Psychological indicators of balance confidence: relationship to actual and perceived abilities.

Background: This study compares several psychological indicators of balance confidence in relation to physical performance, past and current experience, gender bias, and other perceptions of daily functioning.

Methods: Sixty community-dwelling ambulatory elders (aged 65-95) were administered the Falls Efficacy Scale (FES), the Activities-Specific Balance Confidence Scale (ABC), and three dichotomous questions on fear of falling, activity avoidance, and perceived need for personal assistance to ambulate outdoors. Performance measures on walking (average speed) and balance (static posturography) were obtained on a subsample of 21 subjects.

Results: Balance confidence assessed by the ABC and self-perceived need for personal assistance with outdoor ambulation were the only indicators significantly associated with the performance measures. As expected, perceived balance capabilities were more strongly related to current behavior (frequency of doing specific activities) than to past experience (fall history). Gender differences in self-report emerged for the global fear-of-falling indicator but not for the two efficacy ratings.

Conclusions: Psychological indicators of balance confidence are important to measure both in conjunction with balance test performance and as a legitimate focus of rehabilitation. Of the various indicators assessed here, the dichotomous fear-of-falling question appears to have the least utility. Perceived need for personal assistance to ambulate outdoors has merit as an initial clinical screening question for discriminating persons on the basis of both physical ability and confidence. The ABC scale appears to have the greatest utility as an evaluative index for older persons at a moderate to high level of functioning.