Validation of Falls Efficacy Scale Instrument in Romanian Adults with Type 2 Diabetes Mellitus: A Monocenter,...

Background: Fear of falling is common in older adults with type 2 diabetes mellitus (T2DM), particularly in those with balance and mobility impairment. The Falls Efficacy Scale-International (FES-I) is widely used to quantify concern about falling but requires local validation. We aimed to validate the Romanian version of the FES-I in older adults with T2DM. Methods: In this validation study, 124 consecutive outpatients with T2DM aged > 60 years completed the Romanian FES-I at baseline (v1) and at one-month follow-up (v2). Internal consistency was assessed with Cronbach's alpha and item-total correlations. Test-retest reliability was evaluated using intraclass correlation coefficient (ICC) and the Bland-Altman agreement. Construct validity was examined by correlations with the Fear-of-Falling Questionnaire-Revised (FFQ-R), Berg Balance Scale (BBS), Timed Up and Go (TUG), and single-leg stance (SLS). Discriminative performance was assessed via ROC analyses. Results: Mean FES-I scores were 30.8 ± 11.4 (v1) and 31.1 ± 11.6 (v2). Internal consistency (Cronbach's alpha 0.945-0.947) and test-retest reliability (ICC 0.972; 95% CI 0.956-0.983) were excellent, with minimal bias. FES-I correlated strongly with FFQ-R (rho = 0.787) and moderately with function (BBS rho = -0.631; TUG rho = 0.547; SLS rho = -0.498; all p < 0.001). Discrimination was good for BBS (AUROC = 0.779) and TUG (AUROC = 0.800). Conclusions: The Romanian FES-I demonstrates excellent reliability and good validity in older adults with T2DM, with low measurement error and clinically interpretable change thresholds. It can be used for fear-of-falling quantification in routine care and research, including longitudinal monitoring and evaluation of interventions in Romanian patients with diabetes.