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Using the Systems Framework for Postural Control to Analyze the Components of Balance Evaluated in Standardized Balance Measures: A Scoping Review

Open AccessPublished:July 26, 2014DOI:https://doi.org/10.1016/j.apmr.2014.06.021

      Abstract

      Objective

      To identify components of postural control included in standardized balance measures for adult populations.

      Data Sources

      Electronic searches of MEDLINE, EMBASE, and CINAHL databases using keyword combinations of postural balance/equilibrium, psychometrics/reproducibility of results/predictive value of tests/validation studies, instrument construction/instrument validation, geriatric assessment/disability evaluation, gray literature, and hand searches.

      Study Selection

      Inclusion criteria were measures with a stated objective to assess balance, adult populations (18y and older), at least 1 psychometric evaluation, 1 standing task, a standardized protocol and evaluation criteria, and published in English. Two reviewers independently identified studies for inclusion. Sixty-six measures were included.

      Data Extraction

      A research assistant extracted descriptive characteristics and 2 reviewers independently coded components of balance in each measure using the Systems Framework for Postural Control, a widely recognized model of balance.

      Data Synthesis

      Components of balance evaluated in these measures were underlying motor systems (100% of measures), anticipatory postural control (71%), dynamic stability (67%), static stability (64%), sensory integration (48%), functional stability limits (27%), reactive postural control (23%), cognitive influences (17%), and verticality (8%). Thirty-four measures evaluated 3 or fewer components of balance, and 1 measure—the Balance Evaluation Systems Test—evaluated all components of balance.

      Conclusions

      Several standardized balance measures provide only partial information on postural control and omit important components of balance related to avoiding falls. As such, the choice of measure(s) may limit the overall interpretation of an individual's balance ability. Continued work is necessary to increase the implementation of comprehensive balance assessment in research and practice.

      Keywords

      List of Abbreviations:

      BESTest (Balance Evaluation Systems Test)
      Balance is a critical skill for fall avoidance,
      • Tinetti M.E.
      • Kumar C.
      The patient who falls: it’s always a tradeoff.
      and balance impairment is common in both older adults and people living with chronic health conditions.
      • Tyson S.F.
      • Hanley M.
      • Chillala J.
      • Selley A.
      • Tallis R.C.
      Balance disability after stroke.
      • Sturnieks D.L.
      • Tiedemann A.
      • Chapman K.
      • Munro B.
      • Murray S.M.
      • Lord S.R.
      Physiological risk factors for falls in older people with lower limb arthritis.
      • Dillon C.F.
      • Gu Q.
      • Hoffman H.J.
      • Ko C.-W.
      Vision, hearing, balance, and sensory impairments in Americans aged 70 years and older: United States, 1999-2006.
      Balance exercise can reduce falls,
      • Gillespie L.D.
      • Robertson M.C.
      • Gillespie W.J.
      • et al.
      Interventions for preventing falls in older people living in the community.
      • Howe T.E.
      • Rochester L.
      • Neil F.
      • Skelton D.A.
      • Ballinger C.
      Exercise for improving balance in older people.
      • Sherrington C.
      • Tiedemann A.
      • Fairhall N.
      • Close J.C.
      • Lord S.R.
      Exercise to prevent falls in older adults: an updated meta-analysis and best practice recommendations.
      and comprehensive assessment is recommended for identifying impairments in postural control and informing the design of optimal balance exercise programs for fall prevention.
      • Horak F.B.
      Postural orientation and equilibrium: what do we need to know about neural control of balance to prevent falls?.
      However, a plethora of standardized balance measures exist,
      • Orr R.
      • Raymond J.
      • Fiatarone Singh M.
      Efficacy of progressive resistance training on balance performance in older adults: a systematic review of randomized controlled trials.
      and extensive variation in their use has limited the ability to synthesize data on the effects of balance interventions. For example, a systematic review on the effectiveness of exercise interventions to improve balance in older adults identified 95 eligible trials
      • Howe T.E.
      • Rochester L.
      • Neil F.
      • Skelton D.A.
      • Ballinger C.
      Exercise for improving balance in older people.
      but was able to pool <50% of included studies because more than 25 different standardized balance measures were used across individual trials. Varied use of balance measures is also seen in clinical practice, as illustrated in a survey of balance assessment practices among Canadian physical therapists that reported use of more than 20 different measures.
      • Sibley K.M.
      • Straus S.E.
      • Inness E.L.
      • Salbach N.M.
      • Jaglal S.B.
      Balance assessment practices and use of standardized balance measures among Ontario physical therapists.
      These issues emphasize the need for consensus on the use of outcome measures to increase understanding of the most effective components of exercise interventions.
      • Howe T.E.
      • Skelton D.A.
      Consensus on core outcome measures of function are needed to progress our knowledge of “best practice” exercise components for older people.
      Direction is needed to inform balance measurement recommendations, and given the absence of a criterion standard method for evaluating balance,
      • Tyson S.F.
      • Connell L.A.
      How to measure balance in clinical practice: a systematic review of the psychometrics and clinical utility of measures of balance activity for neurological conditions.
      content validity should be a primary consideration. However, previous systematic reviews on standardized balance measures are limited by focusing only on clinical utility, task, and environment issues in a restricted subset of measures
      • McGinnis P.Q.
      • Wainwright S.F.
      • Hack L.M.
      • Nixon-Cave K.
      • Michlovitz S.
      Use of a Delphi panel to establish consensus for recommended uses of selected balance assessment approaches.
      • Pardasaney P.K.
      • Slavin M.D.
      • Wagenaar R.C.
      • Latham N.K.
      • Ni P.
      • Jette A.M.
      Conceptual limitations of balance measures for community-dwelling older adults.
      or narrow population.
      • Tyson S.F.
      • Connell L.A.
      How to measure balance in clinical practice: a systematic review of the psychometrics and clinical utility of measures of balance activity for neurological conditions.
      As such, there is a need to systematically examine the theoretical basis underlying existing balance measures.
      • Tyson S.F.
      • Connell L.A.
      How to measure balance in clinical practice: a systematic review of the psychometrics and clinical utility of measures of balance activity for neurological conditions.
      Contemporary postural control theory views balance as the product of integrated inputs and the body as a mechanical system that interacts with the nervous system in a continuously changing environment.
      • Bernstein N.
      Co-ordination and regulation of movements.
      • Horak F.B.
      • Macpherson J.M.
      Postural orientation and equilibrium.
      • Woollacott M.H.
      • Shumway-Cook A.
      Changes in postural control across the life span—a systems approach.
      Support for this theory has been provided by evidence from multiple laboratories that have demonstrated how imposed constraints or deficits in the underlying systems impair balance.
      • Horak F.B.
      • Wrisley D.M.
      • Frank J.
      The Balance Evaluation Systems Test (BESTest) to differentiate balance deficits.
      Based on this view, the Systems Framework for Postural Control was proposed.
      • Horak F.B.
      Postural orientation and equilibrium: what do we need to know about neural control of balance to prevent falls?.
      It describes 6 major components required for the maintenance of postural control—(1) constraints on the biomechanical system, (2) movement strategies, (3) sensory strategies, (4) orientation in space, (5) dynamic control, and (6) cognitive processing (table 1, column 1)—and highlights that each underlying component and type of control could independently lead to a balance impairment. As such, this framework emphasizes the need for individual assessment of each component and treatment on a case-by-case basis.
      • Horak F.B.
      Postural orientation and equilibrium: what do we need to know about neural control of balance to prevent falls?.
      Table 1Components of balance operational definitions
      Domains in Systems Framework for Postural Control
      • Horak F.B.
      Postural orientation and equilibrium: what do we need to know about neural control of balance to prevent falls?.
      Scoping Review Adaptation of Component of Balance and Operational Definition
      1. Biomechanical constraints: degrees of freedom, strength, limits of stability
      • 1.
        Functional stability limits: Ability to move the center of mass as far as possible in the anteroposterior or mediolateral directions within the base of support
      • 2.
        Underlying motor systems: eg, strength and coordination
      • 3.
        Static stability: Ability to maintain position of the center of mass in unsupported stance when the base of the support does not change (may include wide stance, narrow, 1-legged stance, tandem—any standing condition)
      2. Orientation in space: perception of gravity, verticality
      • 4. Verticality: Ability to orient appropriately with respect to gravity (eg, evaluation of lean)
      3. Movement strategies: reactive, anticipatory, voluntary
      • 5. Reactive postural control: Ability to recover stability after an external perturbation to bring the center of mass within the base of support through corrective movements (eg, ankle, hip, and stepping strategies)
      • 6. Anticipatory postural control: Ability to shift the center of mass before a discrete voluntary movement (eg, stepping-lifting leg, arm raise, head turn)
      4. Control of dynamics: gait, proactive
      • 7. Dynamic stability: Ability to exert ongoing control of center of mass when the base of the support is changing (eg, during gait and postural transitions)
      5. Sensory strategies: integration, reweighting
      • 8. Sensory integration: Ability to reweight sensory information (vision, vestibular, somatosensory) when input altered
      6. Cognitive processing: attention, learning
      • 9. Cognitive influences: Ability to maintain stability while responding to commands during the task or attend to additional tasks (eg, dual-tasking)
      Given its conceptual basis, comprehensive nature, and support from the physiological and biomechanical literature, the Systems Framework for Postural Control can help clarify the components of balance captured in existing measures and inform decisions when selecting measures for evaluating balance and informing rehabilitative interventions. The objectives of this study were to (1) identify existing validated standardized measures of standing balance in adult populations and (2) determine the components of postural control captured in each tool, as outlined by the Systems Framework for Postural Control. The review question was “What components of postural control are included in standardized balance measures whose validity and reliability are established in adult populations (18y and older)?”

      Methods

      Study design

      A scoping review—a rigorous approach useful for identifying gaps in the existing literature
      • Arksey H.
      • O’Malley L.
      Scoping studies: towards a methodological framework.
      —was conducted. We applied Arksey and O’Malley's 5-stage framework for conducting scoping reviews
      • Arksey H.
      • O’Malley L.
      Scoping studies: towards a methodological framework.
      • Levac D.
      • Colquhoun H.
      • O’Brien K.
      Scoping studies: advancing the methodology.
      and incorporated recent recommendations for enhancing this methodology,
      • Levac D.
      • Colquhoun H.
      • O’Brien K.
      Scoping studies: advancing the methodology.
      • Daudt H.M.
      • van Mossel C.
      • Scott S.J.
      Enhancing the scoping study methodology: a large, inter-professional team’s experience with Arksey and O’Malley's framework.
      such as using an iterative approach to develop the research question, defining relevant concepts, and including quality indicators in the eligibility criteria. The steps are outlined below. Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations for systematic review conduct and reporting
      • Moher D.
      • Liberati A.
      • Tetzlaff J.
      • Altman D.G.
      Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.
      also informed the methodology and were adopted where appropriate.

      Develop a research question

      What components of postural control are included in standardized balance measures whose validity and reliability are established in adult populations (18y and older)?

      Search for relevant material

      A professional librarian searched published literature indexed in MEDLINE (from 1946 to February week 4, 2014), EMBASE (from 1974 to March 10, 2014), and CINAHL (from 1981 to March 11, 2014), and the search strategies were reviewed by a second librarian. Combinations of the following terms were used: postural balance/equilibrium, psychometrics/reproducibility of results/predictive value of tests/validation studies, instrument construction/instrument validation, geriatric assessment/disability evaluation. A sample search strategy for MEDLINE is presented in supplemental appendix S1 (available online only at http://www.archives-pmr.org/). A comprehensive gray literature search was also conducted to identify measures not captured by the database searches, including the Canadian Agency for Drugs and Technologies in Health gray literature search checklist,

      Canadian Agency for Drugs and Technologies in Health. Grey Matters: a practical search tool for evidence-based medicine 2013. Available at: http://www.cadth.ca/en/resources/finding-evidence-is/grey-matters. Accessed April 26, 2013.

      as well as a hand search of published narrative review articles describing balance measures identified in the database search, and a search of the Physiotherapy Evidence Database, a database of randomized trials, systematic reviews, and clinical practice guidelines for physiotherapy, to identify additional measures.

      Define study selection

      Level 1 title and abstract screening criteria included descriptive studies (1) focused on balance measurement, (2) in adult populations (18y and older), and (3) published in the English language. Screening criteria were piloted on a random 10% sample of abstracts and clarified where necessary. We were specifically searching for the “index” publication—a measure's first publication presenting its development and/or initial psychometric evaluation—as the definitive reference for the measure. However, in anticipation that not all measures would be published in a way that it would be possible to identify the first publication from the abstract, the names of all balance measures identified in the abstract screen were recorded for manual cross-checking and hand search for the index publication. Two research assistants independently screened the abstracts of studies identified in the database search using the screening criteria. Disagreements were resolved by the primary investigator (K.M.S.), who also reviewed the list of all measures identified in the abstract screening and flagged relevant abstracts for a follow-up hand search.
      Level 2 full-text screening criteria included (1) index publication, (2) having a stated objective or commonly used to assess balance, (3) including at least 1 standing task, (4) having both a standardized testing protocol and a standardized evaluation criteria, and (5) having a minimum of 1 psychometric property (validity or reliability) evaluated. The last criterion (minimum of 1 psychometric property evaluated) was included for quality assessment purposes to prevent measures with no empirical support from being considered. Hand searches were triggered at this phase if (1) no psychometric data were reported in the index publication (to determine whether companion articles existed that would support the inclusion of the measure in the review) or (2) it was not clear from the full text whether the identified article was the index publication. Full-text screening was performed by 2 research assistants, with disagreements resolved by the primary investigator. Two coinvestigators (M.K.B. and K.V.O.) reviewed and approved the final list of included measures to confirm that all known relevant measures were included.

      Chart the data

      Descriptive data abstraction was performed by a research assistant and reviewed by the primary investigator. The research assistant used a standardized template to extract the measures' stated purpose and development methods, characteristics (evaluation parameters and number of items), and results of preliminary psychometric testing (reliability and/or validity data).
      The components of balance evaluated in each measure were explored by coding the individual items and tasks according to the Systems Framework for Postural Control. Review of the framework by the research team suggested that in some cases, multiple constructs were captured in the original 6 domains (eg, reactive and anticipatory postural control under “movement strategies”). As such, the 6 domains were adapted by the primary investigator into 9 operational definitions of balance components that may be uniquely evaluated. These operational definitions were reviewed and revised by two coinvestigators (M.K.B. and K.V.O.) both before and iteratively during coding and validated by an external reviewer with expertise in neurophysiology of postural control. The final operational definitions are presented in table 1. Two investigators (K.M.S. and M.K.B.) independently reviewed the tasks and scoring criteria of each measure and identified on a binary scale (yes/no) which balance components were included in each measure. Individual components were defined as included if they were inherent to task performance, even if not explicitly part of the measure's evaluation criteria. Disagreements were resolved through consensus discussion with a third investigator (K.V.O.).

      Collate, summarize, and report results

      Data abstraction and mapping results were tabulated and descriptive statistics (frequencies and percentages) were calculated for all variables using SAS (version 9.2).a

      Results

      Data synthesis

      The study selection process is illustrated in figure 1. The MEDLINE, CINAHL, and EMBASE searches yielded a total of 1213 records. The hand search and gray literature search yielded an additional 18 records, and the Physiotherapy Evidence Database search did not produce any additional results. After duplicates were removed, and 974 abstracts were identified for review. Of these, 847 records were excluded after the abstract screening and 128 articles were selected for full-text review. After full-text screening, 66 articles representing the index publication of a standardized balance measure for adults were included. Full references for the index publication of all included measures are provided in supplemental appendix S2 (available online only at http://www.archives-pmr.org/).

      Measure characteristics

      Supplemental Table S1 (available online only at http://www.archives-pmr.org/) presents selected characteristics of each measure. The 66 included measures were published between 1986 and 2014. Thirty-seven measures (56%) stated at least 1 component of balance included in the Systems Framework for Postural Control. Reported development methods for each measure ranged from no description (n=33, 50%), to expert or clinician consultation (n=12, 18%), to statistical analysis (eg, Rasch analysis and item response theory; n=13, 20%). The number of items in each measure ranged between 1 and 53, with a median of 9 items. Twelve measures (18%) included some graded progression in which participants must meet specific criteria to complete additional items. Thirty-eight measures (58%) were evaluated on a categorical scale (ranging between 2 and 9 categories), 26 (39%) used a continuous scale, and 2 (3%) used a combination. Psychometric data published with the index publication are presented in supplemental table S2 (available online only at http://www.archives-pmr.org/).

      Components of balance evaluated in each measure

      Coding agreement by the 2 independent reviewers was 87%, and 100% agreement was achieved after consensus discussion with the third investigator. Coding results identifying the components of balance included in each measure are presented in table 2. Underlying motor systems were evaluated in all 66 measures (100%), anticipatory postural control in 47 measures (71%), dynamic stability in 44 measures (67%), static stability in 42 measures (64%), sensory integration in 32 measures (48%), functional stability limits in 18 measures (27%), reactive postural control in 15 measures (23%), cognitive influences in 11 measures (17%), and verticality in 5 measures (8%). Figure 2 illustrates the distribution of number of components evaluated in each measure. Thirty-four measures (52%) evaluated 3 or fewer components of balance, 22 measures (33%) evaluated between 4 and 6 components of balance, 9 measures (14%) evaluated 7 or 8 components of balance, and 1 measure evaluated all 9 components of balance (Balance Evaluation Systems Test [BESTest]).
      Table 2Components of balance evaluated by standardized measures
      MeasureStatic StabilityUnderlying Motor SystemsFunctional Stability LimitsVerticalityReactive Postural ControlAnticipatory Postural ControlDynamic StabilitySensory IntegrationCognitive InfluencesOther Constructs not Included in Systems Framework
      Activity-based Balance Level Evaluation (ABLE) Scale
      • Ardolino E.M.
      • Hutchinson K.J.
      • Pinto Zipp G.
      • Clark M.
      • Harkema S.J.
      The ABLE Scale: the development and psychometric properties of an outcome measure for the spinal cord injury population.
      YesYesYesNoYesYesYesYesNoSitting balance
      Advanced Balance and Mobility Scale (ABMS)
      • Kairy D.
      • Paquet N.
      • Fung J.
      A postural adaptation test for stroke patients.
      YesYesNoYesNoYesYesYesYes
      Balance Computerized Adaptive Testing (CAT) system
      • Hsueh I.
      • Chen J.
      • Wang C.
      • et al.
      Development of a computerized adaptive test for assessing balance function in patients with stroke.
      YesYesNoNoNoYesYesYesNoSupine to sitting, and sitting
      Hierarchical Balance Short Forms (HBSF)
      • Hou W.-H.
      • Chen J.-H.
      • Wang Y.-H.
      • et al.
      Development of a set of functional hierarchical balance short forms for patients with stroke.
      YesYesNoNoNoYesYesYesNoSitting balance
      Balance Error Scoring System (BESS)
      • Riemann B.L.
      • Guskiewicz K.M.
      • Shields E.W.
      Relationship between clinical and forceplate measures of postural stability.
      YesYesNoNoNoNoNoYesNo
      Modified Balance Error Scoring System (M-BESS)
      • Hunt T.N.
      • Ferrara M.S.
      • Bornstein R.A.
      • Baumgartner T.A.
      The reliability of the modified Balance Error Scoring System.
      YesYesNoNoNoN0NoYesNo
      BESTest
      • Horak F.B.
      • Wrisley D.M.
      • Frank J.
      The Balance Evaluation Systems Test (BESTest) to differentiate balance deficits.
      YesYesYesYesYesYesYesYesYes
      Brief Balance Evaluation Systems Test (Brief BESTest)
      • Padgett P.K.
      • Jacobs J.V.
      • Kasser S.L.
      Is the BESTest at its best? A suggested brief version based on interrater reliability, validity, internal consistency, and theoretical construct.
      YesYesYesNoYesYesYesYesNo
      Mini Balance Evaluation Systems Test (Mini BESTest)
      • Franchignoni F.
      • Horak F.
      • Godi M.
      • Nardone A.
      • Giordano A.
      Using psychometric techniques to improve the Balance Evaluation Systems Test: the mini-BESTest.
      YesYesNoYesYesYesYesYesYes
      Balance Outcome Measure for Elder Rehabilitation (BOOMER)
      • Haines T.
      • Kuys S.S.
      • Morrison G.
      • Clarke J.
      • Bew P.
      • McPhail S.
      Development and validation of the balance outcome measure for elder rehabilitation.
      YesYesYesNoNoYesYesYesNo
      Balance Screening Tool (BST)
      • Mackintosh S.
      • Datson N.
      • Fryer C.
      A balance screening tool for older people: reliability and validity.
      YesYesNoNoNoYesYesYesNo
      BDL Balance Scale
      • Lindmark B.
      • Liljenäs Å.
      • Hellström K.
      Assessment of minor or moderate balance disorders: a reliability study and comparison with healthy subjects.
      YesYesNoNoNoYesYesYesYes
      Berg Balance Scale (BBS)
      • Berg K.
      • Wood-Dauphinee S.
      • Williams J.I.
      • Gayton D.
      Measuring balance in the elderly: preliminary development of an instrument.
      YesYesYesNoNoYesYesYesNoSitting balance
      Short Form of the Berg Balance Scale (SFBBS)
      • Chou C.
      • Chien C.
      • Hsueh I.
      • Sheu C.
      • Wang C.
      • Hsieh C.
      Developing a short form of the Berg Balance Scale for people with stroke.
      YesYesYesNoNoYesYesYesNo
      Short Berg Balance Scale
      • Hohtari-Kivimaki U.
      • Salminen M.
      • Vahlberg T.
      • Kivela S.L.
      Short Berg Balance Scale—correlation to static and dynamic balance and applicability among the aged.
      YesYesYesNoNoYesYesYesNo
      Brunel Balance Assessment (BBA)
      • Tyson S.F.
      • DeSouza L.H.
      Development of the Brunel Balance Assessment: a new measure of balance disability post stroke.
      YesYesYesNoNoYesYesNoNoSitting balance
      Clinical Gait and Balance Scale (GABS)
      • Thomas M.
      • Jankovic J.
      • Suteerawattananon M.
      • et al.
      Clinical gait and balance scale (GABS): validation and utilization.
      YesYesYesYesYesYesYesYesNo
      Clinical Test of Sensory Interaction in Balance (CTSIB)
      • Shumway-Cook A.
      • Horak F.B.
      Assessing the influence of sensory interaction of balance: suggestion from the field.
      YesYesNoNoNoNoNoYesNo
      Community Balance and Mobility Scale (CB&M)
      • Howe J.A.
      • Inness E.L.
      • Venturini A.
      • Williams J.I.
      • Verrier M.C.
      The Community Balance and Mobility Scale—a balance measure for individuals with traumatic brain injury.
      YesYesNoNoNoYesYesYesYes
      Dynamic Balance Assessment (DBA)
      • Desai A.
      • Goodman V.
      • Kapadia N.
      • Shay B.L.
      • Szturm T.
      Relationship between dynamic balance measures and functional performance in community-dwelling elderly people.
      YesYesNoNoNoYesNoYesYes
      Dynamic Gait Index
      • Shumway-Cook A.
      • Baldwin M.
      • Polissar N.L.
      • Gruber W.
      Predicting the probability for falls in community-dwelling older adults.
      NoYesNoNoNoYesYesYesYes
      Four-item Dynamic Gait Index (4-DGI)
      • Marchetti G.F.
      • Whitney S.L.
      Construction and validation of the 4-item dynamic gait index.
      NoYesNoNoNoYesYesYesYes
      Functional Gait Assessment (FGA)
      • Wrisley D.M.
      • Marchetti G.F.
      • Kuharsky D.K.
      • Whitney S.L.
      Reliability, internal consistency, and validity of data obtained with the functional gait assessment.
      NoYesNoNoNoYesYesYesYes
      Dynamic One Leg Stance (DOLS)
      • Blomqvist S.
      • Rehn B.
      Validity and reliability of the Dynamic One Leg Stance (DOLS) in people with vision loss.
      YesYesNoNoNoYesNoYesNo
      Equiscale
      • Tesio L.
      • Perucca L.
      • Franchignoni F.P.
      • Battaglia M.A.
      A short measure of balance in multiple sclerosis: validation through Rasch analysis.
      YesYesYesNoYesYesYesYesNo
      Fast Evaluation of Mobility, Balance and Fitness (FEMBAF)
      • Di Fabio R.P.
      • Seay R.
      Use of the “fast evaluation of mobility, balance, and fear” in elderly community dwellers: validity and reliability.
      YesYesNoNoYesYesYesYesNoSitting balance
      Five Times Sit-to-Stand Test (5-STS)
      • Whitney S.L.
      • Wrisley D.M.
      • Marchetti G.F.
      • Gee M.A.
      • Redfern M.S.
      • Furman J.M.
      Clinical measurement of sit-to-stand performance in people with balance disorders: validity of data for the Five-Times-Sit-to-Stand Test.
      NoYesNoNoNoYesYesNoNo
      Four Square Step Test (FSST)
      • Dite W.
      • Temple V.A.
      A clinical test of stepping and change of direction to identify multiple falling older adults.
      NoYesNoNoNoYesYesNoNo
      Fullerton Advanced Balance (FAB) Scale
      • Rose D.J.
      • Lucchese N.
      • Wiersma L.D.
      Development of a multidimensional balance scale for use with functionally independent older adults.
      YesYesYesNoYesYesYesYesYes
      Functional Reach Test
      • Duncan P.W.
      • Weiner D.K.
      • Chandler J.
      • Studenski S.
      Functional reach: a new clinical measure of balance.
      NoYesYesNoNoYesNoNoNo
      Multidirectional Reach Test
      • Newton R.A.
      Validity of the multi-directional reach test: a practical measure for limits of stability in older adults.
      NoYesYesNoNoYesNoNoNo
      Hierarchical Assessment of Balance and Mobility (HABAM)
      • MacKnight C.
      • Rockwood K.
      A hierarchical assessment of balance and mobility.
      YesYesNoNoYesYesYesNoNo
      Kansas University Standing Balance Scale (KUSBS)
      • Kluding P.
      • Swafford B.
      • Cagle P.
      • Gajewski B.
      Reliability, responsiveness, and validity of the Kansas University Standing Balance Scale.
      YesYesNoNoNoYesNoNoNo
      Limits of Stability Test (LOS)
      • Clark S.
      • Rose D.J.
      • Fujimoto K.
      Generalizability of the limits of stability test in the evaluation of dynamic balance among older adults.
      NoYesYesNoNoYesNoNoNo
      Modified Figure of Eight Test
      • Jarnlo G.
      • Nordell E.
      Reliability of the modified figure of eight—a balance performance test for elderly women.
      NoYesNoNoNoNoYesNoNo
      Parallel Walk Test (PWT)
      • Lark S.D.
      • McCarthy P.W.
      • Rowe D.A.
      Reliability of the parallel walk test for the elderly.
      NoYesNoNoNoNoYesNoNo
      Performance Oriented Mobility Assessment (POMA)
      • Tinetti M.E.
      Performance-oriented assessment of mobility problems in elderly patients.
      YesYesYesNoYesYesYesYesNoSitting balance
      Modified Performance Oriented Mobility Assessment
      • Fox K.M.
      • Felsenthal G.
      • Hebel J.R.
      • Zimmerman S.I.
      • Magaziner J.
      A portable neuromuscular function assessment for studying recovery from hip fracture.
      YesYesNoNoNoYesYesYesNo
      Postural Assessment Scale for Stroke Patients (PASS)
      • Benaim C.
      • Perennou D.A.
      • Villy J.
      • Rousseaux M.
      • Pelissier J.Y.
      Validation of a standardized assessment of postural control in stroke patients: the Postural Assessment Scale for Stroke Patients (PASS).
      YesYesNoNoNoYesYesNoNoSupine to sitting, and sitting
      Short Form of Postural Assessment Scale for Stroke Patients (SFPASS)
      • Chien C.W.
      • Lin J.H.
      • Wang C.H.
      • Hsueh I.P.
      • Sheu C.F.
      • Hsieh C.L.
      Developing a Short Form of the Postural Assessment Scale for people with Stroke.
      YesYesNoNoNoNoYesNoNo
      Postural Control and Balance for Stroke Scale
      • Pyöriä O.
      • Talvitie U.
      • Villberg J.
      The reliability, distribution, and responsiveness of the Postural Control and Balance for Stroke Test.
      YesYesYesNoNoYesYesNoNo
      Postural Stress Test (PST)
      • Wolfson L.I.
      • Whipple R.
      • Amerman P.
      • Kleinberg A.
      Stressing the postural response: a quantitative method for testing balance.
      NoYesNoNoYesNoNoNoNo
      Pull/Retropulsion Test
      • Visser M.
      • Marinus J.
      • Bloem B.R.
      • Kisjes H.
      • van den Berg B.M.
      • van Hilten J.J.
      Clinical tests for the evaluation of postural instability in patients with Parkinson’s disease.
      NoYesNoNoYesNoNoNoNo
      Push and Release Test
      • Jacobs J.
      • Horak F.
      • Van Tran K.
      • Nutt J.
      An alternative clinical postural stability test for patients with Parkinson’s disease.
      NoYesNoNoYesNoNoNoNo
      Rapid Step Test (RST)
      • Medell J.L.
      • Alexander N.B.
      A clinical measure of maximal and rapid stepping in older women.
      NoYesNoNoNoYesYesNoNo
      Sensory Organization Test (SOT)
      • Ford-Smith C.D.
      • Wyman J.F.
      • Elswick Jr., R.K.
      • Fernandez T.
      • Newton R.A.
      Test-retest reliability of the Sensory Organization Test in noninstitutionalized older adults.
      YesYesNoNoNoNoNoYesNo
      Head-Shake Sensory Organization Test (HS-SOT)
      • Pang M.Y.
      • Lam F.M.
      • Wong G.H.
      • Au I.H.
      • Chow D.L.
      Balance performance in head-shake computerized dynamic posturography: aging effects and test-retest reliability.
      YesYesNoNoNoNoNoYesNo
      Short Physical Performance Battery (SPPB)
      • Guralnik J.M.
      • Simonsick E.M.
      • Ferrucci L.
      • et al.
      A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission.
      YesYesNoNoNoNoYesNoNo
      Side-Step Test
      • Fujisawa H.
      • Takeda R.
      A new clinical test of dynamic standing balance in the frontal plane: the side-step test.
      NoYesNoNoNoYesYesNoNo
      Single Leg Hop Stabilization Test
      • Riemann B.L.
      • Caggiano N.A.
      • Lephert S.M.
      Examination of a clinical method of assessing postural control during a functional performance task.
      YesYesNoNoNoYesYesNoNo
      Single Leg Stance Test
      • Bohannon R.W.
      Single limb stance times: a descriptive meta-analysis of data from individuals at least 60 years of age.
      YesYesNoNoNoNoNoNoNo
      Spring Scale Test (SST)
      • DePasquale L.
      • Toscano L.
      The Spring Scale Test: a reliable and valid tool for explaining fall history.
      NoYesNoNoYesNoNoNoNo
      Standing Test for Imbalance and Disequilibrium (SIDE)
      • Teranishi T.
      • Kondo I.
      • Sonoda S.
      • et al.
      A discriminative measure for static postural control ability to prevent in-hospital falls: reliability and validity of the Standing Test for Imbalance and Disequilibrium (SIDE).
      YesYesNoNoNoYesNoNoNo
      Star Excursion Balance Test (SEBT)
      • Hertel J.
      • Miller S.J.
      • Denegar C.R.
      Intratester and intertester reliability during the Star Excursion Balance Tests.
      YesYesYesNoNoYesNoNoNo
      Step Test (ST)
      • Hill K.D.
      • Bernhardt J.
      • McGann A.M.
      • Maltese D.
      • Berkovits D.
      A new test of dynamic standing balance for stroke patients: reliability, validity and comparison with healthy elderly.
      NoYesNoNoNoYesYesNoNo
      Tandem Stance
      • Hile E.S.
      • Brach J.S.
      • Perera S.
      • Wert D.M.
      • VanSwearingen J.M.
      • Studenski S.A.
      Interpreting the need for initial support to perform tandem stance tests of balance.
      YesYesNoNoNoNoNoNoNo
      Time on Ball Test
      • Bruinsma J.H.
      • Gebraad M.M.
      • Brumels K.A.
      Clinician’s corner: reliability of the time-on-ball test.
      YesYesNoNoNoNoNoYesNo
      Timed Up-and-Go Test (TUG)
      • Podsiadlo D.
      • Richardson S.
      The timed “Up & Go”: a test of basic functional mobility for frail elderly persons.
      NoYesNoNoNoYesYesNoNo
      Expanded Timed Up-and-Go Test (ETUG)
      • Botolfsen P.
      • Helbostad J.L.
      • Moe-Nilssen R.
      • Wall J.C.
      Reliability and concurrent validity of the Expanded Timed Up-and-Go test in older people with impaired mobility.
      NoYesNoNoNoYesYesNoNo
      TURN180
      • Simpson J.M.
      • Worsfold C.
      • Reilly E.
      • Nye N.
      A standard procedure for using TURN180: testing dynamic postural stability among elderly people.
      NoYesNoNoNoNoYesNoNo
      Unified Balance Scale
      • La Porta F.
      • Franceschini M.
      • Caselli S.
      • Cavallini P.
      • Susassi S.
      • Tennant A.
      Unified Balance Scale: an activity-based, bed to community, and aetiology-independent measure of balance calibrated with Rasch analysis.
      YesYesYesNoYesYesYesYesYes
      Unilateral Forefoot Balance Test
      • Clark M.S.
      The Unilateral Forefoot Balance Test: reliability and validity for measuring balance in late midlife women.
      YesYesNoNoNoNoNoNoNo
      Timed Up-and-Go Assessment of Biomechanical Strategies (TUG-ABS)
      • Faria C.D.
      • Teixeira-Salmela L.F.
      • Nadeau S.
      Clinical testing of an innovative tool for the assessment of biomechanical strategies: the Timed “Up and Go” Assessment of Biomechanical Strategies (TUG-ABS) for individuals with stroke.
      NoYesNoNoNoYesYesNoNo
      Posture and Posture Ability Scale (PPAS)
      • Rodby-Bousquet E.
      • Ágústsson A.
      • Jónsdóttir G.
      • Czuba T.
      • Johansson A.-C.
      • Hägglund G.
      Interrater reliability and construct validity of the Posture and Postural Ability Scale in adults with cerebral palsy in supine, prone, sitting and standing positions.
      YesYesNoYesNoNoNoNoNoSitting balance
      High Level Mobility Assessment Tool (HiMAT)
      • Williams G.P.
      • Robertson V.
      • Greenwood K.M.
      • Goldie P.A.
      • Morris M.E.
      The high-level mobility assessment tool (HiMAT) for traumatic brain injury, part 2: content validity and discriminability.
      • Williams G.
      • Robertson V.
      • Greenwood K.
      • Goldie P.
      • Morris M.E.
      The high-level mobility assessment tool (HiMAT) for traumatic brain injury, part 1: item generation.
      NoYesNoNoNoYesYesNoNo
      Cross Step Moving on Four Spots Test (CSFT)
      • Yamaji S.
      • Demura S.
      Reliability and fall experience discrimination of Cross Step Moving on Four Spots Test in the elderly.
      NoYesNoNoNoYesYesNoNo
      Figure thumbnail gr2
      Fig 2Number of balance components evaluated by measure.

      Discussion

      To our knowledge, this work represents the first attempt to synthesize the literature on standardized balance measures for adult populations and analyze the content of measures with respect to an established theoretical framework for postural control. The primary findings of this review are the large number of independently validated standardized measures available to assess balance in adults, and the high proportion of measures that assess only a few components of balance as identified by the Systems Framework for Postural Control. These findings highlight a number of issues relevant to selecting standardized balance measures, as well as broader issues related to the theoretical basis of postural control.
      With respect to the high number of standardized balance measures, although 66 distinct measures were included in the present study, it is important to note that there was significant overlap in the specific balance tasks performed. For example, alternating steps onto a stool or platform were common across multiple measures (eg, Activity-based Balance Level Evaluation scale, BESTest, Berg Balance Scale, and Community Balance and Mobility scale). Moreover, some stand-alone measures were incorporated as tasks in larger tests, such as single leg stance and functional reach (included in BESTest and Berg Balance Scale), and several “new” measures were developed as combinations, adaptations, or evolutions of other balance measures (eg, Equiscale, Postural Assessment for Stroke Scale, and Unified Balance Scale). However, recent data on clinical balance assessment practices indicate that refined and/or newer standardized balance measures are yet to be widely adopted
      • Sibley K.M.
      • Straus S.E.
      • Inness E.L.
      • Salbach N.M.
      • Jaglal S.B.
      Balance assessment practices and use of standardized balance measures among Ontario physical therapists.
      ; therefore, it is difficult to determine whether actual balance assessment is improving with these changes. Rather, the pool of balance measures continues to widen with additional combinations of tasks in a circuitous fashion.
      Although several components of balance were included in a high proportion of measures (such as underlying motor systems, anticipatory postural control, static stability, and dynamic stability in more than two thirds of measures), certain functionally relevant components were not included in most measures. For example, reactive postural control—corrective responses after instability—was included in only 23% of the measures. The lack of measures evaluating reactive control is concerning because the ability to successfully recover from instability is the most critical component of balance for fall avoidance.
      • Maki B.E.
      • McIlroy W.E.
      Postural control in the older adult.
      Impaired reactive control is independently associated with falls, resulting in as much as a 6-fold increase in fall incidence.
      • Hilliard M.J.
      • Martinez K.M.
      • Janssen I.
      • et al.
      Lateral balance factors predict future falls in community-living older adults.
      Similarly, cognitive contributions to postural control and fall risk are well established, yet only 17% of the measures included a secondary cognitive task.
      • Tinetti M.E.
      • Kumar C.
      The patient who falls: it’s always a tradeoff.
      • Lacour M.
      • Bernard-Demanze L.
      • Dumitrescu M.
      Posture control, aging, and attention resources: models and posture-analysis methods.
      Finally, vertically was the least commonly included component (8% of the measures). Verticality and appropriate orientation to gravity are important for establishing an efficient stable “starting position” for balance,
      • de Oliveira C.B.
      • de Medeiros I.R.
      • Frota N.A.
      • Greters M.E.
      • Conforto A.B.
      Balance control in hemiparetic stroke patients: main tools for evaluation.
      the absence of which may put an individual in an inherently less stable position, which could lessen the likelihood of successful balance recovery, and for whom individuals with sensory or neurological conditions may be particularly at risk.
      • Horak F.B.
      • Wrisley D.M.
      • Frank J.
      The Balance Evaluation Systems Test (BESTest) to differentiate balance deficits.
      Half of the measures included in this review evaluated 3 or fewer components of postural control. Some of these tests are commonly used in clinical practice, such as the Single Leg Stance test,
      • Sibley K.M.
      • Straus S.E.
      • Inness E.L.
      • Salbach N.M.
      • Jaglal S.B.
      Balance assessment practices and use of standardized balance measures among Ontario physical therapists.
      and as such, users need to be aware of what balance information they are getting when they choose a limited-scope measure. These types of tests may be appropriate for screening or risk assessment, but not for treatment planning and intervention selection. For a comprehensive balance assessment, multiple measures can be combined, or users can select a measure that includes most or all components of balance. Only 1 measure contained an explicit evaluation of all 9 components of postural control: the BESTest. Published in 2009, it was developed with the goal of helping clinicians identify underlying postural control systems that may be responsible for poor functional balance—the only identified measure with this specific purpose. However, the BESTest developers also authored the most comprehensive description of the Systems Framework for Postural Control, so it is not unexpected that this measure is the closest match. Four measures included 8 components of balance (Clinical Gait and Balance Scale, Fullerton Advanced Balance Scale, Mini-BESTest, and Unified Balance Scale). From a theoretical perspective, these are the most complete standardized balance measures available to date. However, none of these measures has yet been widely adopted in clinical practice,
      • Sibley K.M.
      • Straus S.E.
      • Inness E.L.
      • Salbach N.M.
      • Jaglal S.B.
      Balance assessment practices and use of standardized balance measures among Ontario physical therapists.
      highlighting the need to study factors influencing balance assessment practices and use of standardized measures in more detail.

      Study limitations

      Although the focus of this review was on balance assessment for treatment planning and intervention selection, theoretical construct is only one characteristic of a measure. Consideration of measure purpose (eg, risk assessment versus outcome measurement) would be beneficial for evaluating the appropriateness of individual measures for their intended function. Examination of evaluation parameters would also be useful because quantitative measurements may provide more precise information than do observed behaviors. Furthermore, this review did not consider the difficulty of individual items related to a particular balance component, such as whether static stability was assessed by normal or narrow stance, tandem stance, or single-leg stance. Nor did we consider how dual-task assessments were conducted and whether instructions were to prioritize the postural or cognitive task. These are important functional distinctions not reflected in the present analysis, and attempts to evaluate particular components of balance across the continuum of difficulty likely have contributed to the proliferation of so many measures. Given the complexities of standardized balance measurement, we suggest that readers interpret our findings in conjunction with the previous reviews that address some of these issues
      • McGinnis P.Q.
      • Wainwright S.F.
      • Hack L.M.
      • Nixon-Cave K.
      • Michlovitz S.
      Use of a Delphi panel to establish consensus for recommended uses of selected balance assessment approaches.
      • Pardasaney P.K.
      • Slavin M.D.
      • Wagenaar R.C.
      • Latham N.K.
      • Ni P.
      • Jette A.M.
      Conceptual limitations of balance measures for community-dwelling older adults.
      and refer to the Rehabilitation Measures Database—a National Institute of Disability and Rehabilitation Research-funded, searchable Web site containing evidence-based summaries of more than 250 rehabilitation measures.

      Rehabilitation Measures Database [May 20, 2014]. Available at: www.rehabmeasures.org. Accessed May 20, 2014.

      In conducting this review, we identified a number of gaps in postural control theory that require attention to move the field forward. First, although the systems-based nature of postural control is accepted and supported throughout the literature, there is no criterion-standard description of all known components and their interactions. Second, the Systems Framework for Postural Control, the model selected for the current review, accounts for all balance components equally, without any hierarchy or order to the individual components. It also considers only standing balance, when sitting balance is an important functional task recognized in a number of the measures included in this review. Indeed, in this review we excluded measures that included only sitting balance (n=8) because they could not be captured in the model. Refinement of the theory to address such issues may more accurately reflect the nature of postural control in vivo as well as facilitate increased efficiency of balance assessment in time- and resource-constrained clinical environments. For example, reactive postural control may be considered a more challenging component than anticipatory control, and if an individual cannot effectively engage anticipatory strategies, it may not be appropriate to explicitly assess reactive control. Conversely, appropriate anticipatory actions do not necessarily indicate that reactive control is “normal,” requiring continued probing. Incorporating such logic to more standardized assessment strategies may preserve the theoretical integrity of balance measures while optimizing efficiency. Two included measures, the Balance Computerized Adaptive Testing system and Hierarchical Balance Short Forms, did incorporate such a system into their approach but lacked consideration of all components of postural control in their models. Continued refinement of these systems from a comprehensive perspective may be a practical approach moving forward.

      Conclusions

      The theoretical components of postural control included in standardized balance measures for adults vary greatly, with some measures omitting important components relevant for avoiding falls. As such, the choice of the measure may limit the overall interpretation of an individual's balance ability. Continued work is necessary to increase implementation of comprehensive assessment in research and practice to facilitate individualized identification of balance deficits and customization of training programs.

      Supplier

      • a.
        SAS, 100 SAS Campus Dr, Cary, NC 27513-2414.

      Supplemental Appendix S1. Sample Search Strategy

      Supplemental Table S1Measure characteristics
      MeasureReferenceStated Purpose of MeasureComponents of Balance Purportedly AssessedTarget Adult PopulationDevelopment MethodsNumber of Items in TestEvaluation ParametersNumber of Scoring CategoriesGraded Progression
      Activity-based Balance Level Evaluation (ABLE) Scale
      • Ardolino E.M.
      • Hutchinson K.J.
      • Pinto Zipp G.
      • Clark M.
      • Harkema S.J.
      The ABLE Scale: the development and psychometric properties of an outcome measure for the spinal cord injury population.
      Ardolino et al. Phys Ther 2012;92:1046-54To assess changes in balance across the full spectrum of recovery in the spinal cord injury populationBalance in the domains of sitting, standing, and walkingSpinal cord injuryLiterature review and clinical expertise, Delphi process, and Rasch analysis28Categorical5No
      Advanced Balance and Mobility Scale (ABMS)
      • Kairy D.
      • Paquet N.
      • Fung J.
      A postural adaptation test for stroke patients.
      Kairy et al. Disabil Rehabil 2003;25:127-35To address shortcomings of previous balance measures that do not address adaptive and reactive control and do not assess the interaction between impairment and disability components of the task usedPostural control in standing and walkingNot specifiedNot specified12Categorical4No
      Balance Computerized Adaptive Testing (CAT) system
      • Hsueh I.
      • Chen J.
      • Wang C.
      • et al.
      Development of a computerized adaptive test for assessing balance function in patients with stroke.
      Hsueh et al. Phys Ther 2010;90:1336-44To assess balance function in people with strokeEntire range of balance function (items with wide range and even distribution of difficulty)StrokePool of 41 items identified on the basis of predefined balance concepts, clinical expert consultation, and field testing to finalize item description and scoring; items administered by 5 raters to 764 patients and item response theory model fit to data and item parameters estimated34Categorical26 items have 2 scoring categories, and 8 items have 3 scoring categoriesNo
      Hierarchical Balance Short Forms (HBSF)
      • Hou W.-H.
      • Chen J.-H.
      • Wang Y.-H.
      • et al.
      Development of a set of functional hierarchical balance short forms for patients with stroke.
      Hou et al. Arch Phys Med Rehabil 2011;92:1119-25To assess balance function precisely in people with stroke with limited assessment burdenSitting, standing, and stepping balanceStroke34 items of the Balance CAT system
      • Hsueh I.
      • Chen J.
      • Wang C.
      • et al.
      Development of a computerized adaptive test for assessing balance function in patients with stroke.
      divided into 3 hierarchical function-related balance levels (sitting, standing, and stepping); simulation program used to make an item selection algorithm proposing 6 candidates (each with 6 items) for each balance level, simulation data used to select candidates with highest reliability, adopted opinions of stroke-related clinicians and psychometricians to determine the final set of 6-item balance short form for each sitting, standing, and stepping level
      16Continuous (binary counts transformed into continuous measure)NAYes, within each of 3 categories
      Balance Error Scoring System (BESS)
      • Riemann B.L.
      • Guskiewicz K.M.
      • Shields E.W.
      Relationship between clinical and forceplate measures of postural stability.
      Riemann et al. J Sport Rehabil 1999;8:71-82To assess postural stabilityNot specifiedNot specifiedNot specified6Continuous (number of errors)NANo
      Modified Balance Error Scoring System (M-BESS)
      • Hunt T.N.
      • Ferrara M.S.
      • Bornstein R.A.
      • Baumgartner T.A.
      The reliability of the modified Balance Error Scoring System.
      Hunt et al. Clin J Sport Med 2009;19:471-5To easily administer an objective assessment tool in a cost-effective wayPostural stabilityConcussionModified BESS
      • Riemann B.L.
      • Guskiewicz K.M.
      • Shields E.W.
      Relationship between clinical and forceplate measures of postural stability.
      by eliminating double-leg stance and increasing number of trials per condition
      4Continuous (number of errors)NANo
      Balance Evaluation Systems Test (BESTest)
      • Horak F.B.
      • Wrisley D.M.
      • Frank J.
      The Balance Evaluation Systems Test (BESTest) to differentiate balance deficits.
      Horak et al. Phys Ther 2009;89:484-98To help physical therapists identify underlying postural control systems that may be responsible for poor functional balanceBiomechanical constraints, stability limits/verticality, anticipatory postural adjustments, postural responses, sensory integration, and stability of gaitNot specifiedInitial test proposed by Horak and Frank, then clinicians provided feedback on clarity, sensitivity, and practicality at 38 workshops over 4y, interrater reliability evaluated, then test revised36Categorical4No
      Brief Balance Evaluation Systems Test (Brief BESTest)
      • Padgett P.K.
      • Jacobs J.V.
      • Kasser S.L.
      Is the BESTest at its best? A suggested brief version based on interrater reliability, validity, internal consistency, and theoretical construct.
      Padgett et al. Phys Ther 2012;92:1197-207To assess balance performance in 6 specific contexts of postural control to allow for identification of specific balance systems responsible for poor balanceMechanical constraints, limits of stability, anticipatory postural adjustments, postural responses to induced loss of balance, sensory orientation, and gaitNot specifiedEvaluated internal consistency of items in each section of the BESTest
      • Horak F.B.
      • Wrisley D.M.
      • Frank J.
      The Balance Evaluation Systems Test (BESTest) to differentiate balance deficits.
      and used item-total correlations to identify each section’s most representative item
      8Categorical4No
      Mini Balance Evaluation Systems Test (Mini BESTest)
      • Franchignoni F.
      • Horak F.
      • Godi M.
      • Nardone A.
      • Giordano A.
      Using psychometric techniques to improve the Balance Evaluation Systems Test: the mini-BESTest.
      Franchignoni et al. J Rehabil Med 2010;42:323-31To comprehensively assess balance in a short time periodDynamic balanceNot specifiedExpert review and Rasch analysis of BESTest
      • Horak F.B.
      • Wrisley D.M.
      • Frank J.
      The Balance Evaluation Systems Test (BESTest) to differentiate balance deficits.
      to remove redundant items
      14Categorical3No
      Balance Outcome Measure for Elder Rehabilitation (BOOMER)
      • Haines T.
      • Kuys S.S.
      • Morrison G.
      • Clarke J.
      • Bew P.
      • McPhail S.
      Development and validation of the balance outcome measure for elder rehabilitation.
      Haines et al. Arch Phys Med Rehabil 2007;88:1614-21To be a global standing balance outcome measure for elder rehabilitationGlobal standing balance (static, dynamic, and function)Older adults undergoing rehabilitationCross-sectional survey with expert panel, selection of 4 stand-alone tests, multicenter prospective cohort randomly divided into development and validation data sets to perform item scaling4Categorical5No
      Balance Screening Tool (BST)
      • Mackintosh S.
      • Datson N.
      • Fryer C.
      A balance screening tool for older people: reliability and validity.
      Mackintosh et al. Int J Ther Rehabil 2006;13:558-61To screen balance in older adults to identify impairments requiring further investigation and interventionStatic and dynamic standing balanceNot specifiedDeveloped by expert physiotherapists on the basis of published evidence and clinical experience6Categorical2No
      BDL Balance Scale
      • Lindmark B.
      • Liljenäs Å.
      • Hellström K.
      Assessment of minor or moderate balance disorders: a reliability study and comparison with healthy subjects.
      Lindmark et al. Adv Physiother 2012;14:3-9To quantitatively measure balance at a relatively high levelNot specifiedPeople of working age with neurological impairment and mild- moderate balance disturbanceNot specified10Categorical5No
      Berg Balance Scale (BBS)
      • Berg K.
      • Wood-Dauphinee S.
      • Williams J.I.
      • Gayton D.
      Measuring balance in the elderly: preliminary development of an instrument.
      Berg et al. Physiother Canada 1989;41:304-11To measure balance in healthy individualsNot specifiedGeriatric (60y and older)Interviews with clinicians and participants, literature review, ranking of items (modified Delphi process)14Categorical5No
      Short Form of the Berg Balance Scale (SFBBS)
      • Chou C.
      • Chien C.
      • Hsueh I.
      • Sheu C.
      • Wang C.
      • Hsieh C.
      Developing a short form of the Berg Balance Scale for people with stroke.
      Chou et al. Phys Ther 2006;86:195-204To evaluate balance performance in people with strokeNot specifiedNot specified (validated in stroke)Selected items from BBS
      • Berg K.
      • Wood-Dauphinee S.
      • Williams J.I.
      • Gayton D.
      Measuring balance in the elderly: preliminary development of an instrument.
      with highest internal consistency and greatest responsiveness in development cohort of patients, and compared 4, 5, 6, and 7-item versions of the SFBBS with 3 and 5 assessment levels
      7Categorical3No
      Short Berg Balance Scale
      • Hohtari-Kivimaki U.
      • Salminen M.
      • Vahlberg T.
      • Kivela S.L.
      Short Berg Balance Scale—correlation to static and dynamic balance and applicability among the aged.
      Hohtari-Kivimaki et al. Aging Clin Exp Res 2012;24:42-6To assess functional balance among community-dwelling aged people with moderate or good physical functioningStatic and dynamic balanceCommunity-dwelling older adultsFactor analysis of BBS,
      • Berg K.
      • Wood-Dauphinee S.
      • Williams J.I.
      • Gayton D.
      Measuring balance in the elderly: preliminary development of an instrument.
      removing 5 items
      9Categorical5No
      Brunel Balance Assessment (BBA)
      • Tyson S.F.
      • DeSouza L.H.
      Development of the Brunel Balance Assessment: a new measure of balance disability post stroke.
      Tyson and DeSouza. Clin Rehabil 2004;18:801-10To assess the effects of specific stroke physiotherapy interventions for balance disability poststrokeNot specifiedStroke14-point hierarchical prototype test proposed with progressively difficult tasks, validated by decreasing pass rates for each item, acceptable coefficients of stability and reproducibility12Categorical2Yes
      Clinical Gait and Balance Scale (GABS)
      • Thomas M.
      • Jankovic J.
      • Suteerawattananon M.
      • et al.
      Clinical gait and balance scale (GABS): validation and utilization.
      Thomas et al. J Neurol Sci 2004;217:89-99To comprehensively measure all essential elements of gait and balanceBalance and postureNot specifiedNot specified18Categorical10 items have 5 levels, 4 items have 3 levels, 2 items have 2 levels, and 2 items have subgroups with multiple categoriesNo
      Clinical Test of Sensory Interaction in Balance (CTSIB)
      • Shumway-Cook A.
      • Horak F.B.
      Assessing the influence of sensory interaction of balance: suggestion from the field.
      Shumway-Cook and Horak. Phys Ther 1986;66:1548-50To assess the influence of sensory interaction on postural stability in the standing patient with neurologic problemsSensory interactions while standingPeople with neurologic problemsNot specified6Suggests continuous (time) or categorical (subjective numeric ranking system for sway)NANo
      Community Balance and Mobility (CB&M) Scale
      • Howe J.A.
      • Inness E.L.
      • Venturini A.
      • Williams J.I.
      • Verrier M.C.
      The Community Balance and Mobility Scale—a balance measure for individuals with traumatic brain injury.
      Howe et al. Clin Rehabil 2006;20:8 85-95To identify postural instability, evaluate change after intervention, and inform rehabilitation team about balance and mobility status of ambulatory individuals with traumatic brain injury returning to community environmentMultitasking, sequencing of movement components, complex motor skillsAmbulatory people with traumatic brain injuryLiterature review, interviews with physical and occupational therapists, ambulatory people with brain injury living in community over multiple phases19Categorical6No
      Dynamic Balance Assessment (DBA)
      • Desai A.
      • Goodman V.
      • Kapadia N.
      • Shay B.L.
      • Szturm T.
      Relationship between dynamic balance measures and functional performance in community-dwelling elderly people.
      Desai et al. Phys Ther 2010;90:748-60Not specifiedDynamic balanceCommunity-dwelling older adultsNot specified, but notes it incorporates features of modified CTSIB
      • Shumway-Cook A.
      • Horak F.B.
      Assessing the influence of sensory interaction of balance: suggestion from the field.
      12Categorical (continuous data collapsed into categories)5No
      Dynamic Gait Index
      • Shumway-Cook A.
      • Baldwin M.
      • Polissar N.L.
      • Gruber W.
      Predicting the probability for falls in community-dwelling older adults.
      Shumway-Cook et al. Phys Ther 1997;77:812-9To evaluate and document a patient’s ability to modify gait in response to changing task demandsNot specifiedNot specifiedNot specified8Categorical4No
      Four-item Dynamic Gait Index (4-DGI)
      • Marchetti G.F.
      • Whitney S.L.
      Construction and validation of the 4-item dynamic gait index.
      Marchetti et al. Phys Ther 2006; 86:1651-60To measure walking function in people with balance and vestibular disordersNot specifiedPeople with balance and vestibular disordersRasch analysis of DGI
      • Shumway-Cook A.
      • Baldwin M.
      • Polissar N.L.
      • Gruber W.
      Predicting the probability for falls in community-dwelling older adults.
      4Categorical4No
      Functional Gait Assessment (FGA)
      • Wrisley D.M.
      • Marchetti G.F.
      • Kuharsky D.K.
      • Whitney S.L.
      Reliability, internal consistency, and validity of data obtained with the Functional Gait Assessment.
      Wrisley et al. Phys Ther 2004; 84:906-18To assess postural stability during gait with higher-level tasksNot specifiedNot specifiedRevised DGI
      • Shumway-Cook A.
      • Baldwin M.
      • Polissar N.L.
      • Gruber W.
      Predicting the probability for falls in community-dwelling older adults.
      and added 3 new items
      10Categorical4No
      Dynamic One Leg Stance (DOLS)
      • Blomqvist S.
      • Rehn B.
      Validity and reliability of the Dynamic One Leg Stance (DOLS) in people with vision loss.
      Blomqvist and Rehn. Adv Physiother 2007;9:129-35To investigate different aspects of balanceDynamic body actions during 1-legged stance, sensory subsystemsNot specifiedNot specified5Categorical2Yes
      Equiscale
      • Tesio L.
      • Perucca L.
      • Franchignoni F.P.
      • Battaglia M.A.
      A short measure of balance in multiple sclerosis: validation through Rasch analysis.
      Tesio et al. Funct Neurol 1997;12:255-65To evaluate balance in people with multiple sclerosisNot specifiedMultiple sclerosis and people with unilateral motor or sensory impairmentsPreliminary 10-item instrument derived from POMA
      • Tinetti M.E.
      Performance-oriented assessment of mobility problems in elderly patients.
      and BBS 40; trial-and-error procedure: administered to 55 patients 1–3 times and Rasch analysis used to explore psychometric validity; 2 items deleted because too easy and uninformative
      8Categorical3No
      Fast Evaluation of Mobility, Balance and Fitness (FEMBAF)
      • Di Fabio R.P.
      • Seay R.
      Use of the “fast evaluation of mobility, balance, and fear” in elderly community dwellers: validity and reliability.
      Di Fabio and Seay. Phys Ther 1997;77:904-17To assess risk of falling, ability to complete functional tasks, and assess reports of fear, pain, mobility, difficulty, and perception of strength deficitsNot specifiedNot specifiedNot specified18Categorical3No
      Five Times Sit-to-Stand (5-STS) Test
      • Whitney S.L.
      • Wrisley D.M.
      • Marchetti G.F.
      • Gee M.A.
      • Redfern M.S.
      • Furman J.M.
      Clinical measurement of sit-to-stand performance in people with balance disorders: validity of data for the Five-Times-Sit-to-Stand Test.
      Whitney et al. Phys Ther 2005; 85:1034-45To measure balance dysfunctionNot specifiedNot specifiedNot specified1Continuous (time)NANo
      Four Square Step Test (FSST)
      • Dite W.
      • Temple V.A.
      A clinical test of stepping and change of direction to identify multiple falling older adults.
      Dite and Temple. Arch Phys Med Rehabil 2002;83:1566-71Not specifiedDynamic standing balance, rapid stepping, obstacle avoidanceOlder adultsNot specified1Continuous (time)NANo
      Fullerton Advanced Balance (FAB) Scale
      • Rose D.J.
      • Lucchese N.
      • Wiersma L.D.
      Development of a multidimensional balance scale for use with functionally independent older adults.
      Rose et al. Arch Phys Med Rehabil 2006;87:1478-85To identify balance problems of varying severity in functionally independent older adults and evaluate system(s) that might be contributing to balance problemsSensory systems and strategies, internal representations, musculoskeletal components, and anticipatory and adaptive mechanismsFunctionally independent older adultsReview of conceptual frameworks, scientific literature, and previously published tests; developed test items and evaluated appropriateness of items, clarity of instructions, and scoring by clinical experts; pilot test of preliminary scale with older adults to establish appropriate test protocols, scoring procedures, and better instructions10Categorical5No
      Functional Reach Test
      • Duncan P.W.
      • Weiner D.K.
      • Chandler J.
      • Studenski S.
      Functional reach: a new clinical measure of balance.
      Duncan et al. J Gerontol 1990;45:M192-7To assess anterior and posterior dynamic stabilityDynamic stabilityNot specifiedNot specified1Continuous (distance)NANo
      Multidirectional Reach Test
      • Newton R.A.
      Validity of the multi-directional reach test: a practical measure for limits of stability in older adults.
      Newton. J Gerontol A Biol Sci Med Sci 2001;56:M248-52To measure limits of stability in 4 reaching directionsLimits of stabilityNot specifiedNot specified4Continuous (distance)NANo
      Hierarchical Assessment of Balance and Mobility (HABAM)
      • MacKnight C.
      • Rockwood K.
      A hierarchical assessment of balance and mobility.
      MacKnight and Rockwood. Age Ageing 1995;24:126-30Not specifiedStatic and dynamic balanceNot specifiedNot specified24Categorical2Yes
      Kansas University Standing Balance Scale (KUSBS)
      • Kluding P.
      • Swafford B.
      • Cagle P.
      • Gajewski B.
      Reliability, responsiveness, and validity of the Kansas University Standing Balance Scale.
      Kluding et al. J Geriatr Phys Ther 2006;29:93-9To measure balance in lower levels of function in more severely impaired peopleStanding balanceNot specifiedDeveloped over 2y by physical therapists; scale developed for lower-functioning patients, to document progress in an objective and quantifiable way, quick to use, no math, no equipment; during development, therapists were encouraged to talk to each other about experiences with scale; script of therapist instruction to patients subsequently developed4Categorical10Yes
      Limits of Stability (LOS) Test
      • Clark S.
      • Rose D.J.
      • Fujimoto K.
      Generalizability of the limits of stability test in the evaluation of dynamic balance among older adults.
      Clark et al. Arch Phys Med Rehabil 1997;78:1078-84To assess multiple indices of dynamic balance performance by evaluating individual’s ability to volitionally move the center of gravity to 8 predetermined positionsDynamic balanceNot specifiedNot specified8Continuous (center of gravity velocity, excursion, endpoint, directional control)NANo
      Modified Figure of Eight Test
      • Jarnlo G.
      • Nordell E.
      Reliability of the modified figure of eight—a balance performance test for elderly women.
      Jarnlo and Nordell. Phys Theory Pract 2003;19:35-43To measure the ability to walk slightly in lateral direction to both sides in an 8 in combination with a narrow step widthNot specifiedNot specifiedModification of Figure of Eight Test
      • Johansson G.
      • Jarnlo G.
      Balance training in 70-year-old women.
      1Continuous (time and number of “oversteps”)NANo
      Parallel Walk Test (PWT)
      • Lark S.D.
      • McCarthy P.W.
      • Rowe D.A.
      Reliability of the parallel walk test for the elderly.
      Lark et al. Arch Phys Med Rehabil 2011;92:812-7To measure dynamic balance during gaitDynamic balance during gaitOlder adultsNot specified3Continuous (time and “footfall score” [+1 when part of foot placed on line, +2 when foot falls outside line or reached for something to maintain balance])NANo
      Performance Oriented Mobility Assessment (POMA)
      • Tinetti M.E.
      Performance-oriented assessment of mobility problems in elderly patients.
      Tinetti. J Am Geriatr Soc 1986;34:119-26To practically assess performance-oriented mobility tasks that incorporate useful feature of both disease-oriented and gait analytic approachesNot specifiedNot specifiedReviewed previous work by bioengineers, orthopedists, neurologists, rheumatologists, and physical therapists to identify what observations should be included and how they should be made; adapted this work to make instrument with 8 position changes for balance and 8 gait observations; 90% agreement between raters when tested in 15 ambulatory people; added 5 balance maneuversBalance- 13, Gait- 9Categorical3 for balance item and 2 for gait itemsNo
      Modified Performance Oriented Mobility Assessment
      • Fox K.M.
      • Felsenthal G.
      • Hebel J.R.
      • Zimmerman S.I.
      • Magaziner J.
      A portable neuromuscular function assessment for studying recovery from hip fracture.
      Fox et al. Arch Phys Med Rehabil 1996;77:171-6To characterize recovery in physical capacity and functional independence after hip fractureNot specifiedPeople aged 65y and older with a hip fractureNot specified13Continuous (time, angle, distance, contact between thigh and abdomen)NAYes for some tasks
      Postural Assessment Scale for Stroke Patients (PASS)
      • Benaim C.
      • Perennou D.A.
      • Villy J.
      • Rousseaux M.
      • Pelissier J.Y.
      Validation of a standardized assessment of postural control in stroke patients: the Postural Assessment Scale for Stroke Patients (PASS).
      Benain et al. Stroke 1999;30:1862-8To assess and monitor postural control after stroke; to assess subject performanceMaintenance of a given posture and to ensure equilibrium in changing postures (lying, sitting, standing)StrokeAdapted items from Fugl-Meyer assessment
      • Fugl-Meyer A.R.
      • Jaasko L.
      • Leyman I.
      • Olsson S.
      • Steglind S.
      The post-stroke hemiplegic patient, 1: a method for evaluation of physical performance.
      14Categorical only4No
      Short Form of Postural Assessment Scale for Stroke Patients (SFPASS)
      • Chien C.W.
      • Lin J.H.
      • Wang C.H.
      • Hsueh I.P.
      • Sheu C.F.
      • Hsieh C.L.
      Developing a Short Form of the Postural Assessment Scale for people with Stroke.
      Chien et al. Neurorehabil Neural Repair 2007;21:81-90To measure balance function in people with strokeBalance in lying, sitting, or standing positionStrokeSelected items from PASS
      • Benaim C.
      • Perennou D.A.
      • Villy J.
      • Rousseaux M.
      • Pelissier J.Y.
      Validation of a standardized assessment of postural control in stroke patients: the Postural Assessment Scale for Stroke Patients (PASS).
      with highest internal consistency and greatest responsiveness in development cohort of patients and compared 5, 6, and 7-item versions of the SFPASS with 3 and 5 assessment levels
      5Categorical3No
      Postural Control and Balance for Stroke Scale
      • Pyöriä O.
      • Talvitie U.
      • Villberg J.
      The reliability, distribution, and responsiveness of the Postural Control and Balance for Stroke Test.
      Pyöriä et al. Archs Phys Med Rehabil 2005;86:296-302To assess postural changes, sitting balance, and standing balance with items of varying difficulty in the same clinical instrumentSitting balance, static standing balance, and postural change tasksStrokeDeveloped and refined by physical therapists23Categorical2–4, depending on questionYes (independent static sitting and standing as inclusion criteria for additional tasks)
      Postural Stress Test (PST)
      • Wolfson L.I.
      • Whipple R.
      • Amerman P.
      • Kleinberg A.
      Stressing the postural response: a quantitative method for testing balance.
      Wolfson et al. J Am Geriatr Soc 1986; 34:845-50To safely, quantitatively assess the postural responsePostural responsesOlder adultsNot specified3CategoricalNumber of trials with effective balance (4 levels) and balance strategy score (9-level grading scale)Yes when using the number of trials effective balance approach
      Pull/Retropulsion Test
      • Visser M.
      • Marinus J.
      • Bloem B.R.
      • Kisjes H.
      • van den Berg B.M.
      • van Hilten J.J.
      Clinical tests for the evaluation of postural instability in patients with Parkinson’s disease.
      Visser et al. Arch Phys Med Rehabil 2003;84:1669-74To assess the ability to maintain balanceBalance reactionsNot specifiedNot specified1Categorical4No
      Push and Release Test
      • Jacobs J.
      • Horak F.
      • Van Tran K.
      • Nutt J.
      An alternative clinical postural stability test for patients with Parkinson’s disease.
      Jacobs et al. J Neurol 2006;253:1404-13To reliably assess postural stability with sensitivity to fall history and low balance confidence in Parkinson’s diseasePostural response to a sudden release of a subject pressing backward on examiner’s hands placed on the subject’s backNot specified; developed so that it is sensitive enough for people with Parkinson’s diseaseNot specified1Categorical5No
      Rapid Step Test (RST)
      • Medell J.L.
      • Alexander N.B.
      A clinical measure of maximal and rapid stepping in older women.
      Medell et al. J Gerontol A Biol Sci Med Sci 2000;55:M429-33To assess maximal and rapid stepping for balance and fall riskNot specifiedNot specifiedNot specified8Continuous (step length, distance, and time)NANo
      Sensory Organization Test (SOT)
      • Ford-Smith C.D.
      • Wyman J.F.
      • Elswick Jr., R.K.
      • Fernandez T.
      • Newton R.A.
      Test-retest reliability of the Sensory Organization Test in noninstitutionalized older adults.
      Ford-Smith et al. Arch Phys Med Rehabil 1995;76:77-81To assess ability to make effective use of visual, vestibular, and proprioceptive inputs separately and the ability to suppress inaccurate sensory informationPostural controlNot specifiedNot specified6Continuous (2 outcomes per condition)NANo
      Head-Shake Sensory Organization Test (HS-SOT)
      • Pang M.Y.
      • Lam F.M.
      • Wong G.H.
      • Au I.H.
      • Chow D.L.
      Balance performance in head-shake computerized dynamic posturography: aging effects and test-retest reliability.
      Pang et al. Phys Ther 2011;91:246-53To enhance the SOT
      • Ford-Smith C.D.
      • Wyman J.F.
      • Elswick Jr., R.K.
      • Fernandez T.
      • Newton R.A.
      Test-retest reliability of the Sensory Organization Test in noninstitutionalized older adults.
      to improve delineation of balance performance
      Sensory interactions in standing balance with additional vestibular input and dual tasksNot specifiedNot specified6Continuous (equilibrium score as percentage from 0% to 100%)NANo
      Short Physical Performance Battery (SPPB)
      • Guralnik J.M.
      • Simonsick E.M.
      • Ferrucci L.
      • et al.
      A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission.
      Guralnik et al. J Gerontol 1994;49:M85-94To assess lower extremity functionNot specifiedNot specifiedAdapted from previously used measures6Categorical for standing and walking items but continuous (time) for rise from sitting itemTimed standing: side-by-side stand = 2, semi-tandem = 5, tandem = 3 Walking item: 5 categories depending on timeStanding and rise from sitting items were graded
      Side-Step Test
      • Fujisawa H.
      • Takeda R.
      A new clinical test of dynamic standing balance in the frontal plane: the side-step test.
      Fujisawa and Takeda. Clin Rehabil 2006;20:340-6To assess dynamic standing balance in the frontal planeDynamic standing balance ability in the frontal planeStrokeNot specified1Continuous (distance)NANo
      Single Leg Hop Stabilization Test
      • Riemann B.L.
      • Caggiano N.A.
      • Lephert S.M.
      Examination of a clinical method of assessing postural control during a functional performance task.
      Riemann et al. J Sport Rehabil 1999;8:171-83To assess postural control during a functional performance taskPostural controlNot specifiedAdapted the modified Bass test described by Johnson and Nelson
      • Johnson B.L.
      • Nelson J.K.
      Practical measurements for evaluation in physical education.
      20Categorical2Yes
      Single leg Stance Test
      • Bohannon R.W.
      Single limb stance times: a descriptive meta-analysis of data from individuals at least 60 years of age.
      Bohannon. Top Geriatr Rehabil 2006;22:70-7To quantify standing balanceStanding balanceNot specifiedNot specified1 or 2 (if one leg or both legs tested)Continuous (time)NANo
      Spring Scale Test (SST)
      • DePasquale L.
      • Toscano L.
      The Spring Scale Test: a reliable and valid tool for explaining fall history.
      DePasquale and Toscano. J Geriatr Phys Ther 2009;32:159-67To assess and quantify effective limits of anterior-posterior stepping for the purposes of fall risk assessmentReactive and proactive balanceCommunity-dwelling older adultsNot specified2Continuous (% body weight)NAYes
      Standing Test for Imbalance and Disequilibrium (SIDE)
      • Teranishi T.
      • Kondo I.
      • Sonoda S.
      • et al.
      A discriminative measure for static postural control ability to prevent in-hospital falls: reliability and validity of the Standing Test for Imbalance and Disequilibrium (SIDE).
      Teranishi et al. Jpn J Compr Rehabil Sci 2010;1:11-6To classify static standing balance ability for fall preventionStatic standing balanceNot specifiedNot specified4CategoricalTask 1: 2, task 2: 2, task 3: 3, task 4: 2Yes
      Star Excursion Balance Test (SEBT)
      • Hertel J.
      • Miller S.J.
      • Denegar C.R.
      Intratester and intertester reliability during the Star Excursion Balance Tests.
      Hertel et al. J Sport Rehabil 2000;9:104-16To challenge the postural control systems of well-conditioned, physically active individuals recovering from lower extremity injuriesDynamic balanceWell-conditioned, physically active individualsNot specified8Continuous (distance)NANo
      Step Test (ST)
      • Hill K.D.
      • Bernhardt J.
      • McGann A.M.
      • Maltese D.
      • Berkovits D.
      A new test of dynamic standing balance for stroke patients: reliability, validity and comparison with healthy elderly.
      Hill et al. Physiother Canada 1996;48:257-62To meet the need for a clinically useful test of balance that incorporates dynamic single limb stanceDynamic standing balanceStrokeNot specified6Continuous (number of steps up to 7.5cm in 15 and 30s and up to 15cm in 15s on each leg)NANo
      Tandem Stance
      • Hile E.S.
      • Brach J.S.
      • Perera S.
      • Wert D.M.
      • VanSwearingen J.M.
      • Studenski S.A.
      Interpreting the need for initial support to perform tandem stance tests of balance.
      Hile et al. Phys Ther 2012;92:1316-28To assess postural stability by narrowing the base of supportNot specifiedNot specifiedNot specified2Continuous (time)NANo
      Time on Ball Test
      • Bruinsma J.H.
      • Gebraad M.M.
      • Brumels K.A.
      Clinician’s corner: reliability of the time-on-ball test.
      Bruinsma et al. Clin Kinesiol 2008;62:1-3Not specifiedDynamic balanceNot specifiedNot specified1Continuous (time)NANo
      Timed Up-and-Go Test (TUG)
      • Podsiadlo D.
      • Richardson S.
      The timed “Up & Go”: a test of basic functional mobility for frail elderly persons.
      Podsiadlo and Richardson. J Am Geriatr Soc 1991;39:142-8To quickly assess basic mobility skillsNot specifiedNot specifiedModified the Get-Up and Go Test
      • Mathias S.
      • Nayak U.S.
      • Isaacs B.
      Balance in elderly patients: the “get-up and go” test.
      by timing person rather than scoring them on scale from 1 to 5
      1Continuous (time)NANo
      Expanded Timed Up-and-Go (ETUG) test
      • Botolfsen P.
      • Helbostad J.L.
      • Moe-Nilssen R.
      • Wall J.C.
      Reliability and concurrent validity of the Expanded Timed Up-and-Go test in older people with impaired mobility.
      Botolfsen et al. Physiother Res Int 2008;13:9 4-106To address shortcomings of the Get-up-and-Go test
      • Mathias S.
      • Nayak U.S.
      • Isaacs B.
      Balance in elderly patients: the “get-up and go” test.
      and the TUG test
      • Podsiadlo D.
      • Richardson S.
      The timed “Up & Go”: a test of basic functional mobility for frail elderly persons.
      Not specifiedNot specifiedNot specified5Continuous (time)NANo
      TURN180
      • Simpson J.M.
      • Worsfold C.
      • Reilly E.
      • Nye N.
      A standard procedure for using TURN180: testing dynamic postural stability among elderly people.
      Simpson et al. Physiotherapy 2002; 88:342-53To be a simple, clinically useful test of dynamic postural control in frail elderly peopleDynamic postural stabilityFrail older adultsNot specified2Continuous (counting number of steps)NANo
      Unified Balance Scale
      • La Porta F.
      • Franceschini M.
      • Caselli S.
      • Cavallini P.
      • Susassi S.
      • Tennant A.
      Unified Balance Scale: an activity-based, bed to community, and aetiology-independent measure of balance calibrated with Rasch analysis.
      La Porta et al. J Rehabil Med 2011; 43:435-44To be a single tool with proven measurement properties, allowing the measurement of balance “from bed to community” regardless of the etiology of the neurological lesion causing the loss of balanceQuiet stance, anticipatory postural adjustments/transitions, responses to external perturbations, sensory orientation, stability during gaitPeople with a neurological lesionLiterature review identifying the BBS,
      • Berg K.
      • Wood-Dauphinee S.
      • Williams J.I.
      • Gayton D.
      Measuring balance in the elderly: preliminary development of an instrument.
      POMA,
      • Tinetti M.E.
      Performance-oriented assessment of mobility problems in elderly patients.
      and FAB Scale,
      • Rose D.J.
      • Lucchese N.
      • Wiersma L.D.
      Development of a multidimensional balance scale for use with functionally independent older adults.
      classical psychometric methods, Rasch analysis
      27Categorical2–5, depending on questionNo
      Unilateral Forefoot Balance Test
      • Clark M.S.
      The Unilateral Forefoot Balance Test: reliability and validity for measuring balance in late midlife women.
      Clark et al. NZ J Physiother 2007;35:110-8Not specifiedHigh-level balancePostmenopausal womenUnpublished pilot study with 31 health volunteers (16 women, mean age, 35y) assessing interrater and test-retest reliability

      Pilot interrater ICC=.99 and test-retest ICC=.95
      2Continuous (time)NANo
      Timed Up-and-Go Assessment of Biomechanical Strategies (TUG-ABS)
      • Faria C.D.
      • Teixeira-Salmela L.F.
      • Nadeau S.
      Clinical testing of an innovative tool for the assessment of biomechanical strategies: the Timed “Up and Go” Assessment of Biomechanical Strategies (TUG-ABS) for individuals with stroke.
      Faria et al. J Rehabil Med 2013;45:232-240To systematically evaluate biomechanical strategies used during performance of the TUG testNot specifiedStrokeLiterature review, opinions of physical therapists, observations of TUG performance, expert panel content validation15Categorical3No
      Posture and Posture Ability Scale (PPAS)
      • Rodby-Bousquet E.
      • Ágústsson A.
      • Jónsdóttir G.
      • Czuba T.
      • Johansson A.-C.
      • Hägglund G.
      Interrater reliability and construct validity of the Posture and Postural Ability Scale in adults with cerebral palsy in supine, prone, sitting and standing positions.
      Rodby-Bousquet et al. Clin Rehabil 2014;28:82-90To evaluate posture and postural ability in people with severe disabilitiesPosture and postural ability in lying, sitting, and standing positionsCerebral palsyAdaptation of pediatric Physical Ability Scale4 tasks, 53 items assessedCategorical scale7 categories for postural ability, 2 categories for quality of postureNo
      High Level Mobility Assessment Tool (HiMAT)
      • Williams G.P.
      • Robertson V.
      • Greenwood K.M.
      • Goldie P.A.
      • Morris M.E.
      The high-level mobility assessment tool (HiMAT) for traumatic brain injury, part 2: content validity and discriminability.
      • Williams G.
      • Robertson V.
      • Greenwood K.
      • Goldie P.
      • Morris M.E.
      The high-level mobility assessment tool (HiMAT) for traumatic brain injury, part 1: item generation.
      Williams et al. Brain Inj 2005;19:833-843To assess people with high-level mobility and balance problemsHigh-level mobilityBrain injuryItem generation proposed by expert clinicians, internal consistency and Rasch analysis determined final set9 tasks, 13 items assessedCategorical5 categoriesNo
      Cross Step Moving on Four Spots Test (CSFT)
      • Yamaji S.
      • Demura S.
      Reliability and fall experience discrimination of Cross Step Moving on Four Spots Test in the elderly.
      Yamaji and Demura. Arch Phys Med Rehabil 2013;94:1312-9To evaluate crossover steps in older adultsCrossover stepsOlder adults (older than 65y)Not reported9Continuous (time to complete 9 steps)NANo
      NOTE. See supplemental appendix S2 for full list of references.
      Abbreviations: ICC, intraclass correlation coefficient; NA, not applicable/available.
      Supplemental Table S2Preliminary psychometric characteristics evaluated in standardized balance measures with index publication
      MeasureReliability TestedReliability TypeReliability Sample SizeReliability ScoreValidity TestedValidity TypeValidity MethodValidity Sample SizeValidity Score
      Activity-based Balance Level Evaluation (ABLE) Scale
      • Ardolino E.M.
      • Hutchinson K.J.
      • Pinto Zipp G.
      • Clark M.
      • Harkema S.J.
      The ABLE Scale: the development and psychometric properties of an outcome measure for the spinal cord injury population.
      NoNANANAYes1. Content validity

      2. Discriminant validity
      1. 3-round Delphi process

      2. Compare scores across 3 functional groups (walker, stander, and wheelchair user)
      1042. F2,101=258.37, P<.0001
      Advanced Balance and Mobility Scale (ABMS)
      • Kairy D.
      • Paquet N.
      • Fung J.
      A postural adaptation test for stroke patients.
      YesInterrater reliability12 people with recent stroke (mean age, 65y), 6 healthy community-dwelling people (mean age, 71y), 5 physiotherapist ratersICC=.97YesConstruct validityCompared scores between high- and low-functioning people with stroke (based on gait speed cutoff of 0.7m/s), and healthy older adults12 people diagnosed with recent stroke (mean age, 65y), 6 healthy community-dwelling people (mean age, 71y)Significant differences in scores across groups (P<.05)
      Balance Computerized Adaptive Testing (CAT) system
      • Hsueh I.
      • Chen J.
      • Wang C.
      • et al.
      Development of a computerized adaptive test for assessing balance function in patients with stroke.
      Yes1. Interrater reliability 2. Item reliability1. 5 raters administered 41 items

      2. 764 patients with stroke and stimulation study using data of patients who had participated in item pool development
      1. Raw sum score of initial 41 items ICC=.95 2. Item simulation study average reliability=.94YesConcurrent validityCorrelated to Berg Balance Scale
      • Berg K.
      • Wood-Dauphinee S.
      • Williams J.I.
      • Gayton D.
      Measuring balance in the elderly: preliminary development of an instrument.
      56 people with stroke (mean age, 62y)Pearson r=.88
      Hierarchical Balance Short Forms (HBSF)
      • Hou W.-H.
      • Chen J.-H.
      • Wang Y.-H.
      • et al.
      Development of a set of functional hierarchical balance short forms for patients with stroke.
      YesItem reliabilitySimulation of data from 764 people with strokeAverage reliability ≥.93YesConcurrent validityCorrelated to Berg Balance Scale
      • Berg K.
      • Wood-Dauphinee S.
      • Williams J.I.
      • Gayton D.
      Measuring balance in the elderly: preliminary development of an instrument.
      85 people with stroke (mean age, 64y)Spearman ρ=.97
      Balance Error Scoring System (BESS)
      • Riemann B.L.
      • Guskiewicz K.M.
      • Shields E.W.
      Relationship between clinical and forceplate measures of postural stability.
      Yes1. Interrater reliability 2. Test-retest reliability1. 3 raters, 18 NCAA Division I varsity male athletes (mean age, 10y)

      2. 12 NCAA Division I varsity male athletes (mean age, 20y)
      1. ICC range=.78 to .93

      2. Significant difference between repeated sessions for double-leg stance-foam target sway
      YesConcurrent validityCorrelated to forceplate target sway111 NCAA Division I varsity male athletes (mean age, 20y)Pearson r range=.31 to .79
      Modified Balance Error Scoring System (M-BESS)
      • Hunt T.N.
      • Ferrara M.S.
      • Bornstein R.A.
      • Baumgartner T.A.
      The reliability of the modified Balance Error Scoring System.
      YesInternal consistency144 high school football athletes (mean age, 16y)Reliability=.88NoNANANANA
      Balance Evaluation Systems Test (BESTest)
      • Horak F.B.
      • Wrisley D.M.
      • Frank J.
      The Balance Evaluation Systems Test (BESTest) to differentiate balance deficits.
      YesInterrater reliability (evaluated once, then test revised and evaluated again)Reliability session 1: 12 ambulatory adults with a range of balance function (age, 50 to 80y)

      Reliability Session 2: 11 subjects, including 4 from first session (age, 67 to 88y)
      Total score ICC=.91; subsection ICC range=.79 to .96YesConcurrent validityCorrelated score of most experienced rater to Activity-Specific Balance Confidence Scale
      • Powell L.E.
      • Myers A.M.
      The Activities-specific Balance Confidence (ABC) Scale.
      12Total score r=.685, subsection r range=.41 to .78
      Brief Balance Evaluation Systems Test (Brief BESTest)
      • Padgett P.K.
      • Jacobs J.V.
      • Kasser S.L.
      Is the BESTest at its best? A suggested brief version based on interrater reliability, validity, internal consistency, and theoretical construct.
      YesInterrater reliability3 raters, 20 participants with and without diagnosed neurological disorders or injuriesTotal score ICC=.99YesDiscriminant validityCompared scores between people with and without neurological diagnosis and multiple sclerosis20 participants with and without neurological diagnosis or injuriesScores were significantly different between people with and without neurological diagnosis (P<.01)
      Mini Balance Evaluation Systems Test (Mini BESTest)
      • Franchignoni F.
      • Horak F.
      • Godi M.
      • Nardone A.
      • Giordano A.
      Using psychometric techniques to improve the Balance Evaluation Systems Test: the mini-BESTest.
      Yes1. Item separation index

      2. Person separation index
      115 people with balance disorders (mean age, 63y)1. Item separation index=7.35, r=.98

      2. Person separation index=2.5, r=.86
      YesInternalOutlier-sensitive mean-square statistic115 people with balance disorders (mean age, 63y)Mean square statistic scores for all items ranged between 0.7 and 1.3
      Balance Outcome Measure for Elder Rehabilitation (BOOMER)
      • Haines T.
      • Kuys S.S.
      • Morrison G.
      • Clarke J.
      • Bew P.
      • McPhail S.
      Development and validation of the balance outcome measure for elder rehabilitation.
      NoInternal consistency784 people (mean age, 74y)Internal consistency range=.87 to .89YesConstruct validityCorrelated to FIM,
      • Linacre J.M.
      • Heinemann A.W.
      • Wright B.D.
      • Granger C.V.
      • Hamilton B.B.
      The structure and stability of the Functional Independence Measure.
      Modified Elderly Mobility Scale (MEMS)
      • Kuys S.S.
      • Brauer S.G.
      Validation and reliability of the Modified Elderly Mobility Scale.
      272 people (mean age, 75y)Admission FIM ρ=.73 Discharge FIM ρ=.72 MEMS admission ρ=.88 and discharge ρ=.83
      Balance Screening Tool (BST)
      • Mackintosh S.
      • Datson N.
      • Fryer C.
      A balance screening tool for older people: reliability and validity.
      Yes1. Intrarater reliability 2. Interrater reliability1. 16 community-dwelling older adults (mean age, 70y)

      2. 14 falls risk assessment community care clients (mean age, 77y)
      1. Spearman rank ρ=.90, κ coefficients range=0.64 to 1.00 for individual items

      2. r=.89, κ coefficients range=.58 to .71 for individual items
      YesConcurrent validityCorrelated to Berg Balance Scale
      • Berg K.
      • Wood-Dauphinee S.
      • Williams J.I.
      • Gayton D.
      Measuring balance in the elderly: preliminary development of an instrument.
      16 community-dwelling older adults and 14 falls risk assessment community care clientsSpearman r range=.87 to .92
      BDL Balance Scale
      • Lindmark B.
      • Liljenäs Å.
      • Hellström K.
      Assessment of minor or moderate balance disorders: a reliability study and comparison with healthy subjects.
      Yes1. Interrater reliability 2. Test-retest reliability 3. Internal consistency1. 2 raters

      2 and 3. 30 people with mild- moderate balance problems (mean age, 53y), 35 people with no balance problems
      1. κ coefficient range=0.56 to 1.0, total score ICC=.99

      2. κ coefficient range=.39 to .73, total score ICC=.96 3. Cronbach α=.87
      NoNANANANA
      Berg Balance Scale (BBS)
      • Berg K.
      • Wood-Dauphinee S.
      • Williams J.I.
      • Gayton D.
      Measuring balance in the elderly: preliminary development of an instrument.
      Yes1. Interrater reliability 2. Internal consistency

      3. Intrarater reliability
      1. 5 experienced physical therapists

      2 and 3. 14 people older than 65y
      1. Interrater total score ICC=.98

      2. Cronbach α=.96

      3. Intrarater total score ICC=.99
      Yes1. Content validity 2.Criterion validity1. Panel of 32 geriatric patients and health professionals

      2. Correlated scores with 3 global ratings of balance (good, fair, and poor)
      232. Significant association between global rating and BBS score (P<.0001)
      Short Form of the Berg Balance Scale (SFBBS)
      • Chou C.
      • Chien C.
      • Hsueh I.
      • Sheu C.
      • Wang C.
      • Hsieh C.
      Developing a short form of the Berg Balance Scale for people with stroke.
      YesInternal consistency113 people with strokeCronbach α=.96Yes1. Concurrent validity

      2. Convergent validity

      3. Predictive validity
      1. Compared with PASS
      • Benaim C.
      • Perennou D.A.
      • Villy J.
      • Rousseaux M.
      • Pelissier J.Y.
      Validation of a standardized assessment of postural control in stroke patients: the Postural Assessment Scale for Stroke Patients (PASS).
      at 14d poststoke

      2. Correlated to Fugl-Meyer motor test
      • Fugl-Meyer A.R.
      • Jaasko L.
      • Leyman I.
      • Olsson S.
      • Steglind S.
      The post-stroke hemiplegic patient, 1: a method for evaluation of physical performance.
      and Barthel Index
      • Mahoney F.I.
      • Barthel D.W.
      Functional evaluation: the Barthel index.


      3. Correlated to Barthel Index
      • Mahoney F.I.
      • Barthel D.W.
      Functional evaluation: the Barthel index.
      90d poststroke
      113 people with stroke (81 at 90d poststroke)1. ICC=.99

      2. Barthel Index r=.86 & Fugl Meyer r=.68

      3. r=.60
      Short Berg Balance Scale
      • Hohtari-Kivimaki U.
      • Salminen M.
      • Vahlberg T.
      • Kivela S.L.
      Short Berg Balance Scale—correlation to static and dynamic balance and applicability among the aged.
      YesInternal consistency519 people (mean age, 72y)Cronbach α=.69YesConcurrent validityCorrelated to static and dynamic balance outcomes assessed on a force platform519 people (mean age, 72y)Correlation range with static outcomes=−.32 to −.45 (all P<.0001), correlation range with dynamic outcomes=−.25 to −.41 (all P< .0001)
      Brunel Balance Assessment (BBA)
      • Tyson S.F.
      • DeSouza L.H.
      Development of the Brunel Balance Assessment: a new measure of balance disability post stroke.
      Yes1. Internal consistency

      2.Test-retest reliability 3. Interrater reliability
      1. 80 people poststroke (mean age, 67y)

      2. 37 people poststroke (mean age, 66y)

      3. 2 raters
      1. Cronbach α=.93 2. κ coefficient=1 3. κ coefficient=1YesCriterion-related validityCorrelated with Motor Assessment Scale,
      • Carr J.H.
      • Shepherd R.B.
      • Nordholm L.
      • Lynne D.
      Investigation of a new motor assessment scale for stroke patients.
      the BBS,
      • Berg K.
      • Wood-Dauphinee S.
      • Williams J.I.
      • Gayton D.
      Measuring balance in the elderly: preliminary development of an instrument.
      Rivermead Mobility Index
      • Collen F.M.
      • Wade D.T.
      • Robb G.F.
      • Bradshaw C.M.
      The Rivermead Mobility Index: a further development of the Rivermead Motor Assessment.
      55 people poststroke (mean age, 68y)Motor Assessment Scale ICC=.83

      BBS ICC=.97

      Rivermead Mobility Index ICC=.95
      Clinical Gait and Balance Scale (GABS)
      • Thomas M.
      • Jankovic J.
      • Suteerawattananon M.
      • et al.
      Clinical gait and balance scale (GABS): validation and utilization.
      YesIntrarater reliability10 people with Parkinson’s diseaseκ coefficient range=.315 to .839YesConcurrent validityCorrelated to spatial and temporal gait characteristics and limits of stability test
      • Clark S.
      • Rose D.J.
      • Fujimoto K.
      Generalizability of the limits of stability test in the evaluation of dynamic balance among older adults.
      35 people with Parkinson’s disease (age, 50 to 75y)Correlation range=.43 to .66
      Clinical Test of Sensory Interaction in Balance (CTSIB)
      • Shumway-Cook A.
      • Horak F.B.
      Assessing the influence of sensory interaction of balance: suggestion from the field.
      Yes
      • Cohen H.
      • Blatchly C.A.
      • Gombash L.L.
      A study of the clinical test of sensory interaction and balance.
      1. Test-retest reliability 2. Interrater reliability1. 22 people (mean age, 21y)

      2. 2 raters
      1. Pearson r=.992. Pearson r=.99NoNANANANA
      Community Balance and Mobility (CB&M) Scale
      • Howe J.A.
      • Inness E.L.
      • Venturini A.
      • Williams J.I.
      • Verrier M.C.
      The Community Balance and Mobility Scale—a balance measure for individuals with traumatic brain injury.
      Yes1. Interrater reliability 2. Intrarater reliability 3. Test-retest reliability1. 4 teams of 2 physical therapists

      2 and 3. 32 people with traumatic brain injury attending neurorehabilitation (mean age, 34y)
      1. ICC=.98

      2. ICC=.98

      3. Immediate ICC=.98 and test-retest 5d apart ICC=.90
      Yes1. Content validity

      2. Construct validity
      1. Physical therapists’ ratings of importance of scale items on 5-point scale from “not at all important” to “extremely important,” correlation to global balance rating

      2. Compared with gait velocity
      36 people with traumatic brain injury attending neurorehabilitation (mean age, 31y)1. Physical therapist global balance scale r=.62 2. Self-paced gait velocity r=.53, maximal gait velocity r=.64
      Dynamic Balance Assessment (DBA)
      • Desai A.
      • Goodman V.
      • Kapadia N.
      • Shay B.L.
      • Szturm T.
      Relationship between dynamic balance measures and functional performance in community-dwelling elderly people.
      NoNANANAYesConvergent validityCorrelated to gait speed, Six-Minute Walk Test,
      • American Thoracic Society
      ATS statement: guidelines for the Six-Minute Walk test.
      the TUG test,
      • Podsiadlo D.
      • Richardson S.
      The timed “Up & Go”: a test of basic functional mobility for frail elderly persons.
      and the BBS
      • Berg K.
      • Wood-Dauphinee S.
      • Williams J.I.
      • Gayton D.
      Measuring balance in the elderly: preliminary development of an instrument.
      72 community-dwelling adults older than 65yCorrelation range=0.1 to 0.31
      Dynamic Gait Index
      • Shumway-Cook A.
      • Baldwin M.
      • Polissar N.L.
      • Gruber W.
      Predicting the probability for falls in community-dwelling older adults.
      NoNANANAYes1. Concurrent validity

      2. Discriminant validity
      1. Correlated to the BBS,
      • Berg K.
      • Wood-Dauphinee S.
      • Williams J.I.
      • Gayton D.
      Measuring balance in the elderly: preliminary development of an instrument.
      assistive device use, history of imbalance, self-perceived balance 2. Compared scores between fallers and nonfallers
      44 community-dwelling people (mean age, 76y)1. Correlation range=.44 to .76

      2. Significant difference in score between groups (P<.001)
      Four-item Dynamic Gait Index (4-DGI)
      • Marchetti G.F.
      • Whitney S.L.
      Construction and validation of the 4-item dynamic gait index.
      Yes1. Subject separation 2. Item difficulty separation 3. Internal consistency131 people (with balance and vestibular disorders and healthy controls)1. r=.79

      2. r=.99

      3. Internal consistency correlation range=.75 to .82
      YesDiscriminant validityCompared scores between fallers and nonfallers34 people who had reported falls in the past 6mo and 89 subjects who had not reported falls in the previous 6moScores were significantly different between fallers and nonfallers (P<.01)
      Functional Gait Assessment (FGA)
      • Wrisley D.M.
      • Marchetti G.F.
      • Kuharsky D.K.
      • Whitney S.L.
      Reliability, internal consistency, and validity of data obtained with the Functional Gait Assessment.
      Yes1. Intrarater reliability 2. Interrater reliability 3. Internal consistency1 and 3. 6 people with vestibular disorders (mean age, 59y)

      2. 10 clinicians
      1. ICC=.83

      2. ICC=.84

      3. Cronbach α=.79
      YesConcurrent validityCorrelated to the DGI,
      • Shumway-Cook A.
      • Baldwin M.
      • Polissar N.L.
      • Gruber W.
      Predicting the probability for falls in community-dwelling older adults.
      Activities-Specific Balance Confidence (ABC) Scale,
      • Powell L.E.
      • Myers A.M.
      The Activities-specific Balance Confidence (ABC) Scale.
      Dizziness Handicap Inventory,
      • Jacobson G.P.
      • Newman C.W.
      The development of the Dizziness Handicap Inventory.
      perception of dizziness symptoms, number of falls, and the TUG test
      • Podsiadlo D.
      • Richardson S.
      The timed “Up & Go”: a test of basic functional mobility for frail elderly persons.
      6 people with vestibular disorders (mean age, 59y)Correlation range=0.1 to 0.8
      Dynamic One Leg Stance (DOLS)
      • Blomqvist S.
      • Rehn B.
      Validity and reliability of the Dynamic One Leg Stance (DOLS) in people with vision loss.
      YesTest-retest reliability12 blind people aged 19 to 61y and 12 sighted people aged 26 to 60yWeighted κ=.47 to .88 for blind people and .47 to .72 for sighted peopleYesConcurrent validityCorrelated scores with single-leg stance test
      • Bohannon R.W.
      Single limb stance times: a descriptive meta-analysis of data from individuals at least 60 years of age.
      and force plate assessment
      12 blind people aged 19 to 61y and 12 sighted people aged 26 to 60yCorrelation with force plate assessment and single-leg stance test for blind subjects: −.13 and .77 for left leg and −.78 and .89 for the right leg, sighted people: correlation was −.56 (NS) and .93 for the left leg and −.61 and .71 for the right leg
      Equiscale
      • Tesio L.
      • Perucca L.
      • Franchignoni F.P.
      • Battaglia M.A.
      A short measure of balance in multiple sclerosis: validation through Rasch analysis.
      YesItem separation reliability24 people with multiple sclerosisr=.98NoNANANANA
      Fast Evaluation of Mobility, Balance and Fitness (FEMBAF)
      • Di Fabio R.P.
      • Seay R.
      Use of the “fast evaluation of mobility, balance, and fear” in elderly community dwellers: validity and reliability.
      YesInterrater reliability5 older adults, 2 ratersMean risk factors κ=.95, task completion κ=.96YesConcurrent validityCorrelated to the POMA,
      • Tinetti M.E.
      Performance-oriented assessment of mobility problems in elderly patients.
      the CTSIB,
      • Shumway-Cook A.
      • Horak F.B.
      Assessing the influence of sensory interaction of balance: suggestion from the field.
      and TUG
      • Podsiadlo D.
      • Richardson S.
      The timed “Up & Go”: a test of basic functional mobility for frail elderly persons.
      tests
      35 older adults without cognitive impairmentPOMA Spearman rank-order r range=−0.1 to 0.91, CTSIB range=−.18 to .56, TUG=−0.2 to 0.6
      Five Times Sit-to-Stand (5-STS) Test
      • Whitney S.L.
      • Wrisley D.M.
      • Marchetti G.F.
      • Gee M.A.
      • Redfern M.S.
      • Furman J.M.
      Clinical measurement of sit-to-stand performance in people with balance disorders: validity of data for the Five-Times-Sit-to-Stand Test.
      NoNANANAYes1. Concurrent validity

      2. Discriminant validity
      1. Compared scores between people with and without diagnosed balance disorders

      2. Compared scores to the DGI
      • Shumway-Cook A.
      • Baldwin M.
      • Polissar N.L.
      • Gruber W.
      Predicting the probability for falls in community-dwelling older adults.
      and the ABC scale
      • Powell L.E.
      • Myers A.M.
      The Activities-specific Balance Confidence (ABC) Scale.
      81 healthy controls and 93 people with balance disorders1: DGI Spearman ρ=−.68 (P<.001) and ABC Spearman ρ=−.58 (P<.001)

      2. The FTSST correctly identified 65% of the subjects with balance dysfunction
      Four Square Step Test (FSST)
      • Dite W.
      • Temple V.A.
      A clinical test of stepping and change of direction to identify multiple falling older adults.
      Yes1. Interrater reliability 2. Test-retest reliability1. 30 community-dwelling adults older than 65y 2. 20 community-dwelling adults older than 65y1. ICC=.99

      2. ICC=.98
      YesConvergent validityCorrelated to the Step Test,
      • Hill K.D.
      • Bernhardt J.
      • McGann A.M.
      • Maltese D.
      • Berkovits D.
      A new test of dynamic standing balance for stroke patients: reliability, validity and comparison with healthy elderly.
      the TUG test,
      • Podsiadlo D.
      • Richardson S.
      The timed “Up & Go”: a test of basic functional mobility for frail elderly persons.
      and the Functional Reach Test
      • Duncan P.W.
      • Weiner D.K.
      • Chandler J.
      • Studenski S.
      Functional reach: a new clinical measure of balance.
      81 community-dwelling older adultsStep Test r= .83, TUG test r=.88, Functional Reach Test r=.47
      Fullerton Advanced Balance (FAB) Scale
      • Rose D.J.
      • Lucchese N.
      • Wiersma L.D.
      Development of a multidimensional balance scale for use with functionally independent older adults.
      Yes1. Test-retest reliability 2. Intrarater reliability 3. Interrater reliability1. 31 older adults (mean age, 75y) with identified balance problems of varying severity

      2 and 3. 10 older adults (61 to 81y), 4 raters
      1. Spearman rank r=.96

      2. Correlation range=0.51 to 1.0

      3. Correlation range=0.22 to 1.0
      YesConvergent validityCorrelated to BBS
      • Berg K.
      • Wood-Dauphinee S.
      • Williams J.I.
      • Gayton D.
      Measuring balance in the elderly: preliminary development of an instrument.
      scores
      31 older adults (mean age, 75y) with identified balance problems of varying severitySpearman rank r=.75 (P<.01)
      Functional Reach Test
      • Duncan P.W.
      • Weiner D.K.
      • Chandler J.
      • Studenski S.
      Functional reach: a new clinical measure of balance.
      YesTest-retest reliability14 people (age, 20 to 79y)ICC=.92YesConcurrent validityCorrelated with the COP excursion128 people (age, 20 to 79y)Pearson r=.71
      Multidirectional Reach Test
      • Newton R.A.
      Validity of the multi-directional reach test: a practical measure for limits of stability in older adults.
      Yes1. Internal consistency

      2. Test-retest reliability
      254 community-dwelling older adults (mean age, 74y)1. Cronbach α=.842

      2. ICC range=.93 to .94
      YesConcurrent validityCorrelated to the BBS
      • Berg K.
      • Wood-Dauphinee S.
      • Williams J.I.
      • Gayton D.
      Measuring balance in the elderly: preliminary development of an instrument.
      and the TUG test
      • Podsiadlo D.
      • Richardson S.
      The timed “Up & Go”: a test of basic functional mobility for frail elderly persons.
      254 community-dwelling older adults (mean age, 74y)Correlation with BBS total score: forward reach r=.476, backward reach r=.356, right reach r=.389, and left reach r=.39 Correlation with TUG: forward reach r=−.442, backward reach r=−.333, right reach r=−.26, and left reach r= −.31
      Hierarchical Assessment of Balance and Mobility (HABAM)
      • MacKnight C.
      • Rockwood K.
      A hierarchical assessment of balance and mobility.
      YesInterrater reliability2 raters, 30 people admitted to a general medicine service or geriatric assessment unit (mean age, 80y)ICC=.94Yes1. Convergent construct validity

      2. Discriminant construct validity
      Correlated to the Barthel Index,
      • Mahoney F.I.
      • Barthel D.W.
      Functional evaluation: the Barthel index.
      Folstein Mini Mental Status Exam (MMSE),
      • Folstein M.F.
      • Folstein S.E.
      • McHugh P.R.
      “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician.
      Lawton-Brody Instrumental Activities of Daily Living (ADL),
      • Lawton M.P.
      • Brody E.M.
      Assessment of older people: self-maintaining and instrumental activities of daily living.
      Spitzer Quality of Life Index
      • Spitzer W.O.
      • Dobson A.J.
      • Hall J.
      • et al.
      Measuring the quality of life of cancer patients: a concise QL-index for use by physicians.
      30 people admitted to a general medicine service or geriatric assessment unit (mean age, 80y)1. Barthel Index r= .76 2. Folstein MMSE r=.15, Lawton-Brody ADL r=.30, Spitzer Quality of Life Index r=.39
      Kansas University Standing Balance Scale (KUSBS)
      • Kluding P.
      • Swafford B.
      • Cagle P.
      • Gajewski B.
      Reliability, responsiveness, and validity of the Kansas University Standing Balance Scale.
      Yes1. Intrarater reliability 2. Interrater reliability23 people admitted to inpatient rehabilitation (mean age, 58y)1. ICC=.89 for novice raters, ICC=.76 for experienced raters

      2. ICC=.73
      YesConcurrent validityCorrelated to FIM
      • Linacre J.M.
      • Heinemann A.W.
      • Wright B.D.
      • Granger C.V.
      • Hamilton B.B.
      The structure and stability of the Functional Independence Measure.
      transfer and walking scores
      25 people admitted to inpatient rehabilitation (mean age, 63y)FIM transfer r=.49, FIM walking r=.38
      Limits of Stability Test (LOS)
      • Clark S.
      • Rose D.J.
      • Fujimoto K.
      Generalizability of the limits of stability test in the evaluation of dynamic balance among older adults.
      YesTest-retest reliability38 community-dwelling healthy older adults (mean age, 68y)Generalizability coefficient range=.69 to .89NoNANANANA
      Modified Figure of Eight Test
      • Jarnlo G.
      • Nordell E.
      Reliability of the modified figure of eight—a balance performance test for elderly women.
      Yes1. Interrater reliability 2. Test-retest reliability1. 2 raters

      2. 30 community-dwelling women older than 70y (mean age, 76y)
      1. ICC=0.94 to 1.0 at first session and 0.99 to 1.00 at second session, .79 to .93 for number of oversteps

      2. ICC=.93 and ICC=.73 for oversteps value
      YesConcurrent validityCorrelated to one-legged stance test,
      • Bohannon R.W.
      Single limb stance times: a descriptive meta-analysis of data from individuals at least 60 years of age.
      tandem stance with eyes closed, preferred and maximal gait velocity
      30 community-dwelling women older than 70y (mean age, 76y)Correlation range=.05 to .52
      Parallel Walk Test (PWT)
      • Lark S.D.
      • McCarthy P.W.
      • Rowe D.A.
      Reliability of the parallel walk test for the elderly.
      Yes1. Interrater reliability 2. Test-retest reliability1. 2 raters

      2. 36 elderly fallers (mean age, 81y)
      1. ICC range=.71 to .99

      2. ICC range=.70 to .90
      Yes1. Concurrent validity

      2. Discriminative validity
      1. Correlated to tandem
      • Hile E.S.
      • Brach J.S.
      • Perera S.
      • Wert D.M.
      • VanSwearingen J.M.
      • Studenski S.A.
      Interpreting the need for initial support to perform tandem stance tests of balance.
      and parallel stance tests and tandem walk tests

      2. Compared scores between fallers and nonfallers
      61 older adult fallers and nonfallersCorrelation range=.28 to .49, significant differences in scores between fallers and nonfallers (P<.05)
      Performance Oriented Mobility Assessment (POMA)
      • Tinetti M.E.
      Performance-oriented assessment of mobility problems in elderly patients.
      Yes
      • Cipriany-Dacko L.M.
      • Innerst D.
      • Johannsen J.
      • Rude V.
      Interrater reliability of the Tinetti Balance Scores in novice and experienced physical therapy clinicians.
      Interrater reliability26 residents of a skilled nursing home (mean age, 80y), 3 student physical therapists (phase 1), 9 physical therapy clinicians (phase 2)Phase 1: κ range=0.4 to 1.0; Phase 2: κ range=0.4 to 0.75NoNANANANA
      Modified Performance Oriented Mobility Assessment
      • Fox K.M.
      • Felsenthal G.
      • Hebel J.R.
      • Zimmerman S.I.
      • Magaziner J.
      A portable neuromuscular function assessment for studying recovery from hip fracture.
      YesInterrater reliability23 people after hip fracture (mean age, 81y), 4 ratersκ range=0.1 to 0.4

      ICC range=.08 to .92
      NoNANANANA
      Postural Assessment Scale for Stroke Patients (PASS)
      • Benaim C.
      • Perennou D.A.
      • Villy J.
      • Rousseaux M.
      • Pelissier J.Y.
      Validation of a standardized assessment of postural control in stroke patients: the Postural Assessment Scale for Stroke Patients (PASS).
      Yes1. Interrater reliability 2. Intrarater reliability1. 2 unique raters

      2. 12 people with stroke
      1. Average κ coefficient= .72 (range= 0.45 to 1), Pearson r=.99 2. Average k-coefficient= .88 (range, 0.64 to 1), Pearson r=.98Yes1. Construct validity

      2. Predictive validity
      1. Correlated scores with motricity, somatosensory threshold, spatial inattention, spasticity, and functional status and instrumental measures of sitting balance, when available

      2. Correlated with FIM score
      • Linacre J.M.
      • Heinemann A.W.
      • Wright B.D.
      • Granger C.V.
      • Hamilton B.B.
      The structure and stability of the Functional Independence Measure.
      at 3mo
      70“Strong correlations with the transferring and locomotion sections of FIM, with motricity, sensibility, and spatial neglect scores, negative correlations with postural stabilization (r=.48; P<.0001) and postural orientation with respect to gravity (r=.36; P=.05); strong correlation to total FIM score (r=.75; P<.0001)
      Short Form of Postural Assessment Scale for Stroke Patients (SFPASS)
      • Chien C.W.
      • Lin J.H.
      • Wang C.H.
      • Hsueh I.P.
      • Sheu C.F.
      • Hsieh C.L.
      Developing a Short Form of the Postural Assessment Scale for people with Stroke.
      YesInternal consistency287 people with stroke (mean age, 65.5y)Cronbach α=.93Yes1. Concurrent validity

      2. Convergent validity

      3. Predictive validity
      1. Compared with PASS
      • Benaim C.
      • Perennou D.A.
      • Villy J.
      • Rousseaux M.
      • Pelissier J.Y.
      Validation of a standardized assessment of postural control in stroke patients: the Postural Assessment Scale for Stroke Patients (PASS).
      at 14d poststoke

      2. Correlated to Fugl-Meyer motor test
      • Fugl-Meyer A.R.
      • Jaasko L.
      • Leyman I.
      • Olsson S.
      • Steglind S.
      The post-stroke hemiplegic patient, 1: a method for evaluation of physical performance.
      and Barthel Index
      • Mahoney F.I.
      • Barthel D.W.
      Functional evaluation: the Barthel index.


      3. Correlated to Barthel Index
      • Mahoney F.I.
      • Barthel D.W.
      Functional evaluation: the Barthel index.
      90d poststroke
      287 people with stroke (mean age, 65.5y)1. ICC=.98 2. Barthel Index r=.86 and Fugl Meyer r=.75

      3. r=.48
      Postural Control and Balance for Stroke Scale
      • Pyöriä O.
      • Talvitie U.
      • Villberg J.
      The reliability, distribution, and responsiveness of the Postural Control and Balance for Stroke Test.
      Yes1. Internal consistency

      2. Interrater reliability 3. Intrarater reliability
      1 and 3. 19 people (1 to 8wk poststroke)

      2. 5 raters
      1. Cronbach α=.96

      2. Total score ICC=.95

      3. Total score ICC=.96
      NoNANANANA
      Postural Stress Test (PST)
      • Wolfson L.I.
      • Whipple R.
      • Amerman P.
      • Kleinberg A.
      Stressing the postural response: a quantitative method for testing balance.
      YesInterrater reliability51 (22 nursing home residents with ≥2 unexplained falls in previous year, 18 age- and sex-matched, nonfalling control group, 21 young controls)Cronbach α=.99YesDiscriminant validityCompared scores between 3 groups51 (22 nursing home residents with ≥2 unexplained falls in previous year, 18 age- and sex-matched, nonfalling control group, 21 young controls)Significant difference in scores between groups (P<.05)
      Pull/Retropulsion Test
      • Visser M.
      • Marinus J.
      • Bloem B.R.
      • Kisjes H.
      • van den Berg B.M.
      • van Hilten J.J.
      Clinical tests for the evaluation of postural instability in patients with Parkinson’s disease.
      YesInterrater reliability3 raters, 42 people with Parkinson’s disease (mean age, 64y) and 15 healthy volunteers (mean age, 64y)Weighted κ mean range=.57 to .98Yes1. Concurrent criterion validity

      2. Predictive validity
      1. Compared scores between unstable Parkinson’s disease, stable Parkinson’s disease, and health control groups

      2. Sensitivity and specificity
      42 people with Parkinson’s disease (mean age, 64y) and 15 healthy volunteers (mean age, 64y)1. Significant differences for all but 2 conditions (P<.05)

      2. Predictive: sensitivity=.63, specificity=.88, positive predictive value=.86, negative predictive value=.69, and overall predictive accuracy=.75
      Push and Release Test
      • Jacobs J.
      • Horak F.
      • Van Tran K.
      • Nutt J.
      An alternative clinical postural stability test for patients with Parkinson’s disease.
      YesInterrater reliability3 examiners, 3 healthy people (mean age, 62y), 8 people with Parkinson’s disease (mean age, 62y)ICC range=.83 to .84YesDiscriminant validityCompared scores between people with and without Parkinson’s disease68 people with Parkinson’s disease (mean age, 67y), 69 healthy people (mean age, 67y)Significant differences in scores between people with and without Parkinson’s disease (P<.001)
      Rapid Step Test
      • Medell J.L.
      • Alexander N.B.
      A clinical measure of maximal and rapid stepping in older women.
      Yes1. Test-retest reliability 2. Interrater reliability34 women (12 healthy young, 12 healthy older, and 10 balance-impaired older adults)1. ICC range=.71 to .97

      2. ICC=.98 for primary session and .95 for follow-up
      YesConvergent validityCorrelated to balance and fall risk measures34 women (12 healthy young, 12 healthy older, and 10 balance-impaired older adults)Correlation range=.60 to .84
      Sensory Organization Test (SOT)
      • Ford-Smith C.D.
      • Wyman J.F.
      • Elswick Jr., R.K.
      • Fernandez T.
      • Newton R.A.
      Test-retest reliability of the Sensory Organization Test in noninstitutionalized older adults.
      YesTest-retest reliability (completed for each condition for first trial and average of 3 trials)40 community-dwelling adults older than 65yFirst-trial ICC range=.15 to .70, 3-trial average ICC range=.26 to .68NoNANANANA
      Head-Shake Sensory Organization Test (HS-SOT)
      • Pang M.Y.
      • Lam F.M.
      • Wong G.H.
      • Au I.H.
      • Chow D.L.
      Balance performance in head-shake computerized dynamic posturography: aging effects and test-retest reliability.
      YesTest-retest reliability77 people (56 young adults [mean age, 24y] and 21 older adults [mean age, 58y])Overall HS-SOT condition 2 ICC=.82, overall HS-SOT condition 5 ICC=.77NoDiscriminant validityCompared scores between young and older adults165 people (92 young adults [mean age, 28y], 73 older adults [mean age, 60y])HS-SOT scores significantly lower in older adults (P<.01)
      Short Physical Performance Battery (SPPB)
      • Guralnik J.M.
      • Simonsick E.M.
      • Ferrucci L.
      • et al.
      A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission.
      YesInternal consistency5104 community-dwelling people from 3 population studies (aged 65y and older)Cronbach α=.76YesConcurrent validityCorrelated scores to performance of self-reported disability5104 community-dwelling people from 3 population studies (65y and older)Summary performance score showed a very strong association with measures of self-reported disability
      Side-Step Test
      • Fujisawa H.
      • Takeda R.
      A new clinical test of dynamic standing balance in the frontal plane: the side-step test.
      YesTest-retest reliability28 people with hemiplegia (mean age, 67y)ICC=.97 (for both affected and unaffected legs)YesConvergent validityCorrelated to one-footed standing duration, walking speed, stride length, and cadence28 people with hemiplegia (mean age, 67y)Correlation range=.84 to .89
      Single Leg Hop Stabilization Test
      • Riemann B.L.
      • Caggiano N.A.
      • Lephert S.M.
      Examination of a clinical method of assessing postural control during a functional performance task.
      YesInterrater reliability3 testers, 15 people (mean age, 21y)Landing score: ICC=.92 Balance scale: ICC=.70NoNANANANA
      Single-leg Stance Test
      • Bohannon R.W.
      Single limb stance times: a descriptive meta-analysis of data from individuals at least 60 years of age.
      Yes
      • Suni J.H.
      • Oja P.
      • Laukkanen R.T.
      • et al.
      Health-related fitness test battery for adults: aspects of reliability.
      Interrater reliability42 people (mean age, 42y)ICC=.76NoNANANANA
      Spring Scale Test (SST)
      • DePasquale L.
      • Toscano L.
      The Spring Scale Test: a reliable and valid tool for explaining fall history.
      YesTest-retest reliability58 community-dwelling adults older than 65y (29 fallers and 29 nonfallers)ICC=.94Yes1. Convergent construct validity

      2. Known groups validity
      1. Correlated to gait speed, the TUG test,
      • Podsiadlo D.
      • Richardson S.
      The timed “Up & Go”: a test of basic functional mobility for frail elderly persons.
      the Single-leg Stance Test,
      • Bohannon R.W.
      Single limb stance times: a descriptive meta-analysis of data from individuals at least 60 years of age.
      and Tandem Stance
      • Hile E.S.
      • Brach J.S.
      • Perera S.
      • Wert D.M.
      • VanSwearingen J.M.
      • Studenski S.A.
      Interpreting the need for initial support to perform tandem stance tests of balance.


      2. Known groups: Compared with gait speed, the TUG test,
      • Podsiadlo D.
      • Richardson S.
      The timed “Up & Go”: a test of basic functional mobility for frail elderly persons.
      the Single-leg Stance Test,
      • Bohannon R.W.
      Single limb stance times: a descriptive meta-analysis of data from individuals at least 60 years of age.
      and Tandem Stance
      • Hile E.S.
      • Brach J.S.
      • Perera S.
      • Wert D.M.
      • VanSwearingen J.M.
      • Studenski S.A.
      Interpreting the need for initial support to perform tandem stance tests of balance.
      58 community-dwelling adults older than 65y (29 fallers and 29 nonfallers)1. Gait speed r=.53, TUG r=−.67, Single limb stance r=.54, and Tandem stance r=.55 2. Significant difference between fallers and nonfallers (T= 11.6; P=.001)
      Standing Test for Imbalance and Disequilibrium (SIDE)
      • Teranishi T.
      • Kondo I.
      • Sonoda S.
      • et al.
      A discriminative measure for static postural control ability to prevent in-hospital falls: reliability and validity of the Standing Test for Imbalance and Disequilibrium (SIDE).
      YesInterrater reliability30 rehabilitation inpatients with neurological or musculoskeletal impairment (mean age, 57.4y), 2 physiotherapistsCohen k=.76YesCriterion-related validityCorrelated with the BBS
      • Berg K.
      • Wood-Dauphinee S.
      • Williams J.I.
      • Gayton D.
      Measuring balance in the elderly: preliminary development of an instrument.
      30 rehabilitation inpatients with neurological or musculoskeletal impairment (mean age, 57.4y)Spearman rank r=.93 (P<.01)
      Star Excursion Balance Test (SEBT)
      • Hertel J.
      • Miller S.J.
      • Denegar C.R.
      Intratester and intertester reliability during the Star Excursion Balance Tests.
      Yes1. Intrarater reliability 2. Interrater reliability16 recreationally active, healthy young adults (mean age, 21y)1. ICC range=.78 to .96

      2. ICC range=.35 to .84 on day 1 and .81 to .93 on day 2
      NoNANANANA
      Step Test (ST)
      • Hill K.D.
      • Bernhardt J.
      • McGann A.M.
      • Maltese D.
      • Berkovits D.
      A new test of dynamic standing balance for stroke patients: reliability, validity and comparison with healthy elderly.
      YesTest-retest reliability14 healthy older adults (mean age, 72y) and 21 people with stroke (mean age, 76y)Healthy elderly ICC range=.90 to .94; stroke ICC range=.88 to .97YesConcurrent validityCorrelated to the Functional Reach Test,
      • Duncan P.W.
      • Weiner D.K.
      • Chandler J.
      • Studenski S.
      Functional reach: a new clinical measure of balance.
      gait velocity, and stride length
      49 people (20 with stroke and 29 healthy elderly, mean age, 71y)Correlation range=.68 to .83
      Tandem Stance
      • Hile E.S.
      • Brach J.S.
      • Perera S.
      • Wert D.M.
      • VanSwearingen J.M.
      • Studenski S.A.
      Interpreting the need for initial support to perform tandem stance tests of balance.
      Yes
      • Franchignoni F.
      • Tesio L.
      • Martino M.T.
      • Ricupero C.
      Reliability of four simple, quantitative tests of balance and mobility in healthy elderly females.
      1. Interrater reliability 2. Test-retest reliability45 women (mean age, 63y), 2 observers1. ICC=.99

      2. ICC range=.76 to .91
      YesDiscriminant validityCompared test performance by fall historyNANA
      Time on Ball Test
      • Bruinsma J.H.
      • Gebraad M.M.
      • Brumels K.A.
      Clinician’s corner: reliability of the time-on-ball test.
      Yes1. Intrasession reliability 2. Intersession reliability 3. Interrater reliability1. 10 college-aged students (mean age, 20y)2. 10 college-aged students (mean age, 20y)

      3. 2 testers
      1. ICC=.374

      2. ICC=.203

      3. ICC=>.98
      NoNANANANA
      Timed Up-and-Go (TUG) Test
      • Podsiadlo D.
      • Richardson S.
      The timed “Up & Go”: a test of basic functional mobility for frail elderly persons.
      Yes1. Interrater reliability 2. Intrarater reliability22 medically stable people attending day hospital over a 2-mo period1. ICC=.99

      2. ICC=.99
      YesConcurrent validityCorrelated to the BBS,
      • Berg K.
      • Wood-Dauphinee S.
      • Williams J.I.
      • Gayton D.
      Measuring balance in the elderly: preliminary development of an instrument.
      Barthel Index,
      • Mahoney F.I.
      • Barthel D.W.
      Functional evaluation: the Barthel index.
      and gait speed
      60 elderly volunteer subjects (mean age, 80y)BBS r=−.72, gait speed r=−.55, Barthel Index r=−.51
      Expanded Timed Up-and-Go (ETUG) test
      • Botolfsen P.
      • Helbostad J.L.
      • Moe-Nilssen R.
      • Wall J.C.
      Reliability and concurrent validity of the Expanded Timed Up-and-Go test in older people with impaired mobility.
      Yes1. Intrarater reliability 2. Interrater reliability 3. Test-retest reliability1 and 3. 28 home-dwelling people (mean age, 80y) with impaired mobility

      2. 3 raters
      1. ICC=.91

      2. ICC range=.86 to.96

      3. ICC range=.54 to .85
      YesConcurrent validityCompared with the TUG
      • Podsiadlo D.
      • Richardson S.
      The timed “Up & Go”: a test of basic functional mobility for frail elderly persons.
      test score
      28 home-dwellingpeople (mean age, 80y) with impaired mobilityCorrected Pearson=.85
      TURN18091NoNANANAYesConcurrent validityCorrelated with gait speed, fall history, perceived steadiness, and fear of falling142 people admitted to an acute geriatric ward (mean age, 81y)Spearman r with fall history=.35, gait speed=.71, perceived steadiness=.35
      Unified Balance Scale
      • La Porta F.
      • Franceschini M.
      • Caselli S.
      • Cavallini P.
      • Susassi S.
      • Tennant A.
      Unified Balance Scale: an activity-based, bed to community, and aetiology-independent measure of balance calibrated with Rasch analysis.
      YesInternal consistency217 people with a neurological diagnosis (mean age, 59.5y)Cronbach α=.98NoNANANANA
      Unilateral Forefoot Balance Test
      • Clark M.S.
      The Unilateral Forefoot Balance Test: reliability and validity for measuring balance in late midlife women.
      YesTest-retest reliability28 women (age, 58 to 69y)ICC=.96YesConcurrent validityCompared with Single-leg Stance Test
      • Bohannon R.W.
      Single limb stance times: a descriptive meta-analysis of data from individuals at least 60 years of age.
      with eyes closed
      142 women (mean age, 61.6y)r=.63
      Timed Up-and-Go Assessment of Biomechanical Strategies (TUG-ABS)
      • Faria C.D.
      • Teixeira-Salmela L.F.
      • Nadeau S.
      Clinical testing of an innovative tool for the assessment of biomechanical strategies: the Timed “Up and Go” Assessment of Biomechanical Strategies (TUG-ABS) for individuals with stroke.
      Yes1. Intrarater reliability 2. Interrater reliability22 people with stroke (mean age, 54.7y), 4 ratersκ coefficient range=0.36 to 1.0Yes1. Content validity

      2. Criterion-related validity
      1. Ranking by experts

      2. Compared with Sit-to-Stand task
      13 people with stroke (mean age, 63.4y)1. Final set of items reached κ>.72

      2. κ ranges from 0.29 to 1.0
      Posture and Posture Ability Scale (PPAS)
      • Rodby-Bousquet E.
      • Ágústsson A.
      • Jónsdóttir G.
      • Czuba T.
      • Johansson A.-C.
      • Hägglund G.
      Interrater reliability and construct validity of the Posture and Postural Ability Scale in adults with cerebral palsy in supine, prone, sitting and standing positions.
      Yes1. Interrater reliability 2. Internal consistency30 adults with cerebral palsy (age, 19 to 22y)1. κ coefficient ranges from .85 to .99

      2. Cronbach α ranges from .96 to .97
      YesConstruct validityCompared with Gross Motor Function Classification System30 adults with cerebral palsy (age, 19 to 22y)Significant differences between known groups represented by gross motor function levels (P< .02)
      High Level Mobility Assessment Tool (HiMAT)
      • Williams G.P.
      • Robertson V.
      • Greenwood K.M.
      • Goldie P.A.
      • Morris M.E.
      The high-level mobility assessment tool (HiMAT) for traumatic brain injury, part 2: content validity and discriminability.
      • Williams G.
      • Robertson V.
      • Greenwood K.
      • Goldie P.
      • Morris M.E.
      The high-level mobility assessment tool (HiMAT) for traumatic brain injury, part 1: item generation.
      YesInternal consistency103 people with traumatic brain injury (median age, 27y)Cronbach α=.99NoNANANANA
      Cross Step Moving on Four Spots Test (CSFT)
      • Yamaji S.
      • Demura S.
      Reliability and fall experience discrimination of Cross Step Moving on Four Spots Test in the elderly.
      YesTest-retest reliability533 older adults (age, 65 to 94y)ICC=.833 in men, ICC=.825 in womenNoNANANANA
      NOTE. See supplemental appendix S2 for full list of references.
      Abbreviations: ICC, intraclass correlation coefficient; NA, not applicable/available; NCAA, National Collegiate Athletic Association; NS, not significant.

      References

        • Tinetti M.E.
        • Kumar C.
        The patient who falls: it’s always a tradeoff.
        JAMA. 2010; 303: 258-266
        • Tyson S.F.
        • Hanley M.
        • Chillala J.
        • Selley A.
        • Tallis R.C.
        Balance disability after stroke.
        Phys Ther. 2006; 86: 30-38
        • Sturnieks D.L.
        • Tiedemann A.
        • Chapman K.
        • Munro B.
        • Murray S.M.
        • Lord S.R.
        Physiological risk factors for falls in older people with lower limb arthritis.
        J Rheumatol. 2004; 31: 2272-2279
        • Dillon C.F.
        • Gu Q.
        • Hoffman H.J.
        • Ko C.-W.
        Vision, hearing, balance, and sensory impairments in Americans aged 70 years and older: United States, 1999-2006.
        NCHS Data Brief. 2010; : 1-8
        • Gillespie L.D.
        • Robertson M.C.
        • Gillespie W.J.
        • et al.
        Interventions for preventing falls in older people living in the community.
        Cochrane Database Syst Rev. 2012; : CD007146
        • Howe T.E.
        • Rochester L.
        • Neil F.
        • Skelton D.A.
        • Ballinger C.
        Exercise for improving balance in older people.
        Cochrane Database Syst Rev. 2011; : CD004963
        • Sherrington C.
        • Tiedemann A.
        • Fairhall N.
        • Close J.C.
        • Lord S.R.
        Exercise to prevent falls in older adults: an updated meta-analysis and best practice recommendations.
        N S W Public Health Bull. 2011; 22: 78-83
        • Horak F.B.
        Postural orientation and equilibrium: what do we need to know about neural control of balance to prevent falls?.
        Age Ageing. 2006; 35: ii7-11
        • Orr R.
        • Raymond J.
        • Fiatarone Singh M.
        Efficacy of progressive resistance training on balance performance in older adults: a systematic review of randomized controlled trials.
        Sports Med. 2008; 38: 317-343
        • Sibley K.M.
        • Straus S.E.
        • Inness E.L.
        • Salbach N.M.
        • Jaglal S.B.
        Balance assessment practices and use of standardized balance measures among Ontario physical therapists.
        Phys Ther. 2011; 91: 1583-1591
        • Howe T.E.
        • Skelton D.A.
        Consensus on core outcome measures of function are needed to progress our knowledge of “best practice” exercise components for older people.
        Age Ageing. 2011; 40: 532-533
        • Tyson S.F.
        • Connell L.A.
        How to measure balance in clinical practice: a systematic review of the psychometrics and clinical utility of measures of balance activity for neurological conditions.
        Clin Rehabil. 2009; 23: 824-840
        • McGinnis P.Q.
        • Wainwright S.F.
        • Hack L.M.
        • Nixon-Cave K.
        • Michlovitz S.
        Use of a Delphi panel to establish consensus for recommended uses of selected balance assessment approaches.
        Physiother Theory Pract. 2010; 26: 358-373
        • Pardasaney P.K.
        • Slavin M.D.
        • Wagenaar R.C.
        • Latham N.K.
        • Ni P.
        • Jette A.M.
        Conceptual limitations of balance measures for community-dwelling older adults.
        Phys Ther. 2013; 93: 1351-1368
        • Bernstein N.
        Co-ordination and regulation of movements.
        Pergamon Pr, New York1967
        • Horak F.B.
        • Macpherson J.M.
        Postural orientation and equilibrium.
        in: Rowell L.B. Shepherd J.T. Handbook of physiology, Section 12, Exercise: regulation and integration of multiple systems. American Physiological Society, New York1996: 255-292
        • Woollacott M.H.
        • Shumway-Cook A.
        Changes in postural control across the life span—a systems approach.
        Phys Ther. 1990; 70: 799-807
        • Horak F.B.
        • Wrisley D.M.
        • Frank J.
        The Balance Evaluation Systems Test (BESTest) to differentiate balance deficits.
        Phys Ther. 2009; 89: 484-498
        • Arksey H.
        • O’Malley L.
        Scoping studies: towards a methodological framework.
        Int J Soc Res Methodol. 2005; 8: 19-32
        • Levac D.
        • Colquhoun H.
        • O’Brien K.
        Scoping studies: advancing the methodology.
        Implement Sci. 2010; 5: 69
        • Daudt H.M.
        • van Mossel C.
        • Scott S.J.
        Enhancing the scoping study methodology: a large, inter-professional team’s experience with Arksey and O’Malley's framework.
        BMC Med Res Methodol. 2013; 13: 48
        • Moher D.
        • Liberati A.
        • Tetzlaff J.
        • Altman D.G.
        Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.
        Open Med. 2009; 3: e123-e130
      1. Canadian Agency for Drugs and Technologies in Health. Grey Matters: a practical search tool for evidence-based medicine 2013. Available at: http://www.cadth.ca/en/resources/finding-evidence-is/grey-matters. Accessed April 26, 2013.

        • Maki B.E.
        • McIlroy W.E.
        Postural control in the older adult.
        Clin Geriatr Med. 1996; 12: 637-658
        • Hilliard M.J.
        • Martinez K.M.
        • Janssen I.
        • et al.
        Lateral balance factors predict future falls in community-living older adults.
        Arch Phys Med Rehabil. 2008; 89: 1708-1713
        • Lacour M.
        • Bernard-Demanze L.
        • Dumitrescu M.
        Posture control, aging, and attention resources: models and posture-analysis methods.
        Neurophysiol Clin. 2008; 38: 411-421
        • de Oliveira C.B.
        • de Medeiros I.R.
        • Frota N.A.
        • Greters M.E.
        • Conforto A.B.
        Balance control in hemiparetic stroke patients: main tools for evaluation.
        J Rehabil Res Dev. 2008; 45: 1215-1226
      2. Rehabilitation Measures Database [May 20, 2014]. Available at: www.rehabmeasures.org. Accessed May 20, 2014.

        • Ardolino E.M.
        • Hutchinson K.J.
        • Pinto Zipp G.
        • Clark M.
        • Harkema S.J.
        The ABLE Scale: the development and psychometric properties of an outcome measure for the spinal cord injury population.
        Phys Ther. 2012; 92: 1046-1054
        • Kairy D.
        • Paquet N.
        • Fung J.
        A postural adaptation test for stroke patients.
        Disabil Rehabil. 2003; 25: 127-135
        • Hsueh I.
        • Chen J.
        • Wang C.
        • et al.
        Development of a computerized adaptive test for assessing balance function in patients with stroke.
        Phys Ther. 2010; 90: 1336-1344
        • Hou W.-H.
        • Chen J.-H.
        • Wang Y.-H.
        • et al.
        Development of a set of functional hierarchical balance short forms for patients with stroke.
        Arch Phys Med Rehabil. 2011; 92: 1119-1125
        • Riemann B.L.
        • Guskiewicz K.M.
        • Shields E.W.
        Relationship between clinical and forceplate measures of postural stability.
        J Sport Rehabil. 1999; 8: 71-82
        • Hunt T.N.
        • Ferrara M.S.
        • Bornstein R.A.
        • Baumgartner T.A.
        The reliability of the modified Balance Error Scoring System.
        Clin J Sport Med. 2009; 19: 471-475
        • Padgett P.K.
        • Jacobs J.V.
        • Kasser S.L.
        Is the BESTest at its best? A suggested brief version based on interrater reliability, validity, internal consistency, and theoretical construct.
        Phys Ther. 2012; 92: 1197-1207
        • Franchignoni F.
        • Horak F.
        • Godi M.
        • Nardone A.
        • Giordano A.
        Using psychometric techniques to improve the Balance Evaluation Systems Test: the mini-BESTest.
        J Rehabil Med. 2010; 42: 323-331
        • Haines T.
        • Kuys S.S.
        • Morrison G.
        • Clarke J.
        • Bew P.
        • McPhail S.
        Development and validation of the balance outcome measure for elder rehabilitation.
        Arch Phys Med Rehabil. 2007; 88: 1614-1621
        • Mackintosh S.
        • Datson N.
        • Fryer C.
        A balance screening tool for older people: reliability and validity.
        Int J Ther Rehabil. 2006; 13: 558-561
        • Lindmark B.
        • Liljenäs Å.
        • Hellström K.
        Assessment of minor or moderate balance disorders: a reliability study and comparison with healthy subjects.
        Adv Physiother. 2012; 14: 3-9
        • Berg K.
        • Wood-Dauphinee S.
        • Williams J.I.
        • Gayton D.
        Measuring balance in the elderly: preliminary development of an instrument.
        Physiother Canada. 1989; 41: 304-311
        • Chou C.
        • Chien C.
        • Hsueh I.
        • Sheu C.
        • Wang C.
        • Hsieh C.
        Developing a short form of the Berg Balance Scale for people with stroke.
        Phys Ther. 2006; 86: 195-204
        • Hohtari-Kivimaki U.
        • Salminen M.
        • Vahlberg T.
        • Kivela S.L.
        Short Berg Balance Scale—correlation to static and dynamic balance and applicability among the aged.
        Aging Clin Exp Res. 2012; 24: 42-46
        • Tyson S.F.
        • DeSouza L.H.
        Development of the Brunel Balance Assessment: a new measure of balance disability post stroke.
        Clin Rehabil. 2004; 18: 801-810
        • Thomas M.
        • Jankovic J.
        • Suteerawattananon M.
        • et al.
        Clinical gait and balance scale (GABS): validation and utilization.
        J Neurol Sci. 2004; 217: 89-99