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Vol. 22. Issue 4.
Pages 255-344 (01 July 2018)
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Vol. 22. Issue 4.
Pages 255-344 (01 July 2018)
Original Research
DOI: 10.1016/j.bjpt.2018.01.003
Cross-cultural adaptation and measurement properties testing of the Iconographical Falls Efficacy Scale (Icon-FES)
Marcia Rodrigues Francoa,
Corresponding author

Corresponding author at: Faculdade de Ciências e Tecnologia, Departamento de Fisioterapia, Universidade Estadual Paulista – UNESP, Rua Roberto Simonsen 305, Presidente Prudente, São Paulo, CEP 19060-900, Brazil.
, Rafael Zambelli Pintob, Kim Delbaerec, Bianca Yumie Etoa, Maíra Sgobbi Fariaa, Giovana Ayumi Aoyagia, Daniel Steffensd,e, Carlos Marcelo Pastrea
a Departamento de Fisioterapia, Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista UNESP, Presidente Prudente, SP, Brazil
b Departamento de Fisioterapia, Universidade Federal de Minas Gerais UFMG, Belo Horizonte, MG, Brazil
c Neuroscience Research Australia (Neura), University of New South Wales, Sydney, NSW, Australia
d Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Sydney, NSW, Australia
e Sydney Medical School, The University of Sydney, Sydney, NSW, Australia

  • Icon-FES uses pictures of daily activities to assess concern of falling.

  • Icon-FES-Brazil is a semantically and linguistically appropriate tool.

  • The 30-item and 10-item Icon-FES-Brazil showed acceptable measurement properties.

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Tables (4)
Table 1. Original version, consensus Brazilian-Portuguese version, back translations and final Brazilian-Portuguese version of the Icon-FES instructions, items and 4-point scale.
Table 2. Participants’ characteristics.
Table 3. Descriptive analyses, internal consistency analysis, test–retest reliability, standard error of the measure, minimal detectable change and construct validity of the 30-item and 10-item Icon-FES questionnaire.
Table 4. Means and standard deviation of 30-item Iconographical Falls Efficacy Scale (Icon-FES; 30–120 scale), 10-item Icon-FES (10–40 scale) and medians and interquartile range of Falls Efficacy Scale – International (FES-I, 16–64 scale) for subgroups based on demographic characteristics, fall risk factors and cognitive performance.
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The Iconographical Falls Efficacy Scale (Icon-FES) is an innovative tool to assess concern of falling that uses pictures as visual cues to provide more complete environmental contexts. Advantages of Icon-FES over previous scales include the addition of more demanding balance-related activities, ability to assess concern about falling in highly functioning older people, and its normal distribution.


To perform a cross-cultural adaptation and to assess the measurement properties of the 30-item and 10-item Icon-FES in a community-dwelling Brazilian older population.


The cross-cultural adaptation followed the recommendations of international guidelines. We evaluated the measurement properties (i.e. internal consistency, test–retest reproducibility, standard error of the measurement, minimal detectable change, construct validity, ceiling/floor effect, data distribution and discriminative validity), in 100 community-dwelling people aged ≥60 years.


The 30-item and 10-item Icon-FES-Brazil showed good internal consistency (alpha and omega >0.70) and excellent intra-rater reproducibility (ICC2,1=0.96 and 0.93, respectively). According to the standard error of the measurement and minimal detectable change, the magnitude of change needed to exceed the measurement error and variability were 7.2 and 3.4 points for the 30-item and 10-item Icon-FES, respectively. We observed an excellent correlation between both versions of the Icon-FES and Falls Efficacy Scale – International (rho=0.83, p<0.001 [30-item version]; 0.76, p<0.001 [10-item version]). Icon-FES versions showed normal distribution, no floor/ceiling effects and were able to discriminate between groups relating to fall risk factors.


Icon-FES-Brazil is a semantically and linguistically appropriate tool with acceptable measurement properties to evaluate concern about falling among the community-dwelling older population.

Older people
Fear of falling
Accidental falls
Measurement properties


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