Qom University of Medical Sciences Journal

Introduction
Almost one-third of people over the age of 65 experience at least one fall, 15% of whom fall at least twice in their lifetime. Fall is known to be one of the most common causes of injury in the elderly; up to 60% of falls result in injuries that can cause physical disability, reduced quality of life, and even death. It is necessary to identify the risk factors for fall in order to prevent the accident and reduce the related costs. To predict the risk of fall, initial assessments by using self-report tools have been recommended since they are easy to use, cost-effective, and useful. Patient-reported outcomes have been shown to be a proper way to obtain information about their balance and overall function. The Fall Risk Questionnaire (FRQ) designed in 2011 by the U.S. Centers for Disease Control and Prevention (CDC) for the Elderly is an evidence-based self-rated tool that can be used to screen older adults at risk of falling and consists of 13 items answered by “yes” or “no”. A total score of 4 or higher is an important indicator of a person’s risk of fall.. This study aims to determine the validity and reliability of the Persian version of FRQ.
Methods
This is a methodological study. The recommended backward-forward method based on the protocol of the International Quality of Life Assessment Project was used for translation. For this purpose, first, two translators fluent in English translated the English version of the questionnaire into Persian. Then, two experts in English translated the Persian version back into English. After comparing it with the English version, making necessary corrections and modifications, the final Persian version was approved.
To determine the face validity, ten eligible elderly people were asked to complete the questionnaire. To determine the content validity using the qualitative method, ten specialists in health and nursing education were asked to assess the questionnaire based on the defined criteria. After obtaining permission from the Vice-Chancellor for Research and coordination with one of the retirement centers in Qom, 60 elderly people were included in the study based on the inclusion criteria: Age ≥60 years, living at home, no mental and cognitive impairment  (A score of 6 or above in the Persian Abbreviated Mental Test), ability to read and write, ability to communicate, and consent to participate in the study. Considering ethical considerations, the questionnaire was completed within three months.
To collect the data, the Persian FRQ, the Activities-Specific Balance confidence (ABC) scale, timed up & go test, 30-second chair stand test, and a demographic form were used. In order to determine the construct validity of the questionnaire, the Known-Group validity was used. This type of validity determines the ability of a tool to differentiate groups according to the defined criteria. The used parameter was the history of falling and the comparison of the FRQ scores between the two groups of older adults with and without a history of fall was performed using the independent t-test. In order to evaluate the convergent validity, Pearson correlation test was used to assess the relationship between the scores of Persian FRQ and timed up & go test. To determine the divergent validity, the relationship of the score of Persian FRQ with the scores of ABC scale and 30-second chair stand test was examined. To determine the internal consistency, Kuder-Richardson coefficient was calculated. Data analysis was performed in SPSS software, version 23. The significance level was set at 0.05.
Results
The test results showed that the mean score of the FRQ in the elderly with a history of fall was significantly higher than in the elderly without a history of fall (P=0.003). The score of FRQ had a significant correlation with the scores of timed up & go test (r=0.428, P<0.001), and 30-second chair stand test (r=-0.333, P<0.01), which confirmed the convergent and divergent validity of the Persian FRQ. However, the correlation of FRQ score with the ABC scale score was not significant. The internal consistency of the Persian FRQ was obtained 0.624.
Discussion
Since fall in the elderly is known to be multifactorial, the use of a questionnaire to assess its risk factors is undoubtedly important to prevent falls. The FRQ is easy to use and can be completed by the elderly or health care providers in a shore time. The results of known-group validity assessment for the Persian FRQ showed that the score of FRQ in the elderly with a history of falling was significantly higher than what was expected. It is concluded that the Persian version of the FRQ is a valid and reliable instrument for assessing the risk of falls in the community-dwelling elderly living in Iran. This scale can also be useful in fall prevention interventions and measuring the impact of these interventions on the risk of falls in the elderly.

Ethical Considerations
Compliance with ethical guidelines
The study was part of a research project with a code of ethics IR.MUQ.REC.1400.135.
Funding
The study was supported by the Qom University of Medical Sciences.
Authors contributions
All authors contributed equally in preparing all parts of the research.
Conflicts of interest
The authors declared no conflict of interest.
Acknowledgements
Researchers would like to express their gratitude to the Research deputy , the staff of the educational and medical centers, and the patients participating in this study.