Content uploaded by Oznur Büyükturan
Author content
All content in this area was uploaded by Oznur Büyükturan on May 16, 2019
Content may be subject to copyright.
Turkish Journal of Geriatrics
2014; 17 (2) 157-163
Çiğdem AYHAN1
Öznur BÜYÜKTURAN2
Nuray KIRDI1
Yavuz YAKUT1
Çağatay GÜLER3
RESEARCH
THE TURKISH VERSION OF THE ACTIVITIES
SPECIFIC BALANCE CONFIDENCE (ABC) SCALE:
ITS CULTURAL ADAPTATION, VALIDATION AND
RELIABILITY IN OLDER ADULTS
ABSTRACT
Introduction: To describe the cultural adaptation of the Turkish Activities Specific Balance
Confidence Scale and to examine the factor structure, reliability and validity of the scale in older
adults.
Materials and Method: One hundred and six elderly people were recruited in the study. The
assessments included the Turkish Activities Specific Balance Confidence Scale, Falls Efficacy Scale,
Berg Balance Scale, Mini Mental State Test, Yesavage Geriatric Depression Scale, and Short Form-
36 (physical function and mental health subgroups). Outcome measures were conducted twice
within 2 weeks (test-retest) for reliability.
Results: The Cronbach's a coefficient was 0.9649 for the test and 0.9648 for the re-test. The
Intraclass Correlation Coefficient for the test-retest reliability was 0.997 with 95% confidence in-
terval 0.996-0.998. A strong negative correlation was found between the Turkish Activities Spe-
cific Balance Confidence Scale and the Falls Efficacy Scale (r=-0.835, p<0.001). There were strong
positive correlations between the scale and the physical function subgroup of the Short Form-36
(r=0.614, p<0.001), and the Berg Balance Scale (r=0.748, p<0.001). No significant correlation was
found between the scale and the mental health subgroup of the Short Form-36 (r=-0.110,
p=0.262). Results of a factor analysis conducted on the scale showed evidence of a 2-domain
structure.
Conclusion: The Turkish Activities Specific Balance Confidence Scale showed excellent reliabi-
lity and good validity. It can be suggested that the scale promises to be useful and practical when
used with different groups of elderly for the assessment and management of balance confidence.
Key Words: Aged; Accidental Falls, Postural Balance; Fear; Outcome Assessment (Health
Care).
İletişim (Correspondance)
Çiğdem AYHAN
Hacettepe University, Faculty of Health Sciences,
Physiotherapy and Rehabilitation ANKARA
Tlf: 0312 305 25 25
e-posta: cayhan@hacettepe.edu.tr
Geliş Tarihi: 12/06/2013
(Received)
Kabul Tarihi: 25/12/2013
(Accepted)
1 Hacettepe University, Faculty of Health Sciences,
Physiotherapy and Rehabilitation ANKARA
2 Ahi Evran University, School of Physical Therapy and
Rehabilitation KIRŞEHİR
3 Hacettepe University, Faculty of Medicine, Department of
Public Health ANKARA
W ARAŞTIRMA
AKTIVITEYE ÖZGÜ DENGE GÜVEN ÖLÇEĞININ
TÜRKÇE VERSIYONU: YAŞLı BIREYLERDE
KÜLTÜREL ADAPTASYON, GÜVENÎRLÎK VE
GEÇERLIK ÇALıŞMASı
ÖZ
Giriş: Bu çalışmanın amacı, Aktiviteye Özgü Denge Güven Ölçeğinin Türkçe kültürel adaptasyo-
nunu yapmak ve yaşlı bireylerde faktöriyel yapısını geçerlik ve güvenirlik özelliklerini test etmekti.
Gereç ve Yöntem: Çalışmaya katılmayı kabul eden 106 yaşlı birey dahil edildi. Değerlendir-
me kapsamında Aktiviteye Özgü Denge Güven Ölçeği, Düşme Etkinlik Ölçeği, Berg Denge Ölçe-
ği, Mini Mental Durum Testi, Geriatrik Depresyon Ölçeği, Kısa Form-36'nın Fiziksel fonksiyon ve
Mental sağlık alt başlıkları yer aldı. Ölçekler test-tekrar test güvenirliği değerlendirmek için iki haf-
ta arayla tekrarlandı.
Bulgular: iç tutarlıkta, Cronbach alfa değeri, test için 0.9649, ve tekrar test için 0.9648 ola-
rak belirlendi. Aktiviteye Özgü Denge Güven Ölçeğinin tekrar test güvenirliği (Intraclass Correla-
tion Coefficient) 0,997, % 95 güven aralığı 0,996-0,998 olarak bulundu. Ölçütsel geçerlik yönün-
den, Aktiviteye Özgü Denge Güven Ölçeği ve Düşme Etkinlik Ölçeği (r=-0,835, p<0,001) arasında
negatif ilişki kaydedildi. Aktiviteye Özgü Denge Güven Ölçeği, Kısa Form-36 Fiziksel fonksiyon alt
başlığı (r=0,614, p<0,001) ve Berg Denge Ölçeği (r=0,748, p<0,001) arasında pozitif yönde ilişki
saptandı. Aktiviteye Özgü Denge Güven Ölçeği ve Kısa Form-36 mental sağlık arasında herhangi
bir ilişki (r—0,110, p=0,262) saptanmadı. Kullanılan faktör analizi iki faktörün belirlenmesi ile so-
nuçlandı.
Sonuç: Bu çalışma, Aktiviteye Özgü Denge Güven Ölçeğinin yaşlı bireylerde kabul edilebilir
derecede güvenilir ve geçerli olduğunu gösterdi. Aktiviteye Özgü Denge Güven Ölçeği, yaşlı bi-
reylerin denge güven durumunun değerlendirme ve tedavisinde kullanılabilecek yararlı ve kullanı-
mı kolay bir ölçektir.
Anahtar Sözcükler: Yaşlı; Düşmeler; Denge; Korku; Ölçekler.
157
THE TURKISH VERSION OF THE ACTIVITIES SPECIFIC BALANCE CONFIDENCE (ABC) SCALE:
ITS CULTURAL ADAPTATION, VALIDATION AND RELIABILITY IN OLDER ADULTS
INTRODUCTION
T
he occurrence of "fear of falling" (FOF) among non-falling
elderly is between 12% and 65%; while it is between
29% and 92% among elderly who have fallen. FOF, which is
multifactorial in etiology, may lead to serious physical, psy-
chological and social problems in the elderly (1). Activity
restriction, decreased mobility, social isolation, anxiety, and
depression are the most important consequences of the FOF
(1,2).
In recent years there has been a growing focus on the
measurement of FOF in the elderly with a view to developing
prevention and rehabilitation management strategies (3).
Tinetti (1990) has defined fall-related self-efficacy or balance
confidence as people's personal beliefs about their own abili-
ties to perform certain activities (4). The Fall Efficacy Scale
(FES) is the first developed scale to be reported in the litera-
ture; it focuses on the performance of indoor activities by the
elderly. This scale was reported to have a high level of test-
retest reliability and internal consistency (5). However, the
FES measures only simple indoor activities and does not pro-
vide information about more difficult and complex outdoor
activities.
The Activity Specific Balance Confidence Scale (ABC) is
an alternative scale for assessing FOF, developed by Powell
and Myers. The ABC scale was designed to measure subjective
balance confidence for both indoor and outdoor activities in
ambulatory community-dwelling elderly (6). Up to now, this
scale has been translated into many languages (7-14).
Previous studies have reported that the ABC scale has good
psychometric properties with high internal consistency and
test-retest reliability.
The Turkish version of the ABC scale (ABC-T) was used
by Karapolat et al. (2010) on patients with unilateral periph-
eral vestibular diseases, which demonstrated acceptable meas-
urement properties (15). The aim of this study was to produce
a cross-cultural adaptation of the scale and to test the psycho-
metric quality of the scale in elderly participants.
MATERIALS AND METHOD
Participants
One hundred and six elderly people who agreed to participate
in the study were recruited from hospital units. Inclusion cri-
teria for the study were that participants were over age 65,
volunteered for the study, were able to stand independently
and unsupported for 90 seconds, and were cognitively able to
communicate adequately. Participants whose mother lan-
guage was not Turkish, who had malignancy, and who had
hearing or vision loss were excluded from the study. All par-
ticipants were asked to sign an informed consent form and
were informed about the study prior to its start. The study
was approved by the Research Ethics Board.
Demographic data of the participants, including age, gender,
history of falls and detailed medical history were recorded at
the baseline assessment. All assessments were made during
face-to-face interviews including Mini Mental State Test
(MMST), Short Form 36 (SF-36) Mental Health subgroup and
Yesavage Geriatric Depression Scale (GDS). Balance-related
assessments included ABC scale, FES, Berg Balance Scale
(BBS) and SF-36 Physical Function subgroup. ABC, FES,
BBS, GDS and SF-36 tests were made twice within 2 weeks.
All assessments were completed on the same day.
Activity Specific Balance Confidence Scale (ABC)
The ABC scale was developed by Powell and Myers. This scale
contains 16 tasks related to indoor and outdoor daily living
activities, to measure balance confidence in elderly people
who have various levels of functioning. Scores range from 0%
(no confidence) to 100% (complete confidence) for each ques-
tion item. Higher scores indicate greater confidence (6).
The cross-cultural adaptation process of the ABC scale was
performed by following the guidelines provided by Beaton et
al (16). Those guidelines are as follows: First, two independ-
ent translators performed the forward translations from
English to Turkish. The translations were compared and dis-
crepancies were resolved. Second, bilingual translators, whose
mother language was English, back translated the same ver-
sion. Although one of the translators was aware of the study,
the other translator was not aware of it. Third, the two back-
translations were synthesized by the authors to achieve a con-
sensus. Finally, a second meeting was held with participation
of all the interested professionals. This team reviewed the
English and Turkish versions of the translations to control for
and pinpoint possible meaning differences and inconsisten-
cies. A final version was established and field tested on 30 eld-
erly adults after a number of slight corrections and changes by
consensus.
Mini Mental State Test (MMST)
The MMST evaluates the cognitive status of the elderly. It
contained seven domains, each with an assigned point value
totaling 30. MMST scores higher than or equal to 24 were
considered as normal cognitive function, while scores lower
158 TURKISH JOURNAL OF GERIATRICS 2014; 17(2)
AKTİVİTEYE ÖZGÜ DENGE GÜVEN ÖLÇEĞİNİN TÜRKÇE VERSİYONU:
YAŞLI BİREYLERDE KÜLTÜREL ADAPTASYON, GÜVENİRLİK VE GEÇERLİK ÇALIŞMASI
than 24 indicated cognitive impairment. Low MMST scores
have also been associated with an increased fall risk in elderly
adults (17).
Yesavage Geriatric Depression Scale (GDS)
The GDS consists of 30 questions to be answered as "yes" or
"no", with a maximum score of 30 points. The Turkish ver-
sion of the GDS was used in this study. GDS scores equal to
or higher than 6 were considered to indicate clinically signif-
icant depression (18).
Berg Balance Scale (BBS)
The BBS is a 14-item scale that measures sitting, standing
and postural changes while performing tasks. Each task is
scored from 0 points to 4 points. Higher scores indicate bet-
ter balance control. Scores of 0-20 indicate a high fall risk, 21-
40 indicates a medium fall risk, and 41-56 indicates a low fall
risk (19).
Tinetti Falls Efficacy Scale (FES)
The FES was designed to assess the level of self-perceived FOF
during the performance of daily living activities by the elder-
ly. The FES consists of 10 simple indoor activities rated on a
10-point scale. The scores are summed to give a total score
ranging from 10 to 100 points, where lower scores indicate a
low level of confidence. Tinetti reported a test-retest reliabil-
ity for the FES in a community-based elderly population of
r=0.71 (5).
Short Form-36 Quality of Life Questionnaire
The SF-36 was developed by the RAND Corporation and the
Medical Outcomes Study (20). SF-36 has eight subgroups
with a total of 36 questions. The Turkish version of the SF-36
has shown acceptable measurement properties (21). "Physical
Function" and "Mental Health" subtests of the SF-36 were
used in this study. Higher scores indicate higher levels of
health.
Falls
A fall history was obtained from the responses to the question
"How many times did you fall during the past year?" (22).
Falls were recorded as numbers.
Statistical Analysis
All analyses were conducted using the Statistical Package for
the Social Sciences 15.00 (SPSS Inc., Chicago, USA). The
variables were expressed in terms of arithmetic means (X) and
standard deviation (SD) values. The critical level of signifi-
cance was set at p<0.05.
The psychometric properties of the ABC scale were evalu-
ated in terms of reliability and validity. Test-retest reliability
was determined by calculating the intraclass correlation coef-
ficient (ICC), which shows the strength of agreement. ICC
values are defined as fair (<0.40), moderate (0.40-0.59), sub-
stantial (0.60-0.79), and excellent (>0.80). Internal consisten-
cy, which means that all items of the scale measure aspects of
a single construct, was assessed using Cronbach's alpha, which
is expected to be above 0.70. A Pearson correlation coefficient
was used to assess the strength of the linear relationships. (23)
Concurrent convergent validity refers to the extent to
which an instrument correlates with other measures of the
same construct, which it is theoretically predicted to correlate
with. Concurrent convergent validity of the ABC scale with
other measures was estimated using Pearson's correlation
coefficient. The correlation between the ABC scale and the
FES (taken as a criterion variable), which is referred as criteri-
on validity, was performed. Construct validity was evaluated
by the principal component and factor analysis method.
RESULTS
O
ne hundred and six elderly people between the ages of 65
and 88, with an average of 69.52±5.17 years, were
included in the study as subjects, of which 49 (46%) were
females and 57 (54%) were males. Demographic data of the
participants are shown in Table 1. The scores on the FSS,
MSS, GDS and FES are also shown in Table 1.
Content Equivalence of ABC-T Scale: Three of the 16 items
on the ABC scale were found to be culturally irrelevant due to
differences in the physical living environment and climate in
Turkey. First, in item 4 we used the term "height level"
instead of "eye level". This is a more common expression in
Turkey. In item 8, "to a car parked in the driveway" was mod-
ified as "to the street", as most elderly people do not use a car
for transportation in Turkey, and they usually live in a house
without a driveway. In item 16 we replaced "icy sidewalks"
with "slippery sidewalks" because of the climate of Turkey.
The three modified questions are summarized in Table 2.
Reliability: The Cronbach's a coefficients for the ABC Scale
were 0.9649 for the test and 0.9648 for the re-test, which
indicated a higher internal consistency than was expected.
Item-total correlations for all items ranged from 0.578 to
TÜRK GERİATRİ DERGİSİ 2014; 17(2) 159
THE TURKISH VERSION OF THE ACTIVITIES SPECIFIC BALANCE CONFIDENCE (ABC) SCALE: X
Table 1— Demographic Characteristics of the Participants. Table 2— Results of the Cultural Adaptation of the ABC Scale.
Age (years) (X±SD) 69.52+5.17
65-74 (n (%)) 88 (83.0)
75-84 (n (%)) 17 (16.0)
85< (n (%)) 1 (1.0)
Height (cm) (X+SD) 165.34+8.99
Body weight (kg) (X+SD) 77.03+12.81
Body Mass Index (kg/m2) (X+SD) 28.31+5.23
MMST (0-30) (X+SD) 29.76+0.43
Falls during twelve months (n (%))
Non fallers 48 (45.3)
Fallers
1 time 25(23.6)
2 times 16 15.1)
3 times 8 (7.5)
4 times 9 (8.5)
ABC (0-100) 86.97+22
BBS (0-56) 53.91+3.71
FSS (0-100) 47.38+12.96
MSS (0-100) 46.17+6.78
GDS (0-30) 3.14+2.56
FES (10-100) 23.75+21.49
MMST: Mini Mental State Test, BBS: Berg Balance Scale, FSS: Physical
function subgroup of SF-36, MSS: Mental health subgroup of SF-36,
GDS: Geriatric Depression Scale, FES: Falls Efficacy Scale.
0.894, which demonstrates moderately strong evidence
(Table 3). The ICC for the test-retest reliability of the ABC
Scale was 0.997, with a 95% confidence interval (CI)
0.996-0.998, which suggested reasonably high test-retest
reliability for the ABC Scale (Table 3). The ICC values for
individual items ranged from 0.962 to 0.999, with the high-
est ICC value for item 15 (Step onto or off an escalator while
holding onto parcels such that you cannot hold onto the rail-
ing) and the lowest value for item 2 (Walk up or down stairs)
(Table 3).
Convergent Validity: The total score of the ABC scale was
negatively correlated with a history of falls (r=-0.770,
p<0.001). There were high positive correlations between
ABC scores and the physical function subgroup score of the
SF-36 (r=0.614, p<0.001), and the BBS (r=0.748, p<0.001).
There was no significant correlation between ABC scores and
the mental health subgroup score of SF-36 (r
=
-0.110,
p
=
0.262).
Criterion Validity: There was a high negative correlation
between ABC scores and FES scores (r=-0.835, p<0.001).
4. Reach for a small can off a Reach for a small can off a shelf
shelf at eye level? at height level?
8. Walk outside the house to a Walk outside the house to the
car parked in the driveway? street?
16. Walk outside on icy Walk outside on slippery
sidewalks? sidewalks?
Construct Validity: The ABC scale was factor analyzed using
principal component analysis with Varimax (orthogonal) rota-
tion. The Kaiser—Meyer Olkin value was 0.849, p
=
0.000,
which suggested that the sample was factorable. Chi-square
was 2514.168 (120 degrees of freedom, p<0.001) in Bartlett's
test of sphericity, indicating that the correlation matrix was
an identity matrix. The analysis yielded two factors, explain-
ing a total matrix variance of 78.629% (Table 4). The factor
analysis was performed without imposing any preconceived
structure on the outcome. Two factors were extracted, as was
estimated in the theoretical phase. Seven items, numbers
7,11,12,13,14,15,16, were loaded onto Factor 1. This factor
was labeled "Attentional demands activities" and explained
68.651% of the variance (Table 4). Factor 2 was labeled
"Simple demands activities" due to high loadings on tasks
numbered 1,2,3,4,5,6,8,9,10. This factor explained 9.978%
of the variance (Table 4).
DISCUSSION
B
alance confidence is an important issue among the elderly
population in terms of functional mobility, participation
and personal well-being. The present study investigated the
psychometric properties and factorial analysis of the ABC-Tin
elderly participants. The results of the study indicate that the
Turkish ABC scale has strong measurement properties, which
make it a reliable and valid instrument for research and prac-
tice.
Test-retest reliability indicates whether the items of the
ABC scale measure a single construct or not. In the original
study, test-retest reliability of the ABC Scale in community
dwelling older people was high (ICC
=
0.92). Similarly, in
other studies performed on elderly adults, the ICC values
ranged from 0.73 to 0.98. Test-retest reliability was found to
vary between 0.67 to 0.92 in the Turkish version of the scale.
In this study, the ABC scale has high test-retest reliability
160 TURKISH JOURNAL OF GERIATRICS 2014; 17(2)
AKTİVİTEYE ÖZGÜ DENGE GÜVEN ÖLÇEĞİNİN TÜRKÇE VERSİYONU:
YAŞLI BİREYLERDE KÜLTÜREL ADAPTASYON, GÜVENİRLİK VE GEÇERLİK ÇALIŞMASI
Table 3— Test-retest Reliability and Item Total Correlations of the Turkish Version of the ABC Scale.
r ICC
Lower
95% CI
Upper
1. Walk around the house? 0.887* 0.970 0.9562 0.9795
2. Walk up or down stairs? 0.875* 0.962 0.9449 0.9741
3. Bend over and pick up a slipper from the
front of a closet floor? 0.821* 0.987 0.9817 0.9915
4. Reach for a small can off a shelf at height level? 0.578* 0.993 0.9911 0.9958
5. Stand on your tiptoes and reach for something above your head? 0.817* 9.985 0.9785 0.9900
6. Stand on a chair and reach for something? 0.817* 0.997 0.9957 0.9980
7. Sweep the floor? 0.811* 0.998 0.9978 0.9990
8. Walk outside the house to the street? 0.870* 0.998 0.9974 0.9988
9. Get into or out of a car? 0.853* 0.987 0.9815 0.9913
10. Walk across a parking lot to the mall? 0.894* 0.989 0.9843 0.9927
11. Walk up or down a ramp? 0.890* 0.994 0.9919 0.9962
12. Walk in a crowded mall where people rapidly walk past you? 0.843 0.997 0.9967 0.9985
13. Are bumped into by people as you walk through the mall? 0.891* 0.998 0.9983 0.9992
14. Step onto or off of an escalator while holding onto a railing? 0.790* 0.993 0.9911 0.9958
15. Step onto or off an escalator while holding onto parcels such that you
cannot hold onto the railing? 0.746* 0.999 0.9985 0.9993
16. Walk outside on slippery sidewalks? 0.806* 0.993 0.9897 0.9952
Total 0.997 0.9967 0.998
r , Pearson correlation coefficient, item-total correlation
*p<0.001
ICC, intraclass correlation coefficient
CI, Confidence interval
Table 4— Varimax Rotated 2-Factor Solution of the ABC Scale.
Item nb.
Factor loadings of Factor 1
Attentional Demands Activities
Factor loadings of Factor 2
Simple Demands Activities
15 0.936 0.083
13 0.852 0.381
16 0.839 0.263
11 0.820 0.417
14 0.773 0.330
12 0.742 0.444
7 0.697 0.424
4 -0.042 0.921
3 0.343 0.852
1 0.484 0.787
2 0.466 0.781
10 0.577 0.710
6 0.477 0.663
8 0.588 0.653
9 0.587 0.636
5 0.569 0.606
The total percentage of matrix variance is 78.629.
TÜRK GERİATRİ DERGİSİ 2014; 17(2) 161
THE TURKISH VERSION OF THE ACTIVITIES SPECIFIC BALANCE CONFIDENCE (ABC) SCALE:
ITS CULTURAL ADAPTATION, VALIDATION AND RELIABILITY IN OLDER ADULTS
(ranged from 0.962 to 0.999), similar to that found in other
studies performed with the community dwelling elderly.
The ABC scale has shown high internal consistency with
community-dwelling older people in previous studies (6,8-
12). The Cronbach's alpha of Turkish version of ABC scale
performed in patients with unilateral peripheral vestibular
dysfunction also showed high internal consistency with a
value of 0.95 (15). In line with the previous studies the
Turkish ABC scale showed high internal consistency in older
adults in this study.
Results of the factor analysis in the Chinese Cantonese
version of the ABC scale showed evidence of a coherent 1-
domain structure (11); however, two factors were extracted in
the Chinese Mandarin version (12). Botner et al. also calculat-
ed 2 factors that were labeled according to the levels of per-
ceived risk (24). Similarly, in this study two factors were
extracted. The first factor, which was labeled "attentional
demands activities", mostly, included difficult outdoor activ-
ities. The second factor, which was labeled "simple demands
activities", included simple activities. Tasks such as walking
outside on icy sidewalks, walking up or down a ramp, step-
ping onto or off an escalator, etc. need more postural control
with respect to the difficulty of the task, environmental influ-
ences and unstable sensory information. The attentional
demands of balance control vary according to the complexity
of the situation. Balance control in the elderly, following an
external perturbation, requires more attention than it does for
younger adults; hence, increased attentional requirements of
certain activities could affect task execution (25).
In the study by Karapolat, significant correlation was
observed between the Turkish ABC scale and, Dizziness
Handicap Inventory but no correlation was found with the
other tests including various balance and gait outcome meas-
ures. The lack of correlation was explained with the balance
problems in patients with peripheral vestibular disease (15).
However, the ABC scale demonstrated good convergent and
criterion validity in community dwelling older people. The
original scale and the French Canadian version of the scale,
used among people with stroke, showed a moderate level of
correlation with BBS comfortable and maximum gait speeds,
Time Up and Go Test (TUG), 6 Minutes Walking Test
(6MWT), the Barthel Index and the GDS (13). Concurrent
validity between the ABC and the physical performance tests
and self-reported health status were significant. Thus, it was
suggested that the scale might be used for rehabilitation tar-
geting to improve physical function. Similarly, in this study
there was a positive correlation between ABC scores and the
physical function subgroup of the SF-36 (r=0.614, p<0.001);
BBS (r=0.748, p<0.001); and FES (r=-0.835, p<0.001). In
addition, there was a significant difference in the German ver-
sion of the ABC scores between the fallers and non-fallers, the
fallers having lower scores than the non-fallers (10). In this
study, a significant correlation was found between scores on
the ABC scale and the patient's history of falls (r=-0.770,
p<0.001).
Divergent validity was established by correlating the ABC
and mental health subgroup scores of the SF-36 in a study of
Ylva (14). No significant correlation between these scores (r=-
0.110, p
=
0.262) was found.
The incidence of balance problems and falls in the elderly
is associated with the severity of FOF. Therefore, the measure-
ment of FOF should be complementary to geriatric assess-
ments with respect to fall management. This study analyzed
the psychometric qualities of the ABC-Tin terms of reliabili-
ty, validity and factorial structure. The results showed that
the scale had excellent reliability and good validity. In con-
clusion, the ABC-T appears to be a promising tool to use with
different elderly groups for the assessment and management
of balance confidence.
REFERENCES
1. Legters K. Fear of falling. Phys Ther 2002;82:264-72.
(PMID:11869155).
2. Fletcher PC and Hirdes JP. Restriction in activity associated
with fear of falling among community-based seniors using
home care services. Age Ageing 2004;33:273-9.
(PMID:15082433).
3. Jorstad EC, Hauer K, Becker C, Lamb SE. Measuring the
psychological outcomes of falling: a systematic review. J Am
Geriatr Soc 2005;53:501-10. (PMID:15743297).
4. Tinetti ME, Richman D, Powell L. Falls efficacy as a measure of
fear of falling. J Gerontol 1990;45:239-43. (PMID:2229948).
5. Tinetti ME, Powell L. Fear of falling and low self-efficacy: A
cause of dependence in elderly persons. J Gerontol 1993;48:35-
8. (PMID:8409238).
6. Powell LE, Myers AM. The Activities-specific Balance
Confidence (ABC) Scale. J Gerontol A Biol Sci Med Sci
1995;50:28-34. (PMID:7814786).
7. Parry SW, Steen N, Galloway SR, Kenny RA, Bond J. Falls and
confidence related quality of life outcome measures in an older
British cohort. Postgrad Med J 2001;77:103-8.
(PMID:11161077).
8. van Heuvelen MJ, Hochstenbach J, de Greef MH, Brouwer
WH, Mulder T, Scherder E. Is the Activities-specific Balance
Confidence Scale suitable for Dutch older persons living in the
community? Tijdschr Gerontol Geriatr 2005;36(4):146-54.
(PMID:16194061).
162 TURKISH JOURNAL OF GERIATRICS 2014; 17(2)
AKTİVİTEYE ÖZGÜ DENGE GÜVEN ÖLÇEĞİNİN TÜRKÇE VERSİYONU:
YAŞLI BİREYLERDE KÜLTÜREL ADAPTASYON, GÜVENİRLİK VE GEÇERLİK ÇALIŞMASI
9. Schott N. German adaptation of the Activities-specific Balance
Confidence (ABC) scale for the assessment of falls-related self-
efficacy. Z Gerontol Geriatr 2008;41(6):475-85.
(PMID:18327692).
10. Mak KM, Lau AL, Law FS, Cheung CC, Wong SI. Validation
of the Chinese translated Activity-Specific Balance Confidence
Scale. Arch Phys Med Rehabil 2007;88:496-503.
(PMID:17398252).
11. Guan Q, Han H, Li Y, Zhao L, Jin L, Zhan Q. Activity-specific
Balance Confidence (ABC) Scale adapted for mainland
population of China. Clin Rehabil 2011;26(7):648-55.
(PMID:22169829).
12. Salbach NM, Mayo NE, Hanley JA, Richards CL, Wood-
Dauphinee S. Psychometric evaluation of the original and
Canadian French version of the activities-specific balance
confidence scale among people with stroke. Arch Phys Med
Rehabil 2006;87(12):1597-604. (PMID:17141639).
13. Ylva N, Anette F. Psychometric properties of the Activities-
Specific Balance Confidence Scale in persons 0-14 days and 3
months post stroke. Disabil Rehabil 2012;34(14):1186-91.
(PMID:22148983).
14. Arnadottir SA, Lundin-Olsson L, Gunnarsdottir ED, Fisher
AG. Application of rasch analysis to examine psychometric
aspects of the activities-specific balance confidence scale when
used in a new cultural context. Arch Phys Med Rehabil
2010;91(1):156-63. (PMID:20103411).
15. Karapolat H, Eyigor S, Kirazli Y, Celebisoy N, Bilgen C,
Kirazli T. Reliability, validity, and sensitivity to change of
Turkish Activities-specific Balance Confidence Scale in patients
with unilateral peripheral vestibular disease. Int J Rehabil Res
2010;33(1):12-8. (PMID:20183891).
16. Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines
for the process of cross-cultural adaptation of self-report
measures. Spine 2000;25(24):3186-3191. (PMID:11124735).
17. Güngen C, Ertan T, Eker E, Yaşar R, Engin F. Reliability and
validity of the standardized Mini Mental State Examination in
the diagnosis of mild demantia in Turkish population. Turk
Psikiyatri Derg 2002 Winter; 13(4):273-81. (PMID:12794644).
18. Ertan T, Eker E. Reliability, validity and factor structure of the
Geriatric Depression Scale in Turkish elderly: Are their
different factor structure for different cultures? Int Psychogeriat
2000;12:163-72. (PMID:10937537).
19. Berg KO, Wood-Dauphinee SL, Williams JI, Maki B.
Measuring balance in the elderly: validation of an instrument
Can J Public Health 1992;83 Suppl 2:7-11. (PMID:1468055).
20. Ware JE, Sherbourne CD. The MOS 36-item short form health
survey (SF-36). I. Conceptual framework and item selection.
Med Care 1992;30:473-83. (PMID:1593914).
21. Kocyigit H, Aydemir O, Fisek G, Olmez N, Memis A. Validity
and reliability of Turkish version of Short form 36. Journal of
Drug and Therapy 1999,12:102-6 (in Turkish).
22. Anstey KJ, vond Sanden C, Luszcz MA. An 8 year prospective
study of the relationship between cognitive performance and
falling in very old adults. J Am Geriatr Soc 2006;54(8):1169-
76. (PMID:16913981).
23. Deyo RA, Diehr P, Patrick DL. Reproducibility and
responsiveness of health status measures statistics and strategies
for evaluation. Control Clin Trials 1991;12(4):142-58.
(PMID:1663851).
24. Botner EM, Miller WC, Eng JJ. Measurement properties of the
Activities-specific Balance Confidence Scale among individuals
with stroke. Disabil Reh 2005;27(4):156-63.
(PMID:15824045).
25. Brown LA, Shumway-Cook A, Woollacott MH. Attentional
demands and postural recovery: The effects of aging. J Gerontol
A Biol Sci Med 1999;54(4):165-71. (PMID:10219006).
TÜRK GERİATRİ DERGİSİ 2014; 17(2) 163
CopyrightofTurkishJournalofGeriatrics/TürkGeriatriDergisiisthepropertyofTurkish
GeriatricsSocietyanditscontentmaynotbecopiedoremailedtomultiplesitesorpostedtoa
listservwithoutthecopyrightholder'sexpresswrittenpermission.However,usersmayprint,
download,oremailarticlesforindividualuse.
