editor - Sinead Greenan

Top Contributors - Sinead Greenan, Oyemi Sillo, Scott Buxton, Naomi O'Reilly and Evan Thomas

Objective

The Tinetti Falls Efficacy Scale is used to assess perception of balance and stability during activities of daily living and fear of falling in the elderly population, along with those diagnosed with Multiple Sclerosis

Intended Population

Community and hospital inpatients with acquired brain injury, multiple sclerosis, spinal cord injury, stroke and the elderly population.

Method of Use

  • The Tinetti Falls Efficacy Scale is a 10-item questionnaire designed to assess confidence in patients' ability to perform 10 daily tasks without falling as an indicator of how one's fear of falling impacts physical performance
  • Each item is rated from 1 ("very confident") to 10 ("not confident at all"), and the per item ratings are added to generate a summary total score
  • Total scores can range from 10 (best possible) to 100 (worst possible). Thus, lower scores indicate more confidence and higher scores indicate lack of confidence and greater fear of falling

Evidence

Reliability

Test-retest Reliability:

Geriatric: (Tinetti et al, 1990)[1]

  • Adequate test-retest reliability (r = 0.71)

Chronic Stroke: (Hellstrom & Lindmark, 1999; n = 30; mean age = 65 (11) years; stroke onset between 5 and 84 months prior to assessment) [2]

  • Excellent test-retest reliability (ICC = 0.97)

Validity

Criterion Validity:

Geriatric: (Huang & Wang, 2009)[3]

  • Adequate concurrent validity with the ABC Scale (r = -0.55)
  • Adequate concurrent validity with the Geriatric Fear of Falling Measurement (r = -0.57)

Geriatric: (Powell and Myers, 1995; n = 60 community-dwelling seniors aged 65-95; self-classified as either high or low in mobility confidence)[4]

  • Excellent correlation with the Activities Specific Balance Confidence Scale (ABC) (r = 0.84)

Spinal Cord Injury: (Wirz et al, 2010) [5]

  • Excellent concurrent validity with the Berg Balance Scale and the 16-item FES-I (r = -0.81)

Construct Validity:

Geriatric: (Huang & Wang, 2009)[3]

  • Poor correlation with age (r = -0.23)
  • Excellent correlation with balance (r = 0.66)
  • Excellent correlation with gait (r = 0.67)
  • Excellent correlation with mobility (r = 0.71)
  • Adequate correlation with fall history (r = -0.47)
  • Poor correlation with medical conditions (r = -0.18)
  • Adequate correlation with self-rated health status (r = 0.36)

Responsiveness

Elderly: (Powell & Myers, 1995)[4]

  • Large responsiveness between low and high mobility groups (Effect size = 1.20)

Elderly: (Harada et al, 1995; n = 53 individuals living in two residential care facilities for the elderly)[6]

  • Sensitivity (59%)
  • Specificity (82%)

Parkinson Disease: (Cakit et al 2007)[7]

  • FES scores improved significantly (p < 0.01) in treadmill group but not in control group. (Also significant score change for BBS and DGI). However, FES did not differentiate “fallers” and “non-fallers” at baseline nor after treadmill training

Resources

References

  1. Tinetti, M., Richman, D., et al. "Falls efficacy as a measure of fear of falling." Journal of gerontology 1990 45(6): P239
  2. Hellstrom, K. and Lindmark, B. "Fear of falling in patients with stroke: a reliability study." Clinical rehabilitation 1999 13(6): 509
  3. 3.0 3.1 Huang, T. T. and Wang, W. S. "Comparison of three established measures of fear of falling in community-dwelling older adults: psychometric testing." International Journal of Nursing Studies 2009 46(10): 1313-1319
  4. 4.0 4.1 Powell, L. and Myers, A. "The activities-specific balance confidence (ABC) scale." The Journals of Gerontology: Series A 1995 50(1): M28
  5. Wirz, M., Muller, R., et al. "Falls in persons with spinal cord injury: validity and reliability of the Berg Balance Scale." Neurorehabil Neural Repair 2010 24(1): 70-77
  6. Harada, N., Chiu, V., et al. "Screening for balance and mobility impairment in elderly individuals living in residential care facilities." Physical Therapy 1995 75(6): 462
  7. Cakt, B. D., Nacir, B., et al. "Cycling progressive resistance training for people with multiple sclerosis: a randomized controlled study." American Journal of Physical Medicine and Rehabilitation 2010 89(6): 446-457