Evaluating the construct validity of five concern for falling outcome measures and the concern for falling framework in people with lower limb loss using the International Classification of Functioning, Disability and Health framework.

Abstract

To evaluate construct validity of five concern for falling (CFF) outcome measures: 1) Locomotor Capability Index (LCI); 2) Prosthetic Limb Users Survey-Mobility (PLUS-M); 3) Consequences of Falling (COF) Scale; 4) Perceived Ability to Manage a Fall (PAMF) Scale; and 5) Perceived Control Over Falling (PCOF) Scale in people with lower limb loss (PWLLL). Two coders independently linked ICF codes to measures using established linking rules. Consensus was achieved through discussion and consultation with an additional author. Inter-rater reliability was assessed using Cohen's kappa. ICF codes were compared with established CFF construct codes using descriptive statistics, and codes from limb loss-specific measures (PLUS-M, LCI) were compared against concepts identified in generic measures (COF, PAMF, PCOF). Inter-rater reliability ranged from moderate to very good (kappa values = 0.52-0.91, <i>p</i> < 0.001); values could not be calculated for the PCOF due to limited items. Forty-seven items were linked; the most common codes were d4602 (<i>n</i> = 11) ('<i>Moving around outside the home/buildings</i>') and d4551 (<i>n</i> = 9) (<i>'Climbing/going up/down steps/hills'</i>), concentrated within the Activities and Participation ICF component. While the ICF offers a standardized framework, greater specificity for limb loss-related mobility demands may enhance its clinical utility for PWLLL.