Construction and validation of content of one instrument to assess falls in the elderly

Silveira, Michele Bittencourt; Saldanha, Ricardo Pedrozo; Leite, José Carlos de Carvalho; Silva, Thamyres Oliveira Ferreira da; Silva, Thiago; Filippin, Lidiane Isabel

doi:10.1590/S1679-45082018AO4154

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ORIGINAL ARTICLE • Einstein (São Paulo) 16 (2) • 2018 • https://doi.org/10.1590/S1679-45082018AO4154 copy

Construction and validation of content of one instrument to assess falls in the elderly

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

To develop and validate the content of the online Questionnaire for Fall Risk Assessment in the Elderly.

Methods

The instrument was developed based on the International Classification of Functioning, Disability and Health (ICF) of the World Health Organization. Initially, the set of items was submitted to evaluation of judges (healthcare professionals with experience in elderly health), who could suggest inclusion or exclusion of questions from the instrument; they were also asked to rate each question according to the expected scope. At this stage, clarity and relevance levels for each item were evaluated, generating a total of Content Validity Coefficient (C_tVC).

Results

Content Validity Coefficient values were satisfactory for both clarity (C_tVC=0.76) and relevance (C_tVC=0.82) of the questions. Next, a group of elderly volunteers participating in a socializing group evaluated the questionnaire for comprehension. The level of comprehension for each item was identified on a Likert scale, ranging from 0 to 5. The questionnaire was considered easy to understand by most participants (95%), with a mean of 4.75 (±0.11) points for each item.

Conclusion

The instrument showed acceptable psychometric qualities for screening fall risk among the elderly population. Future studies shall investigate different validation aspects of construct for this measure.

Validation studies; Surveys and questionnaires; Aging; Accidental falls; Public health

Question	Description of items/questions
1	Do you feel:
	a) Dizziness or loss of balance when standing or walking
	b) Muscle weakness (in your whole body)
	c) Muscle weakness (only in your arms)
	d) Muscle weakness (only in your legs)
	e) Difficulty to walk
	f) Tiredness or exhaustion
2	In the last 12 months, do you feel your strength has decreased?
3	Do you feel your gait has become slower in the last year, in comparison to the year before that?
4	Do you use any device to move/walk?
5	Do you do any physical activity? (regularly – twice a week, for 30 minutes)
	If the answer for question 5 is “yes”, the interviewee is asked how long he/she has been doing physical activities.
5.1	How long have you been doing physical activities?
	a) Less than one year
	b) 2 to 3 years
	c) 4 to 5 years
	d) More than 6 years
6	Do you think your physical activity has decreased in comparison to last year?
7	Have you lost weight in the last year without having gone on a diet?
	If the answer to question 7 is “yes”, the interviewee is asked how many kilos he/she has lost.
7.1	a) Lost 1kg to 3kg
	b) More than 3kg
	c) Has not lost weight
8	Have you fallen in the last 12 months?
	If the answer to question 8 is “yes”, the interviewee is asked four more questions about the fall. If the answer to question 8 is “no”, the questionnaire is over.
8.1	How many times?
	a) once
	b) twice
	c) 3 times
	d) More than 3 times
8.2	Place of the fall:
	a) At home (bedroom, bathroom, kitchen, living room)
	b) On the street (sidewalk, steps, work)
	c) In the backyard (yard, garden)
8.3	Type of fall:
	a) From standing (was standing and fell)
	b) Down a staircase
	c) From sitting (was sitting down or in the act of sitting and fell)
	d) Other
8.4	Due to fall, you:
	a) Had to be admitted to the hospital
	b) Suffered a fracture (broken bone)
	c) Suffered a sprain or dislocation (moved out of the normal position)
	d) Had difficulty walking after the fall
	e) Became dependent on someone else to perform daily activities
	f) Are afraid to fall again

CVC – Clarity					CVC – Relevance

Item	Mean	CVC_i	Pe_i	CVC_c	Item	Mean	CVC_i	Pe_i	CVC_c
1	3	0.6	0.04	0.56	1	4	0.8	0.04	0.76
2	3.66	0.73	0.04	0.70	2	4	0.8	0.04	0.76
3	4	0.8	0.04	0.76	3	4.33	0.86	0.04	0.83
4	3.66	0.73	0.04	0.70	4	4	0.8	0.04	0.76
5	3.33	0.66	0.04	0.63	5	4.33	0.86	0.04	0.83
5.1	2	0.4	0.04	0.36	5.1.	4.66	0.93	0.04	0.90
6	3.66	0.73	0.04	0.70	6	4	0.8	0.04	0.76
7	4	0.8	0.04	0.76	7	4	0.8	0.04	0.76
7.1	4.66	0.93	0.04	0.90	7.1.	4.66	0.93	0.04	0.90
8	4	0.8	0.04	0.76	8	5	1	0.04	0.96
8.1	4.66	0.93	0.04	0.90	8.1.	5	1	0.04	0.96
8.2	3.66	0.73	0.04	0.70	8.2.	4	0.8	0.04	0.76
8.3	3.66	0.73	0.04	0.70	8.3.	3.66	0.73	0.04	0.70
8.4	3	0.6	0.04	0.56	8.4.	4.33	0.86	0.04	0.83

	Total (CVC_{t Clarity})			0.69		Total (CVC_{t Relevance})			0.82

	CVC - Clarity _{(version 2)}

Item	Mean	CVC_i	Pe_i	CVC_c
1	4.33	0.866	0.04	0.83
2	4.33	0.866	0.04	0.83
3	4	0.8	0.04	0.76
4	4.66	0.93	0.04	0.90
5	3.66	0.73	0.04	0.70
5.1	4.33	0.86	0.04	0.83
6	4.33	0.86	0.04	0.83
7	4	0.8	0.04	0.76
7.1	4.33	0.86	0.04	0.83
8	4.33	0.86	0.04	0.83
8.1	4	0.8	0.04	0.76
8.2	3.33	0.66	0.04	0.63
8.3	3	0.6	0.04	0.56
8.4	3.33	0.66	0.04	0.63

	Total - CVC_{t Clarity (version 2)}			0.76

Question	Description of items/questions
1	In the last month, have you felt (you may mark more than one answer):
	a) Dizziness when standing or walking
	b) Weakness in your whole body
	c) Weakness only in your arms
	d) Weakness only in your legs
	e) Difficulty to walk
	f) Tiredness or exhaustion
2	In the last year, do you feel your strength has decreased when performing simple tasks, e.g., climbing stairs or steps, opening containers, carrying grocery bags, cleaning or tidying the house?
	( ) Yes
	( ) No
3	Do you feel the way you walk has become slower in the last year, in comparison to the year before that?
	( ) Yes
	( ) No
4	When you walk, do you need some form of support or device (for example: cane, crutches, or help of another person)?
	( ) Yes
	( ) No
5	Do you exercise regularly, for example: walking, cycling, going to the gym, doing aerobics, playing soccer or volleyball, at least twice a week for at least 30 minutes each day?
	( ) Yes
	( ) No
	If the answer for question 5 is “yes”, the interviewee is asked how long he/she has been exercising.
5.1	How long have you been exercising regularly (that is, without stopping for any period of time)?
	a) Less than one year
	b) 1 to 2 years
	c) 2 to 3 years
	d) 3 to 5 years
	e) More than 5 years
6	Do you believe your ability to perform daily tasks, such as walking, going uphill, tidying the house, has decreased in comparison to the previous year?
	( ) Yes
	( ) No
7	In the last year, have you lost weight or have your clothes become loose, without you having changed the amount of food you eat?
	( ) Yes
	( ) No
	If the answer to question 7 is “yes”, the interviewee is asked how many kilos he/she has lost.
7.1	a) Lost between 1kg and 3kg
	b) More than 3kg
8	Did you fall in the last year?
	( ) Yes
	( ) No
	If the answer to question 8 is “yes”, the interviewee is asked four more questions about the fall. If the answer to question 8 is “no”, the questionnaire is over.
8.1	How many times did you fall in this period (last year)?
	a) once
	b) twice
	c) three times
	d) more than three times
8.2	Where were you when you fell (you may mark more than one option if you have fallen more than once):
	a) At home (bedroom, bathroom, kitchen, living room)
	b) In the backyard of your home (yard or garden)
	c) On the street (sidewalk, curb, slippery sidewalk, at work, sports club, at the gym)
8.3	How did you fall (you may mark more than one option if you have fallen more than once)? You:
	a) Were standing and fell
	b) Were walking and fell
	c) Were walking, tripped and fell
	d) Fell down a staircase
	e) Fell from a chair (you were sitting and fell or were in the act of sitting and fell)
	f) Other
8.4	Because of the fall, you (you may mark more than one option):
	a) Had no consequences
	b) Had to be admitted to the hospital
	c) Suffered a fracture (broken bone)
	d) Had difficulty walking after the fall
	e) Have permanent (forever) difficulty to perform daily activities, such as brushing your hair, getting dressed, taking a shower, or eating on your own
	f) Can no longer perform tasks on your own, such as doing the dishes, tidying the house, grocery shopping, cooking for yourself, answering the door, taking a bus or riding in a car)
	g) Are afraid to fall again
	h) Are apprehensive about performing daily activities for fear of falling again

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[1] Corresponding author: Lidiane Isabel Filippin. Avenida Victor Barreto, 2,288 – Centro, Zip code: 92010-000 − Canoas, RS, Brazil Phone: (55 51) 3476-8716. E-mail: lidiane.filippin@unilasalle.edu.br