Development of a balance recovery confidence scale for community-dwelling older adults

Falls are concerning issues for older people. There is a lack of instruments that measure balance recovery confidence. Balance recovery confidence refers to the perceived ability to arrest falls. Patient-reported outcome measures (PROMs) are used to obtain information directly from the person being cared for. The overall aim of this thesis is to present the development of a PROM that measures balance recovery confidence in community-dwelling older adults. Methods: A sequential series of steps was taken to develop the PROM. First, a literature review was done to understand the self-efficacy theory, types of falls-related psychological concerns, PROMs used, the role of balance recovery control and the development of a PROM for the construct of interest. Four studies were then implemented. The first study systematically reviewed existing falls efficacy-related PROMs for their development, content validity and structural validity. The second study assessed the feasibility of studying near-falls and balance recovery among community-dwelling older adults. The third study constructed and validated the content of the balance recovery confidence scale with 22 community-dwelling older adults and 28 healthcare professionals. The final study assessed the psychometric properties of the newly developed PROM with 84 community-dwelling older adults in Singapore. Results and conclusions: Existing falls efficacy-related PROMs lack high-quality evidence in their development and content validity. The systematic review affirmed an absence of a suitable PROM of balance recovery confidence for community-dwelling older adults. The feasibility study demonstrated that balance recovery was a relatable concept for older adults. A 19-item balance recovery confidence scale was constructed and validated with experts' consensus. Field testing showed that the scale has excellent psychometric properties, having moderate correlations with the Activities-specific Balance Confidence Scale, Falls Efficacy Scale-International, Late Life Function and Disability Instrument-Function and strong correlation with reactive postural control performance.