Balance, Fall Confidence and Risk Scores Grow More Linked Over Six Weeks

Older adults attending physiotherapy at a single Indian hospital showed increasingly tight relationships between their balance, their confidence about falling, and their clinical fall risk as a six-week observation period unfolded, according to a secondary analysis published in the Bulletin of Faculty of Physical Therapy. At the start of the study, only one of the three possible pairings among the three standard assessment tools registered a statistically significant association. By the final assessment, all three correlations were strong or moderate and highly significant, suggesting that the measures capture overlapping but complementary dimensions of fall-related health that converge as repeated assessments proceed.

The parent trial compared conventional physiotherapy alone with conventional physiotherapy combined with progressive resistance exercises in older adults.

The three instruments at the heart of the study each probe a different facet of fall vulnerability. The Berg Balance Scale assesses functional balance through standardized physical tasks and is widely regarded as a reliable and valid clinical instrument for older adults. The Falls Efficacy Scale, in the original version developed by Tinetti and colleagues in 1990, measures fall-related self-efficacy, meaning a person’s confidence in performing daily activities without falling; each activity is scored from 1, indicating very confident, to 10, indicating not confident at all, so higher total scores reflect greater concern about falling. The Morse Fall Scale, meanwhile, is a clinical screening tool used to identify individuals at elevated risk of falling and to support fall prevention strategies in practice.

The correlation pattern shifted markedly over the six weeks. At baseline, the only statistically significant relationship was a weak negative correlation between the Berg Balance Scale and the Morse Fall Scale, with r equal to −0.282 and p equal to 0.022. No significant associations emerged between balance and fall-related self-efficacy, or between self-efficacy and fall risk, at that initial visit. In practical terms, a person’s measured balance, their psychological confidence, and their clinical risk categorization appeared largely independent of one another when first assessed, a pattern the authors attribute to individual variability in physical function, psychological perception, health status, and previous fall experiences.

By the four-week assessment, the web of relationships had begun to tighten. The correlation between balance and fall risk strengthened to a weak-to-moderate negative association, r equal to −0.378 with p equal to 0.002, meaning that participants with better balance scores tended to register lower clinical fall risk. A moderate positive correlation appeared between the Falls Efficacy Scale and the Morse Fall Scale, r equal to 0.497 with p below 0.001. Because higher Falls Efficacy Scale scores indicate lower confidence, this positive sign carries a coherent meaning: greater concern about falling went hand in hand with higher clinical fall risk.

The six-week assessment produced the strongest associations of the entire study. Balance and fall risk showed a strong negative correlation, r equal to −0.704 with p below 0.001, indicating that better balance was associated with lower fall risk. Fall-related self-efficacy and fall risk showed a strong positive correlation, r equal to 0.714 with p below 0.001, meaning that lower confidence, or greater concern about falling, accompanied higher risk. Balance and self-efficacy, which had shown no significant link at baseline, now displayed a moderate negative correlation, r equal to −0.478 with p below 0.001, so participants with better balance tended to report greater confidence in performing daily activities without falling. Taken together, the strength of the associations among the three measures increased steadily across the three assessment points.

The authors are explicit that this tightening pattern must not be read as evidence that physiotherapy caused the changes. Because the analysis was correlational and secondary to a treatment trial, causal inferences regarding rehabilitation cannot be drawn, and the study was not designed to compare progressive resistance exercise with standard physiotherapy or to determine how either intervention influenced the observed correlations. The findings instead describe how the relationships among the three scales evolved during follow-up, irrespective of treatment allocation. The authors also note that falls are multifactorial events shaped by physical, psychological, environmental, and behavioral factors, and that fear of falling has been associated with activity restriction, reduced physical activity, functional decline, impaired postural control, and increased fall risk even among people with no history of falling, observations consistent with the stronger self-efficacy and risk correlations seen during follow-up.

From a clinical standpoint, the practical message is that the three scales provide complementary rather than redundant information. The Berg Balance Scale captures what the body can do, the Falls Efficacy Scale captures what the mind fears, and the Morse Fall Scale condenses clinical risk factors into a screening score. The authors suggest that repeated assessment using all three may help clinicians monitor changes in physical function and perceived fall-related confidence during rehabilitation, potentially offering a more comprehensive picture than any single instrument alone.

The study carries important limitations that frame how far its conclusions can travel. It was a secondary correlational analysis, so no causal claims about rehabilitation are possible. The sample of 66 participants was relatively small and drawn from a single tertiary care center, which may limit generalizability. Follow-up lasted only six weeks, leaving the long-term stability of these relationships unknown. Factors known to influence fall risk, including comorbidities, medication use, cognitive status, and physical activity levels, were not examined. The authors call for larger multicenter studies with longer follow-up, prospective trials testing whether different rehabilitation approaches influence these longitudinal relationships, and research into whether combined BBS, FES, and MFS assessments can predict actual falls and functional outcomes in older adults.

Subject of Research: Longitudinal correlations among balance, fall-related self-efficacy, and fall risk measures in older adults

Article Title: Longitudinal correlations among the berg balance scale, falls efficacy scale, and morse fall scale: a secondary analysis of a randomized controlled trial

Article References: Seju, C., & Patel, J. (2026). Longitudinal correlations among the berg balance scale, falls efficacy scale, and morse fall scale: a secondary analysis of a randomized controlled trial. Bulletin of Faculty of Physical Therapy, 31(1), Article 47. https://doi.org/10.1186/s43161-026-00371-w

Image Credits: AI Generated

DOI: 10.1186/s43161-026-00371-w

Keywords: older adults, Berg Balance Scale, Falls Efficacy Scale, Morse Fall Scale, fall risk, balance, correlational study, physiotherapy, secondary analysis, geriatric rehabilitation, Longitudinal, correlations