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Background The 16-item Falls Efficacy Scale International (FES-I) is widely used to assess concerns-about-falling. Variants include 7-item Short FES-I, 30-item Iconographical Falls Efficacy Scale (Icon FES) and 10-item short Icon FES. No comprehensive systematic review and meta-analysis has been conducted to synthesise evidence regarding the measurement properties of these tools. Objectives To conduct a systematic review and meta-analysis of the measurement properties of four FES-I variants. Methods MEDLINE, Embase, CINAHL Plus, PsycINFO and Web of Science were searched systematically and articles were assessed for eligibility independently. The methodological quality of eligible studies was assessed using COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) Risk of Bias checklist. The quality of measurement properties was assessed using COSMIN criteria for good measurement properties. Where possible, meta-analysis was conducted; otherwise, narrative synthesis was performed. Overall certainty of evidence was rated using a modified Grading of Recommendations, Assessment, Development and Evaluation system approach. Results The review included 58 studies investigating measurement properties of the four instruments. There was high-quality evidence to support internal consistency, reliability and construct validity of all instruments. Moderate- to high-certainty evidence suggests one-factor structure of FES-I with two underlying dimensions, one-factor structure of Short FES-I and two-factor structure of Icon FES. There was high-certainty evidence to support the responsiveness of FES-I, with further research needed for the other instruments. Conclusion There is evidence for excellent measurement properties of all four instruments. We recommend the use of these tools with healthy older people and people at a greater risk of falls due to conditions that might affect mobility and balance.

Background the Pictorial Fit-Frail Scale (PFFS) was designed as a simple and practical approach to the identification of frailty. Objectives To investigate the feasibility and reliability of this visual image-based tool, when used by patients, caregivers and healthcare professionals (HCPs) in clinical settings. Design observational study. Setting three outpatient geriatric healthcare settings. Subjects patients (n = 132), caregivers (n = 84), clinic nurses (n = 7) and physicians (n = 10). Methods the PFFS was administered to all patients. Where available, HCPs and caregivers completed the scale based on the patients’ health. In the geriatric day hospital, the PFFS was completed on admission and administered again within 7–14 days. Time and level of assistance needed to complete the scale were recorded. Intraclass correlation coefficients (ICCs) and 95% confidence intervals (CIs) were used to assess test−retest and inter-rater reliability. Results mean time to complete the scale (minutes:seconds ± SD) was 4:30 ± 1:54 for patients, 3:13 ± 1:34 for caregivers, 1:28 ± 0:57 for nurses and 1:32 ± 1:40 for physicians. Most patients were able to complete the scale unassisted (64%). Mean patient PFFS score was 11.1 ± 5.3, mean caregiver score was 13.2 ± 6.3, mean nurse score was 10.7 ± 4.5 and mean physician score was 11.1 ± 5.6; caregiver scores were significantly higher than patient (P Conclusion the PFFS is a feasible and reliable tool for use with patients, caregivers and HCPs in clinical settings. Further research on the validity and responsiveness of the tool is necessary.

The recently developed Pictorial Fit-Frail Scale (PFFS) is an image-based tool that was designed to be easy to administer, sensitive to cultural differences, and a practical approach to identifying frailty compared to other frailty measures. The feasibility, reliability, validity, and responsiveness of the PFFS are currently being tested across three settings: geriatric day hospital (GDH), memory clinic, and primary care clinic. Preliminary analysis was conducted on data from all sites (n=80) to investigate the feasibility (time taken to complete the scale) and inter-rater reliability of the PFFS. Test-rest reliability was conducted on GDH data where patients attended at two time-points (retest within 7–14 days of initial visit; n=42). At all sites, when available, caregivers, nurses, and physicians completed the scale based on the patients’ health. PFFS scores can range from 0–43. A Frailty Index (FI) was constructed based on PFFS scores. Time taken to complete the scale was 4.9 ± 2.4 minutes for patients (n=46), 3.5 ± 1.4 for caregivers (n=43), 1.5 ± 1.1 for nurses (n=72), and 1.9 ± 2.0 for physicians (n=42). Mean patient PFFS score was 15.2 ± 7.0 (FI=0.36 ± 0.16), mean caregiver score was 19.9 ± 8.6 (FI=0.46 ± 0.20), mean nurse score was 15.4 ± 7.5 (FI=0.36 ± 0.18), and mean physician score was 19.2 ± 8.0 (FI=0.44 ± 0.18). There was no significant difference in scores between raters (p>.05). Test-retest reliability was good for patients (ICC=0.70) and nurses (ICC=0.80). Inter-rater reliability between patients/caregivers (ICC=0.83) and nurses/physicians (ICC=0.87) was good. Preliminary findings suggest the PFFS is a feasible and reliable tool, however further analysis is necessary with a larger sample.