The reliability and validity of the Survey of Activities and Fear of Falling in the Elderly for assessing fear and activity avoidance among stroke survivors

INTRODUCTION: Activity restriction due to fear of falling is a common problem after a stroke. It can lead to deteriorated physical condition, restricted social participation and deprived quality of life. The Survey of Activities and Fear of Falling in the Elderly (SAFE) was developed to assess these difficulties, and its utility has been demonstrated among the older adults and older people with Parkinson’s disease. This study aimed to expand those demonstrations to community-dwelling chronic stroke survivors using a Chinese translation of the instrument. METHODS: One hundred and eight elderly individuals with a history of stroke completed the Chinese version of the SAFE (SAFE-C). The internal consistency of their responses was assessed using Cronbach’s alpha. Twenty of the same subjects were reassessed after a 1-week interval to assess the instrument’s test-retest reliability. Structure validity was examined by exploratory factor analysis. Pearson correlation was used to establish the instrument’s convergent validity with respect to the results from the Chinese version of the Activities-specific Balance Confidence Scale (ABC-C) and the Chinese version of the Lawton Instrumental Activities of Daily Living scale (IADL-C). RESULTS: The items of the SAFE-C demonstrated excellent internal consistency with a Cronbach’s alphas of 0.90. The SAFE-C also had excellent test-retest reliability with an overall intra-class correlaton coefficient of 0.91. A 1-factor structure termed “fear avoidance circumstances” was identified and it was shown to be consistent with the original measure developed among community-living older people. The correlations between the SAFE-C and the ABC-C (r = -0.68) and the IADL-C (r = -0.57) confirmed the convergent validity. CONCLUSIONS: Fear avoidance behavior is a homogeneous construct applicable to people with stroke-specific impairments alike. The SAFE-C is a reliable and valid instrument for measuring the level of fear avoidance behavior among community-dwelling stroke survivors. Stroke survivors with good functional mobility revealed a low level of fear and avoidance as measured by the SAFE-C.