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Total Spinal Cord Injury Falls Concern Scale (SCI-FCS) score (median and interquartile range) on subject characteristics along with results of Mann-Whitney U test
Source publication
Translation of the Spinal Cord Injury Falls Concern Scale (SCI-FCS); validation and investigation of psychometric properties.
Translation, adaptation and validation study.
Eighty-seven wheelchair users with chronic SCI attending follow-up at Rehab Station Stockholm/Spinalis, Sweden.
The SCI-FCS was translated to Swedish and culturally adapted accor...
Context in source publication
Context 1
... with shorter time since injury, who answered 'yes' to the question on FOF, reported higher values on the Hospital Anxiety and Depression Scale, Fatigue Severity Scale or Secondary Conditions Scale and were unable to get up from the ground unaided reported a higher total score on the SCI-FCS (Table 2). ...
Citations
... Falls may result in serious injuries, with the most common including fractures, concussions, and post-fall syndrome; characterized by a fear of falling that results in avoidance of activities that the person could physically perform [1,4]. Post-fall syndrome is common, with 47-63% of people with spinal cord injuries or diseases (SCI/D) and 49% of people with stroke reporting a concern about falling that limits activity and participation [5][6][7], and it results in a loss of independence, reduced balance confidence, depression, and immobilization [8,9]. People at the highest risk of falls are individuals living with neurological injury or disease. ...
Background
Most individuals living with spinal cord injuries/diseases (SCI/D) or stroke experience at least one fall each year; hence, the development of interventions and technologies that target balance control is needed. The purpose of this study was to identify and explore the priorities for balance-focused interventions and technologies from the perspectives of end-users to assist with the design of an intervention that combines functional electrical stimulation (FES) with visual feedback training for standing balance.
Methods
Two individuals with SCI/D, one individual with stroke, two physical therapists (PT) and one hospital administrator were recruited. Participants attended three focus group meetings that followed a participatory co-design approach. A semi-structured interview guide, developed from the FAME (Feasibility, Appropriateness, Meaningfulness, Effectiveness, Economic Evidence) framework, was used to lead the discussion, querying participants’ experiences with balance deficits and interventions, and FES. Meetings were audio-recorded and transcribed verbatim. An iterative and reflexive inductive thematic analysis was applied to the transcripts by three researchers.
Results
Four themes were identified: (1) Balance is meaningful for daily life and rehabilitation. Participants acknowledged various factors influencing balance control and how balance deficits interfered with participation in activities. End-users stressed the importance of continuing to work on one’s balance after discharge from hospital-based rehabilitation. (2) Desired characteristics of balance interventions. Participants explained that balance interventions should be tailored to an individual’s unique needs and goals, relevant to their lives, balance their safety and risk, and be engaging. (3) Prior experiences with FES to inform future therapeutic use. Participants with stroke or SCI/D described initial apprehension with FES, but experienced numerous benefits that motivated them to continue with FES. Challenges with FES were mentioned, including wires, cost, and time of set up. (4) Potential role of FES in balance interventions. Participants felt that FES would complement balance interventions; however, they had not experienced this combination of therapies previously.
Conclusions
End-users described how their experiences with balance deficits, rehabilitation, and FES informed their priorities for balance interventions. The findings inform the design and implementation of future balance interventions for individuals with SCI/D or stroke, including an intervention involving FES and visual feedback training.
... First, we did not include measures of depression or anxiety in this study, which is a notable limitation. Depression and anxiety were previously found to be associated with a fear of falling in individuals with SCI who use a wheelchair (54). Second, 11 (15%) of our participants were lost to follow-up, which was more than the 10% we estimated. ...
Introduction
Individuals with spinal cord injury (SCI) experience reduced participation in meaningful activities, leading to reduced social engagement and negative psychological impact. Two factors that may affect participation post-SCI are fall status (e.g., having experienced a fall) and having a fear of falling. Our objective was to examine if and how fall status and fear of falling impact participation, autonomy and life satisfaction in the first year post-injury.
Methods
Adult inpatients of a SCI rehabilitation hospital were recruited. Following discharge, falls were tracked for 6 months and participants who fell at least once were categorized as “fallers”. At the end of the 6-month period, the Impact on Participation and Autonomy Questionnaire and Life Satisfaction Questionnaire 9 were administered, and participants were asked if they had a fear of falling (i.e., an ongoing concern about falling leading to the avoidance of activities they are capable of doing). Falls were reported using descriptive statistics. Ordinary least squares regression was used to evaluate the relationships between the independent variables (i.e., fall status and fear of falling) and each dependent variable (i.e., questionnaire scores).
Results
Seventy-one individuals were enrolled in the study; however, 11 participants were lost to follow-up. The included participants ( n = 60) were 58.4 ± 14.6 years old and 99 ± 60.3 days post-injury. Over one third (38.3%) of participants fell over the 6-month tracking period. Twenty-seven participants (45%) reported a fear of falling and 14 (51.9%) of these participants were fallers. Fear of falling significantly predicted scores of autonomy indoors (β = 3.38, p = 0.04), autonomy outdoors (β = 2.62, p = 0.04) and family role (β = 3.52, p = 0.05).
Conclusion
Individuals with subacute SCI and a fear of falling experienced reduced participation and autonomy, but with no differences in life satisfaction compared to those without a fear of falling. In contrast, having experienced a fall did not impact participation, autonomy or life satisfaction. In the first year after SCI, rehabilitation programs should place specific attention on the presence of fear of falling to help individuals with SCI prepare for everyday mobility challenges.
... In the literature, the fear of falling varied between 50% and 60% in patients with spinal injuries 5,6 and between 50% and 82% in patients with chronic low back pain. 27,33 Fear of falling is associated with disability, affecting the movement and functional limitations of the elderly. 27 In the regression analysis, we found that fear of falling increased with elderly patients who underwent spinal surgery. ...
This study aimed to examine the relationship between fear of falling in elderly patients who underwent spinal surgery and pain, kinesiophobia, anxiety, depression, and associated factors. The study was a descriptive, cross-sectional design. The research sample consisted of 211 elderly patients who had undergone spinal surgery. The average age of the patients was 66.68 ± 5.57. Of the sample, 83.4% were afraid of falling, and 21.3% were severely afraid of falling. In the study, age (β = 0.115, p = 0.005), being a woman (β = −0.182, p < 0.001), pain (β = 0.269, p < 0.001), risk of falling (β = 0.084, p = 0.49), Hospital Anxiety and Depression Scale-Anxiety (HADS-A) (β = 0.135, p = 0.044), Hospital Anxiety and Depression Scale Anxiety-Depression (HADS-D) (β = 0.382, p < 0.001), and kinesiophobia (β = 0.722, p < 0.001) were statistically significant predictors of fear of falling. This study provided important information about the variables that surgical nurses should pay attention to while evaluating the fear of falling in elderly patients who underwent spinal surgery.
... Considering its usefulness within both research and clinical contexts, the SCI-FCS has been translated to various languages (Swedish, Norwegian, Italian, and Thai) and all translated versions demonstrated adequate measurement properties and clinical applicability [12][13][14][15]. ...
... (1) SCI characteristics, (2) sociodemographic data (age, sex, schooling), (3) occurrence of falls and fall-related injuries over the past year, and (4) self-perceived fear of falling, which was assessed as follows: "In general, are you afraid of falling?" (1 = not at all; 2 = a little; 3 = quite a bit; 4 = very much) [10,14]. Item 1 was collected from the electronic medical records and items 2-4 from the interviews. ...
... As reported in Table 1, the 100 phase II recruited participants, 75% men, had a mean age of 37 (14) years. Their time since SCI was 4.2 years (5.7) and their median SCIM III score was 53 (IQR 36-65). ...
Psychometric study.
To cross-culturally adapt the spinal cord injury-falls concern scale (SCI-FCS) to the Brazilian Portuguese language and to evaluate its measurement properties.
SARAH Network of Rehabilitation Hospitals, Belo Horizonte, Brazil.
The SCI-FCS was translated and culturally adapted to the Brazilian- Portuguese language, following recommended guidelines. The following measurement properties were verified: internal consistency (Cronbach’s α), test–retest reliability (ICC and quadratic-weighted kappa coefficients), and construct validity (Rasch analysis).
One-hundred and thirty individuals participated. The median SCI-FCS-Brazil score was 27 (22–34). The Cronbach’s α was 0.95; ICC was 0.92 (95% CI, 0.86–0.95) for the total test–retest scores, and the Kappa coefficients ranged from 0.04 to 0.87 (95% CI, 0.01–1) for the item-level reliability. Rasch analysis reliability index was 0.81 and 0.98 and the separation index was 2.10 and 6.25 for the persons and items, respectively. Both items and persons fitted the statistics model’s expectations, ensuring its unidimensionality.
The SCI-FCS-Brazil showed adequate measurement properties. Its use in manual wheelchair users with SCI is recommended to help defining rehabilitation strategies.
... Among the participants who reported FOF, 65% reported that they limited performance of specific activities because of their FOF. 8 Although research identifying influences on the development of FOF among individuals who use wheelchairs full time is only just emerging, important insights have been revealed by Butler et al, 12 who studied 87 wheelchair users living with SCI and found FOF to be associated with a shorter duration since injury, depression, anxiety, and fatigue. In addition, reports of FOF were higher among study participants who were unable to get up from the ground independently. ...
Objective
To examine the differences in community participation and quality of life (QOL) among people who use wheelchairs full time with and without fear of falling (FOF).
Design
Cross-sectional study design
Setting
University research laboratory
Participants
Data from 85 people who use a manual or power wheelchair full time living with various health conditions, and have a history of at least one fall in the past 12 months (age=45.4±15.8 years, disability duration=21.5±13.6 years, manual wheelchair user, n= 46, 54%) were analyzed.
Intervention
Not applicable
Main Outcome Measures
To quantify FOF, participants responded (yes/no) to the question: “Are you worried or concerned that you might fall?” Community participation and QOL were indexed by the Community Participation Indicator (CPI) and the World Health Organization Quality of Life-Brief version (WHOQOL-BREF), respectively. A Multivariate Analysis of Variance (MANOVA) was performed to examine the differences in CPI and WHOQOL-BREF scores among wheelchair users who reported FOF and no FOF.
Results
A total of 54 participants (63.5%) reported that they were worried or concerned about falling. The MANOVA revealed significant differences in overall CPI (F (2,82) = 4.714, p=0.012, Wilks’ λ = 0.897), and WHOQOL-BREF (F (4,63) = 3.32, p=.016, Wilks’ λ = .826) scores. Participants who reported a FOF, demonstrated significantly lower CPI and WHOQOL-BREF scores compared to those who did not report a FOF.
Conclusion
FOF and associated activity curtailment are prevalent and may be a factor influencing full time wheelchair users’ community participation, and QOL. Prospective research is needed to better understand how FOF influences community participation and QOL among people who use wheelchairs full time. Findings would support the development of interventions, specifically for people who use wheelchairs full time, to reduce FOF and improve community participation and QOL.
... Also, in this case, the average result (25.53 ± 16.7) was compared to another study that used the SCI-FCS. The correlation showed higher results obtained by the current population compared to the average results in larger samples that included people with acute SCI in England (23.0) [33], Norway (22.0) [34], Italy (18.7) [28,33], and Sweden (21.0). We postulate the high levels of satisfaction with the aid and low levels regarding the concern of falling are because the included individuals had undergone measurement and training prior to the use of the device and study participation. ...
... Also, in this case, the average result (25.53 ± 16.7) was compared to another study that used the SCI-FCS. The correlation showed higher results obtained by the current population compared to the average results in larger samples that included people with acute SCI in England (23.0) [33], Norway (22.0) [34], Italy (18.7) [28,33], and Sweden (21.0). We postulate the high levels of satisfaction with the aid and low levels regarding the concern of falling are because the included individuals had undergone measurement and training prior to the use of the device and study participation. ...
Observational study.
To describe (1) user satisfaction, (2) the Quality of Life (QoL) and (3) fear of falling in individuals with tetraplegia or paraplegia who used a mono-ski for sit-skiing.
Spinal units and Sport associations.
An observational study of people with spinal cord injury (SCI) who used a sit-ski. Participants were recruited in various SCI rehabilitation centers and sport associations. Participants completed three assessment tools: the Quebec User Evaluation of Satisfaction with assistive Technology (QUEST 2.0); the World Health Organization Quality of Life (WHOQoL-BREF); the Spinal Cord Injury Fall Concern Scale (SCI-FCS). Results were evaluated with chi-squared test and Kolmogorov–Smirnov’s test and the significance was set for p values < 0.05.
Fifteen participants were included. Results showed positive and statistically significant values for all the items of the SCI-FCS related to fear of falling, and for most of the items of the WHOQoL-BREF related to QoL and the QUEST 2.0 related to satisfaction with the device.
This study highlights that sit skiing is correlated with high levels of satisfaction with the mono-ski, increases in QoL, and low levels of fear of falling. In adding these findings to the existent literature, it can be stated with more certainty that sit-skiing is a sport that can be recommended in rehabilitation and sports therapy programs.
... The SCI-FCS consists of 16 activities that are related to daily living activities for a wheelchair user with SCI; for example, transferring in/out of bed, pushing a wheelchair on an uneven surface, and pushing a wheelchair up/down a slope [9]. The SCI-FCS has been translated to other languages, including, Swedish, Norwegian, and Italian [10][11][12]. High psychometric properties of the SCI-FCS were presented in previous studies [9][10][11][12]. ...
... The SCI-FCS has been translated to other languages, including, Swedish, Norwegian, and Italian [10][11][12]. High psychometric properties of the SCI-FCS were presented in previous studies [9][10][11][12]. ...
... Cross-cultural adapted items 2 Moving around the bed (including sitting up) Moving around the bed (including sitting up, supine to side lying, moving in each direction while supine or sitting position and sitting up) 3 Inserting enema or toileting Inserting enema or toileting, and cleaning after defecation or urination 10 Cooking or food preparation (e.g., making a sandwich, stirring food on the stove) ...
Translation and adaptation study.
To translate and cross culturally adapt the Spinal Cord Injury Falls Concern Scale (SCI-FCS) English version into Thai, and to examine content validity, internal consistency and test-retest reliability.
A tertiary rehabilitation center in Thailand.
The SCI-FCS was translated into Thai and culturally translated according to guidelines for the process of cross-cultural adaptation of self-report measures. Content validity was examined by the Index of item-objective congruence (IOC). Moreover, internal consistency and test-retest reliability were tested by the Cronbach’s alpha coefficient and intraclass correlation coefficient (ICC) models (3, 1), respectively.
Three items were modified to accommodate cultural differences. After synthesis and cross adaptation, the IOC was 1.0. The Cronbach’s alpha coefficient was 0.88 (range 0.86–0.89) and the ICC of total scores was 0.99 (P < 0.001, range of the subitems 0.98–1). In addition, items that Thai participants scored as being the highest concern of falling were item 13: pushing wheelchair up/down gutters or curbs, item 14: pushing wheelchair up/down a slope, and item 12: pushing wheelchair on an uneven surface.
The SCI-FCS-Thai version is a reliable and valid outcome measure for assessing concern about falling in wheelchair users with SCI in Thailand.
... Even in the absence of a fall history, many individuals living with SCI who use a wheelchair full-time have concerns about falling. 6,7 Such concerns can be detrimental to independence and QOL because they can limit a person's willingness and confidence to participate in both home and community activities. 6 The potential for fall-related concerns to impact QOL among people living with SCI heightens the importance of proactively identifying and mitigating these concerns. ...
Objective: To conduct a pilot study of an intervention to decrease fall incidence and concerns about falling among individuals living with Spinal Cord Injury who use manual wheelchairs full-time.
Design: Pre/post. After a baseline assessment, a structured intervention was implemented. The assessment protocol was repeated 12 weeks after the baseline assessment.
Setting: Research laboratory and community.
Participants: 18 individuals living with SCI who use a manual wheelchair full-time with an average age of 35.78 ± 13.89 years, lived with SCI for 17.06 ± 14.6 years; 61.1% were female.
Intervention: A 1:1, 45 minute, in-person intervention focused on factors associated with falls and concerns about falling: transfers skills and seated postural control.
Outcome measures: Participants reported fall incidence and completed the Spinal Cord Injury Fall Concerns Scale, Community Participation Indicators and the World Health Organization Quality of Life – short version (WHOQOL-BREF). Transfer quality was assessed with the Transfer Assessment Instrument (TAI) and seated postural control with the Function In Seating Test (FIST).
Results: Recruitment, assessment and delivery of the intervention were successfully completed. After exposure to the intervention, fall incidence significantly decreased, (P = 0.047, dz = 0.507) and FIST scores improved (P = 0.035, dz = 0.54). Significant improvements were also found in the WHOQOL-BREF Physical (P = 0.05, dz = 1.566) and Psychological (P = 0.040, dz = 0.760) domains.
Conclusion: The feasibility of the structured intervention was established and the intervention has the potential to reduce fall incidence and improve quality of life among individuals living with SCI who use a wheelchair. Appropriately powered randomized controlled trials of the program are warranted.
... The presence of upper limb pain was also shown to affect the perceived difficulty of transfer performance and increased the sense of anxiety people might experience during the performance of wheelchair transfers. This is particularly important considering transfers have a great influence on the overall fear of falling that wheelchairs users might experience [30]. Anxiety might also negatively affect performance and increase the risk of falls as it has been documented for walking, particularly among elderly respondents [31]. ...
Purpose: Being able to transfer in and out of their wheelchair is an important task for wheelchair users that can be affected by a variety of different factors. The aim of this study was to investigate the interplay between personal characteristics, wheelchair users’ transferring technique and the other factors that can affect the performance of wheelchair transfers.
Method: A cross-sectional survey study was designed to recruit wheelchair users, aged 18 or older, performing sitting-pivot or standing-pivot wheelchair transfers, independently or with assistance.
Results: Forty-two usable surveys were returned. Transferring technique is usually determined by the individual’s impairment. In turn, transferring technique will greatly affect the perceived difficulty of different types of wheelchair transfers and, the number of transfers that people will perform in a day. The presence of upper limb pain increased the difficulty reported for certain types of transfers while the use of assistive technologies appears to be only partially successful in facilitating the performance of wheelchair transfers.
Conclusion: This study highlights the complexity of the factors included in the performance of wheelchair transfers. Findings from this survey can be utilized to broaden the boundaries of future research.
• Implications for rehabilitation
• Transferring technique is usually determined by the individual?s impairment. In turn, transferring technique will greatly affect the perceived difficulty of different types of wheelchair transfers and, the number of transfers that people will perform in a day.
• The performance of wheelchair transfers exacerbate the painful symptomatology of the person, regardless of their medical condition or transferring technique. The presence of pain increases the reported difficulty of wheelchair trasnfers.
• Use of assistive technologies during transfers is linked to the increased body weight of the person, while the choice of the type of assistive technology seems to be dependent of the transferring technique used by the person. Overall, available ATs are only moderately effective in enabling people to perform wheelchair transfer and they can be cause of frustration for the users due to their high cost and limited functionality.
... The SCI-FCS is currently available in Sweden (2015) [15] and Norway (2016) [16]; however, to date, no such tool has been available in Italy to quantify these perceptions. It is imperative to have a universal, validated outcome measure to allow comparisons across practice. ...
... According to preceding validations of the tool [13][14][15][16], a minimum sample size of 54 participants with acute and chronic SCIs was required [23]. ...
... It was determined that the SCI-FCS-I has good internal consistency and strong retest reliability. The SCI-FCS-I produced similar results to the Norwegian version [16], demonstrating good internal consistency with a Cronbach's α of 0.82 and 0.88, respectively, but lower than the original English version (0.92) and the Swedish version (0.95) [15]. As Norwegian authors have pointed out, the slightly lower Italian and Norwegian values might not be a weakness because Cronbach's α describes the extent to which all items measure the same construct, therefore a very high Cronbach's α may indicate overlap between items [16]. ...
Study design:
Psychometrics study.
Objective:
The objective of this study was to develop an Italian version of the Spinal Cord Injury-Falls Concern Scale (SCI-FCS) and examine its reliability and validity.
Setting:
Multicenter study in spinal units in Northern and Southern Italy. The scale also was administered to non-hospitalized outpatient clinic patients.
Methods:
The original scale was translated from English to Italian using the "Translation and Cultural Adaptation of Patient-Reported Outcomes Measures" guidelines. The reliability and validity of the culturally adapted scale were assessed following the "Consensus-Based Standards for the Selection of Health Status Measurement Instruments" checklist. The SCI-FCS-I internal consistency, inter-rater, and intra-rater reliability were examined using Cronbach's alpha coefficient and the intraclass correlation coefficient, respectively. Concurrent validity was evaluated using Pearson's correlation coefficient with the Italian version of the short form of the Wheelchair Use Confidence Scale for Manual Wheelchair Users (WheelCon-M-I-short form).
Results:
The Italian version of the SCI-FCS-I was administered to 124 participants from 1 June to 30 September 2017. The mean ± SD of the SCI-FCS-I score was 16.73 ± 5.88. All SCI-FCS items were either identical or similar in meaning to the original version's items. Cronbach's α was 0.827 (p < 0.01), the inter-rater reliability was 0.972 (p < 0.01), and the intra-rater reliability was 0.973 (p < 0.01). Pearson's correlation coefficient of the SCI-FCS-I scores with the WheelCon-M-I-short form was 0.56 (p < 0.01).
Conclusions:
The SCI-FCS-I was found to be reliable and a valid outcome measure for assessing manual wheelchair concerns about falling in the Italian population.
