Journal of Modern Rehabilitation 2017. 11(2):103-108.

Research Paper: Comparing Falls Efficacy Scale-International and Berg Balance Scale in Predicting Recurrent Risk of Fall in Stroke Patients
Shahid Khan, Mohammad Reza Hadian, Gholamreza Olyaei, Syed Asadullah Arslan, Saeed Yekaninejad, Abbas Tafakhori


Introduction: Stroke patients often experience falls with potentially serious consequences. Associated factors with falling in stroke patients have already been identified. The present study was conducted to find a better assessment tool for measuring the risk of falling, Fear of Falling (FOF), and balance between Falls Efficacy Scale-International (FES-I) and Berg Balance Scale (BBS).
Materials and Methods: One hundred stroke patients were recruited from the physiotherapy clinics affiliated to Tehran University of Medical Sciences (TUMS) based on inclusive criteria to administer two predictive scales; FES-I and BBS. In 16-item FES-I, face to face interview provide information on FOF in daily life activities. BBS is used to measure the FOF during sitting, standing, and postural changes (reaching, balancing on one limb and transferring). Data were analyzed on the basis of age, post stroke duration, history of falling since disease onset and in the last 6 months as well as risk of falling.
Results: Based on FES-I scale, the majority (69.8%) of old patients (50-64 years) showed low risk of falls and according to BBS, the majority of the stroke patients older than 64 years had high concern for falling. Both genders showed low concern for falling on FES-I and BBS scales and the results were not significant. On BBS, the falling concern was more among those who had one falling during the last 6 months.
Conclusion: BBS is more relevant to predict the risk of falls among Iranian stroke patients and is also easy to administer at the stroke centers with minimum equipment.


Berg Balance Scale, Falls Efficacy Scale, Stroke patients, Balance

Full Text:



Goh HT, Nadarajah M, Hamzah NB, Varadan P, Tan MP. Falls and fear of falling after stroke: A case-control study. PM&R. 2016; 8(12):1173-80. doi: 10.1016/j.pmrj.2016.05.012

Schmid AA, Acuff M, Doster K, Gwaltney Duiser A, Whitaker A, Damush T, et al. Poststroke fear of falling in the hospital setting. Topics in Stroke Rehabilitation. 2009; 16(5):357-66. doi: 10.1310/tsr1605-357

Cho K, Yu J, Rhee H. Risk factors related to falling in stroke patients: A cross-sectional study. Journal of Physical Therapy Science. 2015; 27(6):1751-3. doi: 10.1589/jpts.27.1751

Berg KO, Wood Dauphinee SL, Williams JI, Maki B. Measuring balance in the elderly: Validation of an instrument. Canadian Journal of Public Health. 1991; 83:S7-11. PMID: 1468055

Blum L, Korner Bitensky N. Usefulness of the Berg Balance Scale in stroke rehabilitation: A systematic review. Physical Therapy. 2008; 88(5):559.--66. doi: 0.2522/ptj.20070205

Yardley L, Beyer N, Hauer K, Kempen G, Piot Ziegler C, Todd C. Development and initial validation of the Falls Efficacy Scale-International (FES-I). Age and Ageing. 2005; 34(6):614-9. doi: 10.1093/ageing/afi196

Delbaere K, Close JC, Mikolaizak AS, Sachdev PS, Brodaty H, Lord SR. The falls efficacy scale international (FES-I): A comprehensive longitudinal validation study. Age and Ageing. 2010; 39(2):210-6. doi: 10.1093/ageing/afp225

Tinetti ME, Richman D, Powell L. Falls efficacy as a measure of fear of falling. Journal of Gerontology. 1990; 45(6):P239-43. doi: 10.1093/geronj/45.6.p239

Büla CJ, Martin E, Rochat S, Piot Ziegler C. Validation of an adapted falls efficacy scale in older rehabilitation patients. Archives of Physical Medicine and Rehabilitation. 2008; 89(2):291-6. doi: 10.1016/j.apmr.2007.08.152

Mosallanezhad Z, Salavati M, Hellström K, Reza Sotoudeh G, Nilsson Wikmar L, Frändin K. Cross-cultural adaptation, reliability and validity of the Persian version of the modified falls efficacy scale. Disability and Rehabilitation. 2011; 33(25-26):2446-53. doi: 10.3109/09638288.2011.574774

Salavati M, Negahban H, Mazaheri M, Soleimanifar M, Hadadi M, Sefiddashti L, et al. The Persian version of the Berg Balance Scale: Inter and intra-rater reliability and construct validity in elderly adults. Disability and Rehabilitation. 2012; 34(20):1695-8. doi: 10.3109/09638288.2012.660604

Harris JE, Eng JJ, Marigold DS, Tokuno CD, Louis CL. Relationship of balance and mobility to fall incidence in people with chronic stroke. Physical Therapy. 2005; 85(2):150-8. PMID: 15679466

Kornetti DL, Fritz SL, Chiu YP, Light KE, Velozo CA. Rating scale analysis of the Berg Balance Scale. Archives of Physical Medicine and Rehabilitation. 2004; 85(7):1128-35. doi: 10.1016/j.apmr.2003.11.019

Berg K, Wood Dauphine S, Williams J, Gayton D. Measuring balance in the elderly: Preliminary development of an instrument. Physiotherapy Canada. 1989; 41(6):304-11. doi: 10.3138/ptc.41.6.304

Rosario ER, Kaplan SE, Khonsari S, Patterson D. Predicting and assessing fall risk in an acute inpatient rehabilitation facility. Rehabilitation Nursing. 2014; 39(2):86-93. doi: 10.1002/rnj.114

Hyndman D, Ashburn A. People with stroke living in the community: Attention deficits, balance, ADL ability and falls. Disability and Rehabilitation. 2003; 25(15):817-22. doi: 10.1080/0963828031000122221

Ghandehari K, Izadi Z. The Khorasan Stroke Registry: Results of a five-year hospital-based study. Cerebrovascular Diseases. 2007; 23(2-3):132-9. doi: 10.1159/000097050

Belgen B, Beninato M, Sullivan PE, Narielwalla K. The association of balance capacity and falls self-efficacy with history of falling in community-dwelling people with chronic stroke. Archives of Physical Medicine and Rehabilitation. 2006; 87(4):554-61. doi: 10.1016/j.apmr.2005.12.027

Baetens T, De Kegel A, Calders P, Vanderstraeten G, Cambier D. Prediction of falling among stroke patients in rehabilitation. Journal of Rehabilitation Medicine. 2011; 43(10):876-83. doi: 10.2340/16501977-0873

Burn J, Dennis M, Bamford J, Sandercock P, Wade D, Warlow C. Long-term risk of recurrent stroke after a first-ever stroke. Stroke. 1994; 25(2):333–7. doi: 10.1161/01.str.25.2.333

Downs S, Marquez J, Chiarelli P. The Berg Balance Scale has high intra-and inter-rater reliability but absolute reliability varies across the scale: A systematic review. Journal of Physiotherapy. 2013; 59(2):93-9. doi: 10.1016/s1836-9553(13)70161-9

Tutuarima J, Van der Meulen J, De Haan R, Van Straten A, Limburg M. Risk factors for falls of hospitalized stroke patients. Stroke. 1997; 28(2):297-301. doi: 10.1161/01.str.28.2.297


  • There are currently no refbacks.

Creative Commons Attribution-NonCommercial 3.0

This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.