Fall-Risk Screening Checklist (FES-I)
Form Filling and Clinical Assessment Guidance for Physiotherapists
Purpose of the Form
The Falls Efficacy Scale – International (FES-I) is a validated patient-reported outcome measure designed to assess fear of falling during daily and community activities. It does not measure balance or strength directly, but evaluates the psychological and behavioral impact of fall risk, which is strongly associated with future falls, activity restriction, reduced participation, and poorer quality of life.
This checklist is intended for use in:
- Acute wards
- Rehabilitation units
- Outpatient departments
- Home-based and community settings
It supports:
- Early identification of individuals at risk of falls
- Stratification of fall risk based on concern about falling
- Integration of psychological risk into fall-prevention planning
- Documentation for MDT communication and audit
Patient Details Section
How to Fill
Record:
- Patient name and UHID
- Age and sex
- Location of assessment (ward, rehab, OPD, home)
- Date of assessment
Clinical Guidance
Age and location are important contextual factors. Higher concern scores in hospital or post-acute settings may reflect recent illness or hospitalization, whereas high scores in community-dwelling individuals often indicate chronic fear and activity avoidance.
FES-I Item Checklist & Scoring Key
Scoring Explanation
Each activity is scored based on how concerned the patient feels about falling, not on whether they can or cannot perform the activity.
Scoring options:
- 1 – Not at all concerned
- 2 – Somewhat concerned
- 3 – Fairly concerned
- 4 – Very concerned
Administration Guidance
- Ask the patient to rate their concern, not their actual performance.
- If the patient does not currently perform an activity, ask them to imagine doing it.
- Caregiver input may be used when cognitive impairment is present, but this should be noted clinically.
Section A: Basic Activities
Activities Assessed
- Cleaning the house
- Getting dressed or undressed
- Preparing simple meals
- Taking a bath or shower
- Getting in or out of a chair
How to Administer
Read each activity clearly and ask:
“How concerned are you about falling when you do this activity?”
Tick one score (1–4) for each activity.
Clinical Interpretation
High concern during basic activities suggests:
- Reduced confidence in fundamental mobility
- Increased dependence risk
- Potential early functional decline
These patients often benefit from confidence-building exercises, basic balance training, and environmental modification.
Section B: Functional Mobility
Activities Assessed
- Going up or down stairs
- Reaching above head
- Reaching to the ground
- Walking on a flat surface
How to Administer
Ensure the patient understands that the question relates to fear of falling, not pain or fatigue alone.
Clinical Interpretation
High concern in this section indicates:
- Fear during transitional and dynamic movements
- Increased likelihood of cautious gait, reduced speed, and instability
- Strong association with future falls
This section correlates closely with objective measures such as Timed Up and Go (TUG).
Score Calculation
How to Calculate
- Add the scores for all items completed
- Minimum possible score: 16
- Maximum possible score: 64
Write the total score clearly in the score field.
Interpretation & Fall-Risk Stratification
Score Interpretation
| Total FES-I Score | Interpretation | Fall-Risk Level |
|---|---|---|
| 16–19 | Low concern about falling | Low risk |
| 20–27 | Moderate concern | Moderate risk |
| 28–64 | High concern | High risk |
Clinical Guidance
- Low risk: Usually independent, may only require education and reassurance
- Moderate risk: Requires targeted balance, strength, and confidence training
- High risk: High likelihood of activity avoidance, social withdrawal, and future falls; requires comprehensive fall-prevention program
Section C: Community & Complex Activities
Activities Assessed
- Walking in crowded places
- Walking on uneven surfaces
- Walking up or down slopes
- Visiting friends or relatives
- Going to social events
- Walking outdoors
How to Administer
This section is especially important for community-dwelling older adults.
Encourage honest responses and reassure the patient that there are no right or wrong answers.
Clinical Interpretation
High concern in community activities reflects:
- Reduced community participation
- Increased social isolation
- Fear-driven inactivity rather than physical incapacity alone
These patients benefit from graded community exposure, outdoor gait training, and dual-task balance exercises.
Total Score Documentation
Record the final total score clearly in the score section.
Ensure consistency between item scores and total score to avoid calculation errors.
Therapist Details
How to Fill
Record:
- Therapist name
- Signature
- Date and time of assessment
Clinical Significance
This ensures professional accountability and supports medico-legal documentation.
Clinical Notes and Interpretation Guidance
Key Points for Clinicians
- FES-I measures fear of falling, not physical balance alone
- High scores are associated with:
- Activity restriction
- Reduced participation
- Depression and anxiety
- Increased future fall risk
Best-Practice Use
- Always interpret FES-I alongside objective balance and mobility tests, such as:
- Timed Up and Go (TUG)
- Berg Balance Scale
- Functional Reach Test
- Use FES-I scores to:
- Guide education and reassurance
- Identify need for psychological confidence-building
- Monitor change in fear levels over time
Clinical Summary
The Fall-Risk Screening Checklist (FES-I) is a simple, reliable, and clinically powerful tool for identifying fear-related fall risk. Proper administration and interpretation allow physiotherapists to address not only physical impairments but also the psychological drivers of falls, leading to more comprehensive and effective fall-prevention strategies