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Background: Falls efficacy is a widely-studied latent construct in community-dwelling older adults. Various self-reported instruments have been used to measure falls efficacy. In order to be informed of the choice of the best measurement instrument for a specific purpose, empirical evidence of the development and measurement properties of falls efficacy related instruments is needed., Methods: The Consensus-based Standards for the Selection of Health Measurement Intruments (COSMIN) checklist was used to summarise evidence on the development, content validity, and structural validity of instruments measuring falls efficacy in community-dwelling older adults. Databases including MEDLINE, Web of Science, PsychINFO, SCOPUS, CINAHL were searched (May 2019). Records on the development of instruments and studies assessing content validity or structural validity of falls efficacy related scales were included. COSMIN methodology was used to guide the review of eligible studies and in the assessment of their methodological quality. Evidence of content validity: relevance, comprehensiveness and comprehensibility and unidimensionality for structural validity were synthesised. A modified GRADE approach was applied to evidence synthesis., Results: Thirty-five studies, of which 18 instruments had been identified, were included in the review. High-quality evidence showed that the Modified Falls Efficacy Scale (FES)-13 items (MFES-13) has sufficient relevance, yet insufficient comprehensiveness for measuring falls efficacy. Moderate quality evidence supported that the FES-10 has sufficient relevance, and MFES-14 has sufficient comprehensibility. Activities-specific Balance Confidence (ABC) Scale-Simplified (ABC-15) has sufficient relevance in measuring balance confidence supported by moderate-quality evidence. Low to very low-quality evidence underpinned the content validity of other instruments. High-quality evidence supported sufficient unidimensionality for eight instruments (FES-10, MFES-14, ABC-6, ABC-15, ABC-16, Iconographical FES (Icon-FES), FES-International (FES-I) and Perceived Ability to Prevent and Manage Fall Risks (PAPMFR))., Conclusion: Content validity of instruments to measure falls efficacy is understudied. Structural validity is sufficient for a number of widely-used instruments. Measuring balance confidence is a subset of falls efficacy. Further work is needed to investigate a broader construct for falls efficacy.

Patient-reported outcome measures (PROMs) provide clinicians a greater understanding of patients' perceived ability in their physical performance. Existing PROMs on falls efficacy provide meaningful information about the perceived ability in older people to perform common activities of daily living without falling. However, the perceived ability to recover balance from a slip, a trip, or volitional movements has been inadequately assessed. Balance recovery confidence relates to the judgment of self-reactive ability. The scale of balance recovery confidence (BRC) is a new PROM that measures perceived balance recovery self-efficacy. The purpose of the study protocol is to describe the first psychometric evaluation of BRC's measurement properties. This study is a validation phase of a newly developed PROM conducted in Singapore. Two hundred community-dwelling older adults, aged 65 years and older, will complete five self-reported instruments (BRC, Activities-specific Balance Confidence Scale, Falls Efficacy Scale-International, Late-Life Function and Disability Instrument-Function and Global Perceived Effect) and three performance measures (Hand strength dynamometer, 30-second Chair Stand, Mini BESTest). Classical test theory methods will assess acceptability, data completeness, targeting of the items, scaling assumptions, internal consistency reliability and construct validity. Factor analysis will establish unidimensionality. Rasch analysis will evaluate item fit, differential item functioning, response scale ordering, targeting of persons and items and the reliability. The findings from this study will be published in peer-reviewed journals and presented at national and international conferences in rehabilitation-specific context. This is the first validation study of BRC. The study will give confidence among clinicians and researchers to use the BRC in fall management research and clinical practice. [ABSTRACT FROM AUTHOR]

Background: The absence of patient-reported outcome measures (PROMs) for a specific construct or target population suggests a need for such measures to be developed. A case in point is the domain of falls efficacy; a PROM for balance recovery confidence was proposed to improve older persons' agency to arrest a fall. Appropriate participation in its development by relevant stakeholders was identified as essential to maximise the utility of the PROM and its potential to enhance patient care. There is a gap in the practice development literature in terms of PROMs for older persons. This article aims to encourage researchers to use the principles of practice development to address this gap by involving relevant stakeholders to gain greater insight. Methods: The nominal group technique and the Delphi technique were used to generate and refine the content of the measure, and content analysis was applied to assess and summarise the data. Findings: Unique themes emerged, such as 'agency of older people in the prevention of falls' from the community-dwelling older adults in Singapore, and 'clinical specificity' from an international panel of healthcare professionals. Common themes including 'relevance to the target population', 'comprehensibility' and 'cultural and contextual sensitivity' were found in both groups. Conclusion: A collaborative, inclusive and participatory approach involving different stakeholders, underpinned by practice development methodology, can offer rich insights for PROM developers. Implications for practice: • Meaningful perspectives are generated from a diversity of views shared by representatives from all stakeholder groups involved in caregiving • Participation of different stakeholders, such as physiotherapists, occupational therapists, nurses, doctors, podiatrists and older persons, provides a more robust and authentic approach to developing a PROM for older persons. [ABSTRACT FROM AUTHOR]