Modified Falls Efficacy Scale Explained: Uses, Scoring, and Benefits

Falls are among the most common and costly health concerns for older adults, often leading to loss of independence, hospitalization, or long-term care. Beyond physical injury, fear of falling can significantly impact mobility, activity engagement, and quality of life. To better assess a person's confidence in avoiding falls during daily tasks, healthcare professionals often use the Modified Falls Efficacy Scale (MFES)—a validated tool designed to measure self-perceived fall risk across various activities.

This article provides an overview of the Modified Falls Efficacy Scale, its structure and use in clinical and home health settings, and how it contributes to fall prevention strategies. It also includes a practical example of how the tool can be implemented during a patient visit.

What is the Modified Falls Efficacy Scale?

The Modified Falls Efficacy Scale is an expansion of the original Falls Efficacy Scale (FES) created in 1990. While the original FES focused on confidence levels during basic daily activities performed indoors, the modified version includes outdoor tasks and community-based activities that present higher physical demands and environmental variability.

The MFES contains 14 items—the original ten from the FES, plus four additional questions focused on more challenging tasks such as walking on uneven surfaces or navigating crowded environments. Each item is rated on a scale from 0 to 10, with:¹ 

• 0 = not confident at all

• 10 = completely confident

Scores are averaged across all items. A lower score indicates reduced confidence and may suggest a higher risk of functional decline or future falls.

The tool has been validated across various populations, including community-dwelling older adults, stroke survivors, and individuals with vestibular disorders.

Populations where the MFES excels

While the MFES was originally developed for community-dwelling older adults, its use extends across a variety of patient populations where fall-related confidence impacts function and participation. These include:

• Post-stroke rehabilitation: After a stroke, patients may experience a mismatch between physical ability and perceived safety. The MFES can help identify psychological barriers to mobility early in the recovery process.

• Vestibular disorders: Individuals with dizziness or balance dysfunction often report a high fear of falling, which may lead to activity restriction and reduced quality of life.² The MFES can guide vestibular therapy by highlighting specific activities that provoke anxiety or avoidance, supporting more targeted and patient-centered interventions. 

• Parkinson’s disease and other neurologic conditions: Conditions with fluctuating motor control can cause patients to feel uncertain or unsafe, even if their physical assessments appear stable.

• Older adults with mild cognitive impairment: Even in early cognitive decline, self-report tools like the MFES can help identify reduced confidence that may not be obvious through observation alone.

By using the MFES with diverse populations, clinicians can tailor care to each patient’s unique physical and psychological needs.

Why fall-related confidence matters

While gait and balance tests assess physical capability, fall-related self-efficacy addresses the psychological component of fall risk. Low confidence can lead to activity restriction, physical deconditioning, and social isolation. The fear-avoidance cycle can accelerate fall risk and functional decline.³

The MFES serves as a useful screening tool to:

• Identify individuals at risk who may otherwise appear physically capable.

• Guide patient-centered interventions focused on both strength training and behavioral strategies.

• Track progress over time by comparing baseline and follow up scores.

It complements other assessments, such as the Timed Up and Go (TUG), Berg Balance Scale (BBS), or Dynamic Gait Index (DGI), creating a broader picture of a person’s fall risk profile.

Example: Using the MFES in a clinical setting

A home health physical therapist visits a 78-year-old patient who recently experienced a fall two weeks ago. The patient has resumed walking short distances indoors but avoids going outdoors or using stairs due to fear of falling. The therapist is evaluating fall risk and developing a care plan to support safer mobility.

Step 1: Administer the MFES

To assess the patient’s fall-related self-efficacy, the therapist administers the 14-item MFES and asks the patient to rate their confidence performing activities such as reaching into cabinets, walking around the house, and navigating a crowded mall.

Step 2: Score the results

The patient reports high confidence with indoor tasks (average rating: 8.5) but low confidence with outdoor and public activities (average rating: 4.0). The overall MFES score is 6.2, indicating reduced self-efficacy in higher-risk scenarios.

Step 3: Integrate into the plan of care

The therapist identifies psychological barriers to activity and incorporates task-specific graded exposure, starting with short outdoor walks in quiet areas and gradually introducing more complex environments. Strength and balance exercises are also included to improve physical readiness and support confidence-building.

Step 4: Reassess over time

After six weeks, the MFES is re-administered. The patient’s score improves to 8.0, and they report walking outdoors more often with no additional falls. The increase in confidence reflects the combined impact of physical training and progressive exposure.

This example demonstrates how the MFES can guide decision-making, support goal setting, and measure intervention outcomes from both physical and behavioral perspectives.

Interpreting scores and using cut-offs

There is no universally accepted cut off score for the MFES, and interpretation should always consider the broader clinical picture. That said, average scores below 8.0 may indicate reduced fall-related self-efficacy and signal a need for closer monitoring or intervention. Additionally, research suggests that a score below 5.0 on hospital admission may predict an increased risk of in-hospital falls and longer length of stay.⁴

Because the MFES is subjective, scores should be interpreted alongside functional assessments, medical history, and environmental context. The tool is especially useful when tracked over time or combined with observational data.

The tool can also help engage patients in shared decision-making. By identifying which activities cause the most concern, clinicians can involve individuals in prioritizing treatment areas and setting meaningful goals.

Implementation considerations

The MFES is a flexible, low-burden tool that can be used across clinical environments, including home health, outpatient rehab, fall prevention screenings, and wellness programs. It requires no special training or equipment, making it easy to integrate into both new evaluations and ongoing treatment plans

Clinical tips for meaningful administration

To ensure the MFES yields useful insights, clinicians should take a thoughtful, patient-centered approach:

Set expectations early

Explain that the scale measures confidence, not current performance. This can prevent confusion—especially for patients who may avoid certain tasks altogether.

Use conversational language

If a patient hesitates or seems unsure, rephrase questions in more familiar terms. For example: “How confident do you feel walking outside to check the mail?”

Watch for nonverbal cues

Long pauses, changes in tone, or body language may reveal uncertainty even if a high number is given. Use these moments to ask follow-up questions or explore underlying concerns.

Adapt for cognitive or communication needs

Patients with mild cognitive impairment or expressive aphasia may benefit from visual scales, repetition, or support from a caregiver. Modify delivery as needed to ensure comprehension.

Compare confidence to functional findings

MFES scores should be interpreted alongside physical assessments like the TUG or Berg Balance Scale. Discrepancies between confidence and actual performance can help uncover hidden fall risk or identify opportunities for targeted intervention.

Tips for integration into the workflow

For streamlined use across your care team:

• Build the MFES into your electronic documentation templates

• Pair it with mobility and balance tests during evaluations

• Use scores to track progress and guide individualized care planning

• Reassess regularly to measure change and support outcome tracking

By combining clinical observation with patient-reported confidence, the MFES supports a more holistic approach to fall prevention and mobility restoration.

A clinician’s ally in fall prevention

The Modified Falls Efficacy Scale provides a structured, reliable method for measuring fall-related confidence across a wide range of daily and community activities. By identifying perceived risks and psychological barriers to movement, the MFES supports a more complete approach to fall prevention—one that includes both physical and psychological considerations.

Its ease of use, relevance to clinical care, and ability to track change make it a valuable tool for promoting mobility, independence, and safety in older adults.

To learn more about fall prevention tools, training, and solutions, visit Medbridge’s Fall Prevention resource page.

References

1. Edwards, N., & Lockett, D. (2008). Development and validation of a modified falls-efficacy scale. Disability and rehabilitation. Assistive technology, 3(4), 193–200. https://pubmed.ncbi.nlm.nih.gov/19238720/

2. Marchetti, G. F., Whitney, S. L., Redfern, M. S., & Furman, J. M. (2011). Factors associated with balance confidence in older adults with health conditions affecting the balance and vestibular system. Archives of physical medicine and rehabilitation, 92(11), 1884–1891. https://pmc.ncbi.nlm.nih.gov/articles/PMC4886544/

3. Chandrasekaran, S., Hibino, H., Gorniak, S. L., Layne, C. S., & Johnston, C. A. (2021). Fear of Falling: Significant Barrier in Fall Prevention Approaches. American journal of lifestyle medicine, 15(6), 598–601. https://pmc.ncbi.nlm.nih.gov/articles/PMC8669901/

4. Gettens, S., & Fulbrook, P. (2015). Fear of falling: association between the Modified Falls Efficacy Scale, in-hospital falls and hospital length of stay. Journal of evaluation in clinical practice, 21(1), 43–50. https://pubmed.ncbi.nlm.nih.gov/25040834/