Adaptation of the «Modified Fear of Falling Avoidance Behavior Questionnaire» (mFFABQ-R) in a Russian sample of older and elderly adults

Context and Relevance. Fear of falling and the associated avoidance behavior are critical factors affecting the functional activity and quality of life of older adults. However, there are currently no validated instruments in the Russian language specifically designed to assess the severity of avoidance behavior related to fear of falling. This gap limits both clinical diagnostics and scientific research in this area. Objective. To translate and psychometrically adapt the Modified Fear of Falling Avoidance Behavior Questionnaire (mFFABQ-R) into Russian for use with elderly individuals. Methods and Materials. The study included 229 older adults aged 60—97 residing in long-term care facilities. Psychometric validation involved assessments of internal consistency (Cronbach’s α), test—retest reliability (Pearson correlation), item discriminability, and convergent validity. Validation measures included the Berg Balance Scale, a visual analogue scale for fear of falling, the General Self-Efficacy Scale, and the Integrative Anxiety Test. Stability was assessed in a clinical sample of older adults with varying levels of anxiety, depression, and cognitive impairment. Results. The Russian version of the mFFABQ-R demonstrated excellent internal consistency (α = 0.956), high test—retest reliability (r = 0.995; p < 0.001), and strong item discriminability. Convergent validity was supported by significant correlations with related constructs. These results were consistent across subgroups with varying cognitive and emotional status. Conclusions. The mFFABQ-R is a reliable and valid tool for assessing the severity of avoidance behavior associated with fear of falling. It is recommended for use in clinical geriatric practice and psychological research among Russian-speaking elderly populations.

1. Бизюк, А.П., Вассерман, Л.И., Иовлев, Б.В. (2005). Применение интегративного теста тревожности.СПб.: НИИ им. В.М. БехтереваBizyuk, A.P., Vasserman, L.I., Iovlev, B.V. (2005). Primenenie integrativnogo testa trevozhnosti. Petersburg: NII im. V.M. Bekhtereva. (In Russ.)
2. Коновальчик, Т.К. (2024). Страх падения у лиц пожилого возраста с различными заболеваниями. Клиническая и специальная психология,13(4), 76—95. https://doi.org/10.17759/cpse.2024130404Konovalchik, T.K. (2024). Fear of falling in elderly individuals with various diseases. Clinical Psychology and Special Education, 13(4), 76—95. (In Russ.). https://doi.org/10.17759/cpse.2024130404
3. Левина, О.С. (2019). Клинические шкалы в неврологии: руководство для врачей.М.: ГЭОТАР-Медиа.Levina, O.S. (2019). Klinicheskie shkaly v nevrologii: rukovodstvo dlya vrachei. Moscow: GEOTAR-Media. (In Russ.)
4. Самкова, И.А., Макарова, А.А., Воронина, Е.А. (2022). Взаимосвязь риска падений с особенностями когнитивной функции и эмоционального статуса (страха падений) у лиц старшего возраста. Архивъ внутренней медицины,12(6), 459—466. https://doi.org/10.20514/2226-6704-2022-12-6-459-466Samkova, I.A., Makarova, A.A., Voronina, E.A. (2022). Relationship between fall risk and cognitive function and emotional status (fear of falling) in older adults. Russian Archives of Internal Medicine, 12(6), 459—466. (In Russ.). https://doi.org/10.20514/2226-6704-2022-12-6-459-466
5. Шварцер, Р., Ерусалем, М., Ромек, В.Г. (1996). Русская версия шкалы общей самоэффективности Р. Шварцера и М. Ерусалема. Иностранная психология,7, 71—77. https://doi.org/10.1037/t00393-000Schwarzer, R., Jerusalem, M., Romek, V.G. (1996). Russian version of the General Self-Efficacy Scale by R. Schwarzer and M. Jerusalem. Inostrannaya Psikhologiya, 7, 71—77. (In Russ.). https://doi.org/10.1037/t00393-000
6. Alexopoulos, G.S., Abrams, R.C., Young, R.C., Shamoian, C.A. (1988). Cornell Scale for Depression in Dementia. Biological Psychiatry,23(3), 271—284. https://doi.org/10.1016/0006-3223(88)90038-8
7. Berg, K., Wood-Dauphinee, S., Williams, J.I., Maki, B. (1992). Measuring balance in the elderly: Validation of an instrument. Canadian Journal of Public Health,83(Suppl 2), 7—11. https://doi.org/10.1007/BF03404498
8. Cruz-Díaz, D., Lomas-Vega, R., Osuna-Pérez, M.C., Hita-Contreras, F. (2015). Effects of a six-week Pilates intervention on balance and fear of falling in women aged over 65 with chronic low-back pain: A randomized controlled trial. Maturitas,82(4), 371—376. https://doi.org/10.1016/j.maturitas.2015.07.022
9. Dayhoff, N.E., Baird, C., Bennett, S., Backer, J. (1994). Fear of falling: Measuring fear and appraisals of potential harm. Rehabilitation Nursing Research, 3(3), 97—104.
10. Delbaere, K., Smith, S.T., Lord, S.R. (2011). Development and initial validation of the Iconographical Falls Efficacy Scale. Journal of Gerontology: Medical Sciences,66A(6), 674—680. https://doi.org/10.1093/gerona/glr019
11. Folstein, M.F., Folstein, S.E., McHugh, P.R. (1975). "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12(3), 189—198. https://doi.org/10.1016/0022-3956(75)90026-6
12. Franco, M.R., Pinto, R.Z., Delbaere, K., Eto, B.Y., Faria, M.S., Aoyagi, G.A., … Pastre, C.M. (2018). Cross-cultural adaptation and measurement properties testing of the Iconographical Falls Efficacy Scale (Icon-FES). Brazilian Journal of Physical Therapy,22(4), 291—303. https://doi.org/10.1016/j.bjpt.2018.01.003
13. Hill, K.D., Schwarz, J.A., Kalogeropoulos, A.J., Gibson, S.J. (1996). Fear of falling revisited. Archives of Physical Medicine and Rehabilitation,77(10), 1025—1029. https://doi.org/10.1016/S0003-9993(96)90063-5
14. Huang, T.-T., Acton, G.J. (2004). Geriatric fear of falling measure: Development and psychometric testing. International Journal of Nursing Studies,41(8), 857—865. https://doi.org/10.1016/j.ijnurstu.2004.04.004
15. Kline, R.B. (2016). Principles and practice of structural equation modeling (4th ed.).New York, NY: Guilford.
16. Lachman, M.E., Howland, J., Tennstedt, S., Jette, A., Assmann, S., Peterson, E.W. (1998). Fear of falling and activity restriction: The Survey of Activities and Fear of Falling in the Elderly (SAFE). The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences,53(1), P43—P50. https://doi.org/10.1093/geronb/53B.1.P43
17. Landers, M.R., Durand, C., Powell, D.S., Dibble, L.E., Young, D.L. (2011). Development of a scale to assess avoidance behavior due to a fear of falling: The Fear of Falling Avoidance Behavior Questionnaire (FFABQ). Physical Therapy,91(8), 1253—1265. https://doi.org/10.2522/ptj.20100304
18. Lazarus, R.S., Folkman, S. (1984). Stress, appraisal, and coping. New York: Springer Publishing Company.
19. Lee, D., Tak, S.H. (2023). A concept analysis of fear of falling in older adults: Insights from qualitative research studies. BMC Geriatrics, 23(1), e651. https://doi.org/10.1186/s12877-023-04364-5
20. Lee, S.C., Huang, Y.-C., Tsai, M.-J., Chen, K.-C., Wu, C.-T., Lin, C.-H. (2024). Cross-cultural adaptation and psychometric property testing of the Taiwan Chinese version of the Iconographical Falls Efficacy Scale. Journal of the Formosan Medical Association,123(6), 655—663. https://doi.org/10.1016/j.jfma.2023.10.023
21. Mini-Mental State Examination, 2nd Edition™: Russian: материалы психодиагностической методики.PAR, Inc. URL: https://www.parinc.com/products/MMSE-2-RUSSIAN (veiwed: 10.05.2025).
22. Powell, L.E., Myers, A.M. (1995). The Activities-specific Balance Confidence (ABC) Scale. Journal of Gerontology: Medical Sciences,50A(1), M28—M34. https://doi.org/10.1093/gerona/50A.1.M2
23. Rider, J.V., Longhurst, J., Lekhak, N., Landers, M.R. (2022). Activities most avoided because of fear of falling avoidance behavior in people with Parkinson’s disease. The American Journal of Occupational Therapy,76(1), e7610500002p1. https://doi.org/10.5014/ajot.2022.76S1-PO2
24. Rider, J.V., Longhurst, J., Lekhak, N., Landers, M.R. (2024). The psychometric properties of the modified Fear of Falling Avoidance Behavior Questionnaire (mFFABQ). Archives ofPhysiother, 2(14), 11—19.
25. Sapmaz, M., Mujdeci, B. (2021). The effect of fear of falling on balance and dual task performance in the elderly. Experimental Gerontology, 147, e https://doi.org/10.1016/j.exger.2021.111250
26. Scheffer, A.C., Schuurmans, M.J., van Dijk, N., van der Hooft, T., de Rooij, S.E. (2010). Reliability and validity of the visual analogue scale for fear of falling in older persons. Journal of the American Geriatrics Society, 58(11), 2228—2230. https://doi.org/10.1111/j.1532-5415.2010.03105.x
27. Tinetti, M.E., Richman, D., Powell, L. (1990). Falls efficacy as a measure of fear of falling. Journal of Gerontology, Series B: Psychological Sciences,45(6), P239—P243. https://doi.org/10.1093/geronj/45.6.P239
28. Tombaugh, T.N., McIntyre, N.J. (1992). The Mini-Mental State Examination: A comprehensive review. Journal of the American Geriatrics Society, 40(9), 922—935. https://doi.org/10.1111/j.1532-5415.1992.tb01992.x
29. Turen, S., Ozcalik, C.K., Yildiz, G., Tekir, M.I. (2025). Fall risk and avoidance behavior due to fear of falling in elderly nursing home residents. European Journal of Clinical and Experimental Medicine,23(1), 76—82. https://doi.org/10.15584/ejcem.2025.1.12
30. Velozo, C.A., Peterson, E.W. (2001). Developing meaningful fear of falling measures for community-dwelling elderly. American Journal of Physical Medicine & Rehabilitation,80(9), 662—673. https://doi.org/10.1097/00002060-200109000-00006
31. Wolfson, L., Whipple, R., Amerman, P., Kleinberg, A. (1990). Gait assessment in the elderly: A gait abnormality rating scale and its relation to falls. Journal of Gerontology,45(1), 12—19. https://doi.org/10.1093/geronj/45.1.M12
32. Yardley, L., Beyer, N., Hauer, K., Kempen, G, Piot-Ziegler, C., Todd, C. (2005). Development and initial validation of the Falls Efficacy Scale-International (FES-I). Age and Ageing, 34(6), 614—619. https://doi.org/10.1093/ageing/afi196
33. Yardley, L., Smith, H. (2002). A prospective study of the relationship between feared consequences of falling and avoidance of activity in community-living older people. The Gerontologist, 42(1), 17—23. https://doi.org/10.1093/geront/42.1.17
34. Zhang, Q., Huang, S., Liu, H., Wang, Y., Chen, X., Li, Z., Zhao, J., Xu, L., Yang, F., Zhou, T., Sun, Y. (2024). Exploring the association between activities of daily living ability and injurious falls in older stroke patients with different activity ranges. Scientific Reports, 14(1), e https://doi.org/10.1038/s41598-024-70413-7