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Med J Islam Repub Iran. 2014 Nov 18;28:131. eCollection 2014.

Clinical assessment of fear of falling after stroke: validity, reliability and responsiveness of the Persian version of the Fall Efficacy Scale-International.

Author information

1. Lecturer and Researcher, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences (IUMS), Tehran, Iran.
2. PhD in OT, Associate Professor, Department of Occupational Therapy, Rehabilitation Research Center, School of Rehabilitation Sciences, Iran University of Medical Sciences (IUMS), Tehran, Iran.
3. Assistant Professor, Iran University of Medical Science (IUMS), Firoozgar Hospital, Tehran, Iran.
4. Lecturer and Researcher, Institute for Cognitive Science Studies (ICSS), Tehran, Iran.



Fear of falling may be related to falling during stroke onset. The Fall Efficacy ScaleInternational (FES-I) with excellent psychometric properties, is an instrument developed to assess patients' concerns about fallings. The aim of this study was to determine validation of this scale in Iranian patients with stroke.


The "forward-backward" procedure was applied to translate the FES-I from English to Persian. One hundred-twenty patients who had suffered stroke, aged 40 to 80 years (55% male) completed the Persian FES-I, Geriatric Depression Scale-15 (GDS-15), General Health Questionnaire-28 (GHQ-28), Berg Balance Scale (BBS) and Timed up and Go (TUG) questionnaires. The interval time for the test-retest of the Persian scale was 7-14 days.


The test-retest and inter-rater reliabilities of the Persian FES-I were excellent (ICC2,1=0.98, p<0.001) and the internal consistency was high (Cronbach's alpha=0.78). Factor analysis of the 16 items in the Persian scale showed only one significant factor. The total Persian FES-I score had a significantly negative correlation (p<0.001) with the BBS, but it had significantly positive correlation with the TUG, GHQ-28, and GDS-15. The difference in responsiveness scores across fallers and non-fallers yielded a large effect size (0.46), which indicated a good discriminating validity.


The Persian FES-I proved to be an effective and valuable measurement tool to assess stroke patients' fear of falling in practice and research setting.


Fall Efficacy Scale-International (FES-I); Psychometric properties; Reliability; Stroke; Validity


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