Psychometric evaluation of the Sinhala version of the Falls Efficacy Scale-International in older adults with chronic obstructive pulmonary disease

Background: Fear of falling is common among older adults with Chronic Obstructive Pulmonary Disease (COPD) and is linked to activity restriction and poorer quality of life. The Falls Efficacy Scale-International (FES-I) is widely used to assess fear of falling; however, a validated Sinhala version was not available for this population.

Objective: To evaluate the psychometric properties of the Sinhala version of the 16-item Falls Efficacy Scale (FES-I) in older adults with COPD.

Methods: A cross-sectional study was conducted at the Central Chest Clinic and the National Hospital for Respiratory Diseases from August to September 2024. A total of 229 participants were recruited using a purposive sampling technique. The Falls Efficacy Scale-International (FES-I), translated into Sinhala, was used to assess fear of falling. Internal consistency was evaluated using Cronbach’s alpha. Construct validity was examined through exploratory factor analysis. Receiver operating curve (ROC) analysis was conducted to assess specificity and sensitivity and to determine the optimal cut-off score.

Results: The mean age was 70.71±6.83 years, and the mean FES-I score was 33.21±9.0. Internal consistency of the Sinhala FES-I was excellent, with a Cronbach’s alpha of 0.889. Exploratory factor analysis revealed four factors with eigenvalues ranging from 1.121 to 6.030. The four-factor model explained 69.3% of the total variance, indicating a multidimensional structure. Cut-off point for FES-I was 31.5, which differentiates between fallers from non-fallers with a sensitivity of 78.9% and a specificity of 60%.

Conclusions: The Sinhala version of the FES-I is a reliable and valid tool for assessing the level of fear of falling among Sinhala-speaking older adults with COPD in Sri Lanka.